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Eczema

Eczema is frequently called atopic dermatitis because it was noted to occur in individuals with allergic symptoms, e.g., allergic rhinitis (hay fever) and asthma. The term atopic simply means allergic. Even though eczema was considered to be an allergic problem, allergy seems to be less likely as our understanding of the disease increases. Physicians know that eczema is a very complex disease and contains allergic as well as non-allergic elements in different individuals. As a result, the treatment of every individual may vary.

While the causes of eczema continue to be investigated, certain things are known about the disease. The skin is much more easily irritated than normal skin. Dryness of the skin is a primary component and results in significant itching. Eczema is known as “the itch that rashes”. Itching is made worse by irritants on the skin. Winter months are particularly bothersome because of the dry winter air. Flares in the summer months can occur after exercise because sweat is a significant irritant. Citrus or some vegetables, e.g., tomato, can act as a primary irritant when they touch the skin. Stress in some individuals can affect the skin. While emotional factors may play a role in flaring eczema, they are not considered a primary source of causing the onset of eczema, if it is not already present.

Eczema occurs in about 3% of the population. In about 80% of those individuals, the onset occurs in the first year of life. One-half are free of disease by age 2 years, about one-fourth by the end of adolescence, and the remaining one-fourth will continue to have eczema into adult life. Some individuals do not have the onset of symptoms until adolescence or adulthood.

Treatment is multifaceted and includes lifestyle modification as well as various types of medication. A portion of treatment will be listed in the accompanying tables. Adequate attention to clothing, diet manipulation, and attention to the emotional well-being of the affected patient are very important. It is preferable for a patient with eczema to wear clothing which will not irritate the skin; soft cotton material would be best. The room temperature should be kept moderate with controlled humidity (between 35-50%). Overheating and perspiration should be avoided.

Some investigators believe there is a genetic tendency for eczema with approximately 50% of eczema patients ultimately developing allergic rhinitis and/or asthma. This is compared to about 20% without the presence of eczema. While allergy skin testing and allergy injection treatment are usually helpful in cases of allergic rhinitis and/or asthma, it is generally agreed that this is often not the case with eczema. In some individuals, starting allergy shots for allergic rhinitis and/or asthma may actually result in significant flaring of the eczema.

Prevention

  • Trim fingernails short
  • Cotton gloves at night if needed to decrease scratching
  • Clothing should be double rinsed after washing to remove all residual detergent (irritants)
  • Avoid excessive room temperatures
  • Wear light, non-occlusive clothing (e.g., cotton instead of polyester)
  • Keep the bedroom moderate (cool) and avoid excessive bed clothing
  • Allergen contact or ingestion avoidance (e.g., foods, pets, dust mite) can reduce stimulation of the skin

Treatment

  • Bathing for moisturization, e.g., soaking in tepid water for 30-45 minutes at least once daily and if possible 2-3 times.
  • Within 2 minutes after getting out of the tub, a lubricating cream or ointment should be applied to help hold the moisture in the skin. Examples include Aquaphor, Curel, Moisturel, Eucerin, Keri, Lubriderm, Acid Mantle, Unibase, Vanicream, petrolatum, and chilled Noxzema,etc. Newer medications include Triceram/Certopic, Impruv, Mimyx, Nourica Repair, Cerave, Atopiclair, and Hylira. Some of the newer medications are by prescription only. None of the medications in the above list contain steroids.
  • In general, lotions should be avoided since they contain alcohol which may sting and provide limited moisture.
  • If marked irritation or weeping areas are present, wet wraps with a drying solution (e.g., Burrow’s solution, one tablet mixed in one quart of water is available by prescription) will avoid the stinging or burning sensation that can occur with bathing.
  • Addition of oil or similar substances to the bath water generally has little effect on increasing moisturization.
  • Pat dry with a soft towel; do not “rub” dry since this will remove natural, protective oils from the skin.
  • Showers do not add moisture to the skin and actually remove the protective oils from the skin resulting in increased dryness.
  • Topical steroids are the mainstay of therapy for more severe eczema. Ointments or creams are generally used.
  • Nonsteroidal medications that help the immune system in the skin may be necessary either in addition to or in place of topical steroids if the topical steroids are not adequate for relief. Examples of the nonsteroidal medications are Elidel and Protopic.
  • Antibiotics, topical and/or oral, may be needed if the lesions become infected. An alternative to antibiotics is the use of Clorox baths. One-quarter to one-half cup of Clorox in a full bath provides antibacterial activity that will treat all known bacterial infections. No resistant bacteria to Clorox are known.

Conditions Treated

Recent News

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Respiratory Illnesses Are Still Going Strong, But Things May Be Slightly Improving

Flu, COVID-19, and other respiratory sickness activity remains high throughout much of the country.

With the new year underway, you can expect more coughing, runny noses, and fevers in the weeks ahead. As of January 12, cases of flu, COVID-19, and RSV are elevated across most of the U.S, according to the respiratory virus update from the Centers for Disease Control and Prevention (CDC).

Nationwide tracking from the CDC shows 37 states with high or very high respiratory illness activity — more than double from a month ago. Nationally, COVID-19 wastewater viral activity levels are also very high, with all regions recording increasing levels, per the CDC.

In addition to keeping tabs on the results from specific virus tests, the CDC also tracks reports of general respiratory illness symptoms, meaning fever plus cough or sore throat. The number of people seeking care for general respiratory illness symptoms not specifically identified in lab tests is also elevated or on an upward trajectory across most areas of the United States.

“It is common this time of year to see increases in respiratory viruses, but we have seen one of the highest peaks in COVID-19 activity that we have had since the start of the pandemic, and flu activity has been at one of the highest rates we have seen in the past five years,” says Robert H. Hopkins Jr., MD, medical director of the National Foundation for Infectious Diseases (NFID).

Decreases, however, have been seen across all three conditions in the past week. The CDC speculates that numbers may have been affected by less monitoring and fewer healthcare visits during the holidays.

For the week ending January 6, the CDC reports that clinical lab test results show a 14 percent drop in those testing positive for flu. Although flu-related hospitalizations are also trending down, new data show an uptick in flu-related death, and so far 40 children in the U.S. have died from influenza this season.

While declines in RSV have been observed in some areas, CDC figures released on January 11 confirm that RSV activity remains elevated nationally in all regions. The CDC also notes that hospitalization rates for RSV continue to be elevated in young children and increase among older adults.

The CDC's latest COVID-19 reporting suggests that these infections may be tapering off and emergency visits are down. Updated numbers, however, indicate a 3.2 percent rise in COVID hospitalizations and a significant jump in deaths, which are up 14.3 percent, in the last week. The CDC warns that the most prevalent variant, JN.1, is highly transmissible, although there is no evidence at this time that it causes more severe disease than other circulating variants.

Hopkins suggests that CDC numbers may show more of any upward trend in the weeks ahead as viral activity often increases during and after the holidays, and children returning to schools and daycare centers tend to lead to a greater spread of these infections.

Keeping an Eye on Hospitalizations and Those Most Vulnerable

At this time, hospital bed occupancy for all patients, including within intensive care units, remains stable nationally. Still, with all indicators pointing to more respiratory illness in the winter weeks ahead, public health officials are closely monitoring hospital admissions.

 

“I don’t think we’re at a risk of overwhelming our hospitals right now — we’re nowhere near the crisis levels of 2020 and 2021, when many facilities were filled beyond capacity,” says Aaron Glatt, MD, chief of infectious diseases and hospital epidemiologist at Mount Sinai South Nassau in Oceanside, New York. “Still, some hospitals are seeing significant increases.” 

The old and the very young are hit hardest by these viruses, according to the CDC. The percent of all emergency department visits with a COVID-19 diagnosis is highest among children under 2 years old and adults age 65 and up. Visits due to diagnosed RSV are highest among children under 4. Influenza visits are highest among school-aged children 5 to 17 years old, followed by children under the age of 4.

Deaths due to COVID-19, influenza, and RSV are highest among those age 65 and up.

“Many of those people have an underlying chronic medical condition — such as diabetes, heart failure, or chronic obstructive pulmonary disease — that puts them at extra risk,” says William Schaffner, MD, an infectious disease specialist and professor of preventive medicine and health policy at the Vanderbilt University School of Medicine in Nashville, Tennessee.

Nonwhite populations also appear to bear a heavier burden when it comes to respiratory sickness. According to latest CDC figures, flu hospitalization rates are higher in non-Hispanic Black Americans compared to other racial and ethnic groups, and deaths from all the major respiratory illnesses are highest among American Indian/Alaska Natives and Asians/Pacific Islanders.

“These populations are less likely to have primary care, more likely to smoke cigarettes, less likely to be vaccinated, and more likely to work in lower-paying jobs without access to sick leave,” says Dr. Hopkins. “These social factors contribute to the disparity in severe illness among these populations.”

Take Precautions to Stay Well

As this season of sickness continues on, public health officials are encouraging people to take measures to protect themselves and others:

  • Wash your hands regularly. The CDC notes that keeping hands clean can prevent 1 in 5 respiratory infections.
  • Consider wearing a mask in crowded indoor settings. Well-fitting face masks or respirators covering a person's mouth and nose can prevent the spread of germs when people are breathing, talking, sneezing, or coughing, per the CDC.
  • Stay home and seek treatment. “Common sense tells you to stay away from others if you’re contagious and stay away from others who are sick,” says Dr. Glatt.
  • Get vaccinated. Low rates of vaccination are putting people at greater risk of illness and severe disease, according to Dr. Schaffner. 

“Although I don’t think this respiratory virus season will be the worst on record, I think it is moderately severe,” he says. “So get vaccinated and take whatever other precautions you can to stay well and prevent spreading the illness to others.”

For more information,  https://www.everydayhealth.com/cold-flu/respiratory-illnesses-are-still-going-strong-but-things-may-be-slightly-improving/

The post Respiratory Illnesses Are Still Going Strong, But Things May Be Slightly Improving appeared first on Oklahoma Allergy and Asthma Clinic.

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