Allergy

Eczema is a common chronic skin condition that affects about 15% of the population.  In most individuals it starts before age five.  The most common complaint is dry scaly skin that can occur all over the body. The skin can be thickened with creasing often evident on the face or with fissures (or cracks) in the skin especially on the hands and feet.  It is also associated with blocking hair follicles (causing bumps on the skin) and increasing pigmentation of the skin, especially in people of darker complexion.

Diagnosing eczema

Although the full cause of eczema has not been determined, experts agree that it has a strong genetic component. People with eczema have an increased frequency of other diseases such as asthma, nasal allergy and food allergy (which also tend to run in families). Specific genetic defects are starting to be identified including mutations in genes that code for specific proteins such as filaggrin, which are important in maintaining a normal protective skin barrier.

There are no specific blood tests available to diagnose eczema. Skin biopsies are seldom helpful except when a very unusual appearance makes it necessary to rule out other skin conditions.  The diagnosis depends on the symptoms and appearance over time.

There are many things that can aggravate eczema and can keep it active. The expert allergists at Tufts Medical Center will work with you to create a treatment plan that is directed toward mitigating these factors.

Treating factors that affect your eczema

Dryness of the skin - Avoid hot, dry environments or excessive bathing or showering with hot water and detergent soaps.  Maintain skin hydration.  The application of non-scented products that have a low water content are useful because they do not evaporate but enhance the barrier function of the skin.  Examples of these are thick creams or ointments (such as petrolatum jelly, etc).  These products should always be applied after a lukewarm bath or shower in the morning.

Exposure to irritants - Avoid scented skin products or soaps.  Also keep strong chemicals or cleaning products from contact with the skin.

Scratching - This can break the skin barrier and lead to infection and penetration of allergens and irritants.  This leads to a vicious cycle that keeps the eczema active.  To reduce scratching, we often recommend using antihistamines. The use of antihistamines is useful here.  Non-sedating antihistamines can be used during the day but to control nighttime scratching a more potent and sedating antihistamine can be used.

Stress - Can increase the amount of scratching.  However eczema also causes stress!

Exposure to allergens to which a person is sensitive - Skin testing or blood testing can be done to detect sensitivity to environmental allergens or food.  A positive test does not always mean that that substance is causing the eczema especially if the tests are mildly positive. Your Tufts MC doctor will evaluate your test results and determine the best course of action.

Food allergy - This is often a factor in children under age 5.  Ingestion of a food to which a person is sensitive usually will often aggravate eczema within 2-3 hours.  A positive skin test to a food or environmental allergen does not always mean that this is causing or aggravating the eczema especially if the skin test reaction is mild.

Contact allergy - Having an allergic reaction to touching metals or a component of cosmetics can aggravate eczema but usually at the site of contact.  Patch testing is sometimes done to evaluate contact sensitivity, although it can be difficult to interpret.

Infections of the skin - Bacterial infection (often a Staph infection) can be treated with various antibiotics. Herpes simplex virus can also infect eczema and cause a very severe reaction that requires the use of anti-viral drugs.  This is unusual and requires an examination by your Tufts MC doctor to make the diagnosis.

Using medication to control the inflammation

Topical corticosteroids – These creams are the most frequently used drugs to treat eczema. They vary greatly in potency and it is a good principle that the mildest one that is effective should be used.  Long term side effects include thinning of the skin and the effects of absorption into the body which can be a factor if the more potent topical corticosteroids are applied to large surface areas of the skin for a long time.  Your doctor will need to guide you as to when these risks become significant.

Oral corticosteroids – Drugs such as prednisone are useful for a week or two when eczema has become severe.

Topical calcineurin inhibitors (tacrolimus and pimecrolimus creams) – These do not cause thinning of the skin and may be particularly useful on the face, although there are some safety concerns about the use of these drugs.

Other treatments that can also be used

Other treatments that our skilled doctors might recommend include ultraviolet light with PUVA or taking immunosupressives.  These measures are used in very severe cases unresponsive to the usual kinds of treatment.

To make an appointment to meet with one of our expert doctors about your eczema, please call 617-636-5333.