How to Treat Eczema
If I had a list of the most frequently asked questions that I get from patients, “Do I have eczema?” would be at the very top. This is a misunderstood skin condition that is often mistaken for dry skin.
What Is Eczema?
Eczema is a term that many people use for any type of skin inflammation, However, not everything that is red, itchy and flaky on the skin is eczema. Eczema is also called atopic dermatitis. The telltale signs of eczema, which seems to have a strong genetic cause, include itching, scaling, redness, skin thickening or darkening, and skin infection.
How Can You Tell If You Have Eczema?
The best bet is to find a dermatologist. Dermatologists have at least 12 years of training that helps us tell the difference between eczema and many other serious skin diseases that mimic eczema such as a type of cancer known as CTCL. While CTCL is very rare, it is best to see an expert when you have any recurring skin problems. You can find a STS approved dermatologist (one that I personally trained about what skincare is best for eczema) at SkinTypeSolutions.com. If there is not one in your area, look at AAD.org to find a board certified dermatologist in your area.
What does Eczema Look Like?
Eczema is diagnosed by the way the skin looks and in what areas the “rash” is found. In addition, there are other signs that help the dermatologist diagnose eczema. Affected “atopic” skin (this is what you call the skin in an eczema patient) looks different than skin in non-affected areas. The appearance depends on severity, how long you have had the disorder, ethnicity and what you have been using to treat the symptoms. This is why you need an expert to diagnose eczema. I will try to explain the signs of eczema as best as I can, but please understand that I (or another dermatologist) would have to see the lesions in person to make a correct diagnosis.
If you are a light skinned caucasian, affected atopic skin appears pink and scaling in the first stage. As it worsens, the skin gets thicker and redder. If you scratch a lot, scabs may develop.
In darker skin types, the early forms are less noticeable because the pink color does not show as easily. The primary sign is skin ashiness (small light scales) and skin thickening. As the eczema progresses in darker skin types, the affected skin becomes darker (hyperpigmented) from the inflammation.
Later stages of eczema show thickened skin that resembles tree back with prominent skin lines. Oozing of the lesions and yellow crusting and scabbing are signs of infection.
Where on the body does eczema occur?
Eczema usually occurs on the face and neck, wrists, back of the hands, in the antecubital fossa (the inside of the forearm), the back side of the knees and around the ankles. People with eczema often have hyperlinear palms (extra lines on the palms of the hands) and allergic shiners (dark circles around the eyes.) Eczema is often associated with asthma and allergies.
What Causes Eczema?
Genetic research has shed light on the underlying cause of eczema. Many people with eczema have a genetic defect in the gene responsible for the production of the protein filaggrin that is made by skin cells. This structural protein found in the lower layers of the skin is converted to natural moisturizing factor (NMF) in the upper layers of the skin. Natural moisturizing factor binds water and helps the skin hold moisture inside the cells. When faulty DNA produces defective filaggrin, the skin has less NMF, which leads to patches of dry skin.
Not all eczema is genetic. It can be acquired when various environmental exposures lead to a breakdown in the skin’s barrier or in the levels of NMF. Using the wrong cleanser, exposure to allergens and irritants, bacterial infection, lack of fatty acids in diet, friction and immune system disorders can lead to eczema. It is as important to understand the underlying cause of eczema as it is to treat it.
Although it has not been proven in any studies, I have seen many vegan and vegetarian patients with eczema which makes me believe that diet plays a role. patient often think a “food allergy” has caused eczema but I find that it is much more likely to be a topical allergen such as fragrance in laundry detergent or dryer sheets, bubble bath, perfume, room spray, or candles.
How to Treat Eczema
The treatment of eczema is twofold: a treatment regimen and a maintenance regimen. The treatment regimen consists of a soothing cleanser and barrier repair moisturizer in combination with prescription medications to calm the immune system such as tacrolimus, pimecrolimus, and topical steroids such as triamcinolone. Infected eczema should be treated with a prescription antibiotic such as mupirocin because neosporin, bacitracin, polysporin and the other over the counter forms will not work (The bacteria has become resistant to these).
The maintenance regimen is designed to help prevent recurrence of eczema. It should consist of a creamy cleanser that will not harm the skin barrier and a barrier repair body moisturizer twice a day. My favorite creamy body cleanser for my eczema patients is Dove bar soap. The best barrier repair body cream for eczema is Zerafite Ultra Rich Body Cream but you can only buy that from your doctor. Diet tips for eczema prone people are add omega 3 fatty acids and other anti inflammatory fatty acids to your diet. These are found in salmon, fish oil and flax seeds. Vegan patients should take care to add flax seeds to 3 meals a day. Do not use very hot water when bathing and try to avoid prolonged submersion in any water- so quick baths are preferred. If you must take a long bath, addition of an anti- inflammatory oil such as PAORR Argan Oil to the bath or to damp skin is a natural option to protect the skin and deliver soothing fatty acids. Immediately after bathing and applying the oil, seal with a layer of a barrier repair body cream. Try very hard not to scratch. Taking a Benadryl at night can help decrease the itching associated with eczema. if you live in a dry climate, consider a room humidifier.
What to avoid if you have eczema?
People with eczema should avoid foaming cleansers, bubble bath, and any sort of friction like scrubs or microdermabrasion. NEVER get a salt scrub at a spa!! When possible avoid prolonged water immersion and very hot showers and baths. Don’t wear wool and other scratchy fabric that can irritate the skin. Avoid fragrances in any bath or body products and laundry detergents and dryer sheets. if you live in an area with hard water, consider using a water filter in your shower. I have had eczema patients irritated by the local city water- especially in NYC.
Why is the skin barrier important in eczema?
The skin barrier is a layer of cholesterol, fatty acids and ceramides that surround the skin cells. The barrier helps the skin hold onto water and keeps allergens and irritants out. Imagine it as a protective plastic coating on the skin cells– kind of like what Saran Wrap does when placed around food. Click here to see a video that explains the skin barrier. The skin barrier helps the body hold onto water and keep allergens out of the skin which prevents eczema.
Is there an association between food allergies and eczema?
Studies have demonstrated that people with atopic dermatitis are more likely to develop food allergies. This may occur because skin barrier impairment in eczema patients allows allergens to more freely enter the skin and alert the immune system to their presence. This hypothesis is supported by a study called “Skin barrier impairment at birth predicts food allergy at 2 years of age”. This is one of many reasons that it is important to keep eczema under control.
Eczema- the bottom line
If you or your child has a recurrent rash, see your dermatologist to make sure you have the correct diagnosis. Every single product that you put on your skin matters. Treating eczema early may help prevent food allergies, infection and other complications due to long term inflammation.
Dr. Leslie Baumann, M.D. and her team at Baumann Cosmetic Dermatology believe in proof, not promises. World-recognized for both cosmetic and general dermatology, our treatment strategies rely exclusively on evidence-based, scientifically verified products and procedures that promote skin health and a natural appearance. We combine effective medical procedures with individualized instruction on proper skincare, nutrition, supplementation and lifestyle in order to maximize the health of the skin and body as a whole while minimizing the effects of aging. For more, visit Dr. Baumann’s blog for daily updates Monday through Friday, or inquire about an appointment through Derm.net.