With kids in the house, rashes are a way of life. From diaper rash to itchy outbreaks from unfortunate interactions with poison ivy, those little red bumps can cause uncomfortable itching for young and old alike. Most such rashes are considered to be bouts with contact dermatitis and are, fortunately, temporary and easily treated with over-the-counter cortisone creams to relieve the itch and antibiotic creams to help stop or prevent infection (from openings in the skin due to intensive scratching). But an estimated 15 million people in the United States (according to the National Institutes of Health [NIH]) suffer from something more serious, a recurrent and chronic rash called eczema.

According to the National Eczema Association (NEA), eczema is a general term for dermatitis or inflammation of the skin. Atopic Dermatitis or AD is the most severe and long-lasting form of eczema. It affects men and women and all races equally and is more common in urban areas and in developed countries. Eczema and AD are not contagious. The NEA notes that research has determined that eczema and AD are genetically determined—that is they are inherited from one’s parents.

The United States National Library of Medicine and the National Institutes of Health (NLM and NIH) describe eczema as a hypersensitivity reaction (similar to an allergy) in the skin that leads to long-term inflammation. The inflammation causes the skin to become itchy and scaly and long-term irritation and scratching can cause the skin to thicken and develop a leathery texture. The NIH adds that eczema is most common in infants and at least 50% of such cases clear up by the age of 3. In fact, according to the American Academy of Dermatology (AAD), approximately 10 to 20 percent of the world’s population is affected by eczema’s chronic, relapsing, itchy rash at some point during childhood. Eczema in adults is generally a long-term (chronic) or recurring condition.

The NLM notes the symptoms of eczema as:

• Blisters with oozing and crusting
• Changes in skin coloring—more or less coloring than the normal skin tone
• Dry, leathery areas of skin
• Ear discharge or bleeding
• Intense itching
• Rash
• Raw areas of the skin from scratching
• Redness or inflammation around the blisters

The AAD refers to eczema as "the itch that rashes" since the intense scratching of the skin results in the appearance of the rash. The AAD adds that eczema can occur on just about any part of the body but on infants it is typically found on the forehead, cheeks, forearms, legs, scalp, and neck. In children and adults, eczema typically occurs on the face, neck, and the insides of the elbows, knees, and ankles.

The AAD notes that any number of substances can act as itch "triggers" in those with eczema, and they are not the same for every person. Determining the trigger that causes an eczema flare-up is difficult. Some typical triggers noted by the AAD include:

• Animal saliva and dander
• Detergents, disinfectants, soaps
• Dust mites
• High heat
• Juices from fresh fruits and meats
• Rough or coarse materials contacting the skin
• Sweating

Certain conditions can make eczema symptoms worse including: dry skin, exposure to environmental irritants, exposure to water, stress, and temperature changes. Although there is no cure for eczema, the AAD does recommend the following steps to help reduce the frequency and severity of eczema flare-ups:

• Avoid overheating and sweating
• Avoid environmental factors that can trigger allergies such as animal dander, pollen, mites, and molds
• Avoid sudden temperature changes
• Avoid harsh soaps, detergents, and solvents
• Avoid scratchy materials such as wool
• Be aware of any foods that may cause an outbreak and avoid them
• Moisturize frequently
• Reduce stress

Treatments for eczema typically begin with the prevention of scratching since intense scratching damages the skin and can often lead to infection. The AAD recommends the use of lotions and creams (or petroleum jelly) after bathing to keep the skin as moist as possible. When bathing affected areas, use warm, not hot, water and pat the area dry instead of rubbing. When choosing a lotion, avoid those that contain fragrances and additives that may cause further irritation. Lotions are most effective when they are applied within three minutes of bathing so they have the opportunity to "lock-in" moisture. Cold compresses applied to the itchy skin can help relieve some of the itching. The NIH notes that If eczema does not respond to moisturizers or avoiding allergens or if symptoms worsen, treatment is ineffective, or if signs of infection (fever, redness, pain) occur, you should see your family physician or health care provider.

If the itching persists, the AAD recommends the use of non-prescription corticosteroid creams or ointments to help reduce the inflammation. Your physician or health care provider may also prescribe higher strength corticosteroid creams or ointments but such medications should be used under the supervision of a physician to monitor possible side effects such as thinning of the skin. In severe cases a physician may prescribe oral corticosteroids and such treatment is not recommended for long-term use.

The scratching associated with eczema may lead to infected areas of skin. If so, your doctor may prescribe oral antibiotics or topical antibiotic creams to help stop the infection. In cases of intense itching, doctors may prescribe antihistamines to help calm the itch. In any case, the best course of action is to have your family physician examine the rash and recommend a treatment or a subsequent referral to a dermatologist for treatment options.

If eczema affects you or a family member, there are treatment options available that can help one learn to cope with the situation. By keeping skin moisturized, avoiding harsh detergents (both on the skin and those used while laundering clothing), wearing breathable cotton clothing, and keeping bedrooms and play areas free from dust mites (vacuuming and regularly washing bed linens in hot water), you can help reduce many of the situations that trigger eczema’s unpleasant cycle of itching and scratching.

As with any medical condition, consult with your family physician or health care provider for specific diagnosis and treatment options.

Sources:
American Academy of Family Physicians—www. Familydoctor.org
National Eczema Association—www.nationaleczema.org
U.S. National Library of Medicine and the National Institutes of Health—www.nlm.nih.gov
American Academy of Dermatology—www.skincarephysicians.com

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