Eczema: Treatment And Management For ALL AGES

Eczema affects patients of all ages and ethnicities. The condition is most prevalent in children, where it is seen in 10 to 15 percent of children in the first few years of life. Sometimes forgotten is that eczema can persist into adulthood or make its first presentation in adulthood. A precise diagnosis—be it atopic dermatitis, allergic contact dermatitis, or chronic irritant dermatitis— can be elusive.

In the case of allergic contact dermatitis, key to successful management is identification and avoidance of the offending agent, which may be found in the patient's make-up, moisturizer, or other topically applied make-ups. Recently, allergic reaction to aerosolized allergens has been identified as contributing to what had been diagnosed as recalcitrant eczema of the head and neck.¹ In many cases of itchy, dry, inflamed skin, atopic dermatitis is the diagnosis.

Dry skin and inflammation, unfortunately, reinforce each other: Xerosis is associated with itching sensations, scratching comprises the skin barrier, and subsequent inflammation exacerbates itch and rash, and further impacts the skin. Effective control of xerosis, inflammation, and pruritus are the keys to minimize the impact of eczema.

Doris Day, MD, of Day Dermatology and Aesthetics in New York, says, “We think of eczema as an ‘itch that rashes' since the skin can be itchy and the rashes can appear after the affected areas are scratched, as opposed to other conditions where the rashes appear first and are then itchy.” Since eczema is a chronic condition, patients are often troubled by it and it can negatively impact their selfesteem and quality of life. Eczema can also make patients more irritable, affect their sleep, and even alter the clothes they wear, since many fabrics can worsen the itch. Typically, patients are forced to use creams and products that are often greasy and sticky, which only compounds their frustration with the condition.

Common Treatment Options

Comprehensive management of eczema involves addressing some basic components of the disease, and giving individuals tools to minimize the disease. Education is key to successfully minimizing eczema's impact.

“Since education is so important to managing eczema, I am pleased to see smartphone/tablet applications like Bayer's Eczema App coming to the market,” observes Lawrence Eichenfield, MD, of UCSD. “Apps such as this are useful tools for patients and parents to have in their pockets, so that they can have more information about their disease, and a way to record information to have more informed discussions with their doctors.” (Scan the QR code below to access the app or visit the iTunes store.)

Understanding the variability in timing, duration, and instigators of flares, and the appropriate ways to respond to dry skin, inflammation, itch, and secondary effects, such as infection and sleep disturbance, help greatly in acheiving treatment success. A successful bathing regimen with frequent use of moisturizers is an important first intervention and part of maintenance in all regimens of care. Patients should stay well hydrated, says Dr. Day. “That means bathing or showering daily but keeping the exposure to water that is not too hot and not for longer than 10 to 15 minutes.” Afterwards, patients should pat the skin dry and apply a moisturizer in the form of cream or ointment. There are newer products available that are very good emollients and that absorb into the skin quickly without leaving the skin feeling sticky or uncomfortable. “Simple changes like this can make a big difference,” says Dr. Patricia Farris, a professor at Tulane University and in private practice in Metairie, LA.

Topical corticosteroids and calcineurin inhibitors remain the primary therapies used to control inflamed skin, and can be used intermittently to “keep away” eczema. More persistent, frequently flaring eczema may require more aggressive topical regimens, or phototherapy or systemic medications. Anti-infective therapy may also be helpful in patients with active infections, and in frequently recurring infections in children, bleach baths or topical washes or applications may be helpful to prevent recurrent infections. These interventions or modification of them may be suitable for some adult patients, as well. Individuals with eczema need individualized care regimens, but disease control usually can be attained and maintained.

Limiting or managing stress may be important for those suffering from eczema, as stress seems to be a trigger for this and so many other conditions. Dietary factors are a trickier area, as some individual foods may be a trigger of eczema, while in most cases food allergies are not significant in the course of atopic dermatitis. If present, contributing dietary factors are likely to be identified prior to the patient reaching adulthood.

Suggestions to Patients

Every patient is different, so specific treatments will vary. However, the standard of care is topical corticosteroids or non-steroidal creams such as Elidel and Protopic to calm the skin, along with emollients and excellent skin care, explain Drs. Day and Farris. Sometimes phototherapy is also helpful, and in cases where the eczema is very severe, referral to someone who will prescribe stronger systemic immunosuppresants may be needed.

1. http://bmctoday.net/practicaldermatology/2010/03/article.asp?f=epidermal-barrier-dysfunction-beyond-atopicdermatitis

Doris Day, MD is in private practice at Day Dermatology and Aesthetics in New York.

Lawrence F. Eichenfield, MD works at Rady Children's Hospital in San Diego, CA and the University of California, San Diego.

Patti Farris, MD is a clinical associate professor at Tulane University and in private practice in Metairie, LA.