Eczema

Encyclopedia of Alternative Medicine by Judith Turner

Eczema, also called atopic dermatitis (AD), is a noncontagious inflammation of the skin that is characteristically very dry and itchy. The condition is frequently related to some form of allergy, which may include foods or inhalants.

Atopic dermatitis is sometimes described as "the itch that rashes"--the scratching of the irritated areas may very well initiate the rash in some patients. The skin of those affected by AD is abnormally dry because of excessive loss of moisture. Chronic or severe cases of it can cause the affected areas to form thick plaques (patches of slightly raised skin), develop serous (watery) exudates, or become infected.

The areas of the body that are affected by AD tend to vary with age. Children under five years old most commonly have AD, but it can occur at any age. It can be mild and intermittent, or severe and chronic. Infants frequently experience it on the face and other areas of the head. They frequently rub their heads with their hands or on the crib bedding. The stomach and limbs may also become involved. Older children commonly have the worst spots on flexor surfaces, namely the inner wrists and elbows, backs of knees, and tops of ankles. The hands and feet are other common sites. The knees, elbows, hands, and feet may continue to be a problem into adulthood.

Genetic predisposition plays a large role in who will get AD or other allergies. The condition is not contagious. A child who has one parent with some form of allergic, or atopic, disease has somewhere between a 25-60% chance of also experiencing allergies, whether AD or some other form. There is approximately a 50-80% chance that a child of two parents with allergies will also develop some form of atopy. The genetic predisposition of the individual, combined with such factors such as early exposure to strong antigens, will determine whether and to what extent that person will develop allergies.

The hallmark sign of AD is a red, itchy rash. The age of the patient determines what regions are most likely affected, as described above, but exceptions do occur.

No laboratory test can reliably diagnose AD, although some patients will be reactive to tests designed to diagnose allergy. These would include skin tests by intradermal injection, scratch, or patch tests. There is also a blood test available that measures levels of antibodies to suspected allergens. Diagnosis is generally made by the appearance and location of the rash. A personal or family history of allergy of any type, including food allergy, asthma, or hay fever also supports the diagnosis of AD.

Other types of dermatitis that may be described as eczematous include contact dermatitis , nummular dermatitis, and stasis dermatitis. The stasis type is related to poor circulation, which may also be a factor in nummular dermatitis. These forms generally occur in older adults, whereas AD is primarily a disease of children. Contact dermatitis can occur at any age. It results from skin contact with either an irritant or an allergen. The area affected is limited to the area in contact with the offending substance.

The basis of treatment for AD is keeping the skin moist and clean, as well as avoiding irritants and known allergens as much as possible. Further measures become necessary if the case is particularly severe, or if the skin becomes infected.

Conventional wisdom has been that minimal bathing of the patient with AD is ideal. The rationale was that bathing would break down the natural oil barrier of the skin and cause further drying. It actually appears now that frequent long, tepid soaks are beneficial to hydrate the very dry skin that this condition produces. Adding a muslin bag filled with milled oats or the commercially available preparation Aveeno bath to the water can be soothing. The bath water should cover as much of the skin as possible. Wet towels may be draped around the shoulders, upper trunk, and arms if they are above the water level. The face should be dabbed frequently during bathing to keep it moist. The use of soap should be minimized, and limited to very mild agents such as Cetaphil. The bath must followed within two or three minutes by a gentle patting dry, and a thick application of a water barrier ointment, such as Aquaphor, Unibase, or Vaseline. Lotions are not generally recommended as they almost universally contain alcohol, which is drying and may burn when applied. Soaking in plain water can be painful during severe episodes of AD. Adding one-half cup of table salt to one-half tub of water creates a normal saline solution, similar to what is naturally present in the tissues, and may relieve the burning. Commercial Domeboro powder may also be helpful.

One alternative to bathing is to use soaking wraps. For this method, cotton towels or other cloths are soaked in tepid water, with table salt or Domeboro powder added for comfort if desired. The patient's bed is covered with something waterproof, and the bare skin is covered as thoroughly as possible with the wet wrappings. The body should then be covered by a waterproof covering to slow evaporation. Vinyl sheeting and plastic wrap are two alternatives. The wraps should be left in places for as long as possible, but at least for 30 minutes, before the water barrier and any topical medications are applied.