WHAT CAUSES ECZEMA?
One of the predominant theories is that someone with eczema has a short-circuited immune response, where the skin reacts abnormally when a substance comes in contact with it. In severe cases of eczema, the substance can be as benign as water; for others, the trigger can be anything from clothing, detergents, soaps, grass, food products, allergens (including dust mites), a lack of humidity, or a combination of things. Even more frustrating is that the reaction can be intermittent, with no real rhyme or reason for why or when.
There also appears to be a strong hereditary component to eczema. For example, children whose parents suﬀer from eczema run an 80% chance of developing it themselves. Further, in both children and adults, stressful situations tend to trigger, prolong, or worsen eczema ﬂare-ups.
Regardless of the source, eczematous skin reacts to a substance or substances or to environmental conditions by spinning out of control and generating mild to severe inﬂammation, which leads to itching and subsequent scratching that damages skin’s critical barrier function.
TYPES OF ECZEMA
There are several types and varying degrees of eczema, which, as you can imagine, makes diagnosis and treatment a bit tricky! The following are the most common types of eczema:
- Atopic eczema (also referred to as atopic dermatitis): Perhaps the most pernicious and painful type of eczema, it’s characterized by its severity and the intolerable sensation of itching and irritation, leaving skin raw, fssured, and vulnerable to infection. This is the type of eczema that many infants experience between the ages of two and six months. In infants, symptoms appear on the face, scalp, feet, and hands; in older children and into adulthood, symptoms appear in the fold of the arm and behind the knees, though particularly bad outbreaks can appear anywhere on the body.
- Allergic contact dermatitis: This specifc form of eczema often stems from a subset known as irritant contact dermatitis. It occurs when a specifc substance comes in contact with the skin and causes the immune system to overreact. The result is inﬂamed and sensitized skin. Most typically, allergic contact dermatitis is caused by fragrance, nickel, detergents, wool, grass, citrus, household cleaning products, and vinegar. Once you’ve identifed the specifc substance, avoiding it often solves the problem.
A subset of allergic contact dermatitis is eyelid dermatitis. Typically mild to moderate redness is present, as well as scaling, ﬂaking, and swollen skin. This is extremely common and almost exclusively aﬀects women in relation to their use of hairstyling products, makeup, and nail polish (even once it dries) when your manicured nails come in contact with the eye area. The best way to solve the problem is to stop using the oﬀending product(s) and find options that don’t trigger a reaction.
- Infantile seborrheic eczema: Better known as cradle cap, this form of eczema generally aﬀects only babies and children. The crusty, thick, sometimes reddened lesions may look problematic, but this disorder is rarely itchy or even felt by the child. If you want to treat this, and success is limited, consider a 1% hydrocortisone or a 2% topical ketoconazole cream, which are available from your infant’s pediatrician.
- Adult seborrhoeic eczema: This shows up for most people between the ages of 20 and 40, and is estimated to aﬀect 5% of adults. It’s usually seen on the scalp as mild dandruﬀ, but can spread to the face, ears, and chest. The skin becomes red and inﬂamed and starts to ﬂake. It’s believed to be caused by yeast, but its precise cause remains unclear; stress may be a factor. If the area becomes infected, treatment with an antifungal cream, topical steroid creams, or immunomodulators may be necessary.
- Nummular eczema: Typically localized on the legs, nummular eczema is characterized by coin-shaped patches of pink to red skin that may take on an orange cast if crusting or scaling is present. Left untreated, the dry, scaly spots typically darken and thicken. This type of eczema is most common in adolescent girls and in women between the ages of 30 and 60, and the condition tends to occur in winter.
There’s no cure for eczema on the horizon, but the good news is that there are a number of treatments that can reduce the symptoms and decrease the level of discomfort. Keep in mind that many people diagnosed with eczema when they are young eventually, for the most part, outgrow it. The primary treatment options for eczema are as follows:
- Gentle, eﬀective skincare: The frst line of defense is a gentle, fragrance-free skincare routine that prevents or reduces inﬂammation and keeps skin moist and its barrier intact. Improving the skin’s outer structure by providing it with antioxidants, ingredients that improve the skin’s barrier, anti-irritants, and emollients can have amazing results for most forms of eczema. In fact, it’s been theorized that eczema makes skin more susceptible to oxidative damage, which inturn makes topical application of antioxidants even more important!
- Avoid irritants: In addition to using a gentle skincare routine and a well-formulated moisturizer, avoiding things that can trigger skin reactions is also of vital importance. Steering clear of known irritants and prolonged contact with water can be incredibly benefcial. It also helps a great deal to reapply moisturizer within seconds of washing any part of the body, but especially your hands, because soaps and cleansers are notorious for triggering a reaction in those struggling with eczema. Try switching to a creamy, moisturizing body wash (Olay and Dove make good ones) and using that throughout your home as your hand soap. It works beautifully!
- Topical steroids: The most typical and successful medications for eczema are prescription-strength topical steroids (cortisone creams such as Eumovate, active ingredient clobetasone butyrate, or various strengths of hydrocortisone).
Over-the-counter cortisone creams can be eﬀective for very mild or transient forms of eczema, but if those fail, prescription cortisone creams can save your skin. Although there are no short-term detrimental side eﬀects of using most strengths of cortisone cream, it’s still important to apply it only to the aﬀected areas, and only as needed, because repeated, prolonged application of cortisone creams can cause thinning of the skin, prematurely aging it.
- Oral steroids: In severe cases of eczema, when topical steroids have failed to produce any relief, oral steroids may be prescribed, but only under a doctor’s scrutiny due to the serious side eﬀects associated with this type of medication.
Topical immunomodulators: In 2000 and 2001, Protopic (active ingredient tacrolimus) and Elidel (pimecrolimus) were approved by the FDA as new topical drugs for the treatment of eczema. Not cortisones or steroids, these immunomodulators can regulate the skin’s immune response, which plays a pivotal role in eczema. Regrettably, in March 2005, the FDA announced a public health advisory for Elidel (pimecrolimus) Cream and Protopic (tacrolimus) Ointment “to inform healthcare providers and patients about a potential cancer risk from use of Elidel (pimecrolimus) and Protopic (tacrolimus)…”
This risk is uncertain, and more recent studies have refuted it, but the FDA’s precautions still advise that Elidel and Protopic should be used only as labeled, for patients who have failed treatment with other therapies.The topical immunomodulators (pimecrolimus and tacrolimus) don’t present the risk ofskin thinning that’s associated with topical corticosteroids.
- Phototherapy: Research has shown that exposing skin to controlled wavelengths of UVA or UVB light can help reduce the symptoms of chronic eczema.Under medical supervision, the use of specially designed bulbs can allow aﬀected parts of the body to be exposed to the specifc light source. More severe or chronic eczema can be treated with UVA light in combination with a prescription medication called psoralen. Psoralen can be administered either orally or topically, increasing the skin’s sensitivity to light. This treatment is known as PUVA (Psoralen + UVA light) and is administered more often to adults than to infants or children with eczema.
Phototherapy treatments are complicated and expensive. They are administered several times per week over a span of one week to several months at a doctor’s ofce. As you might have guessed, the risk of accelerated aging of the skin and increased risk of skin cancer from UV radiation therapy can be the same as for sunbathing, so this isn’t an optimal way to treat eczema, as it just replaces one problem (eczema) with another (UV damage).
- Non-fragrant oils and dietary changes: Evening primrose oil and borage oil contain gamma linolenic acid, a fatty acid that may play a part in general skin health and that has gained a reputation for reducing the occurrence of eczema when applied topically. Several studies, however, have shown that not to be the case. Nonetheless, if you’re interested in alternative treatments for eczema, this is one you can try with very little risk of adverse eﬀects. Other non-fragrant plant oils, like safower or jojoba, may also be worth experimenting with, and you can add a few drops of these to your regular body moisturizer, hand cream, or facial moisturizer.
There’s also some research pointing to dietary considerations as a source of reactions. It’s worth experimenting to see if eliminating certain foodgroups, such as dairy, gluten, processed foods, or nuts, can decrease the severity and/or frequency of eczema outbreaks.
Skincare if you have eczema:
From the neck down, treating eczema means being as gentle as you absolutely can, which almost always means avoiding bar soaps and scrubs. Below we list fragrance-free gentle cleansers and body lotions we strongly recommend. If you have eczema on your face, follow our recommendations in the sections that are appropriate for your skin type, also adding products to treat other concerns like rosacea, brown spots, and wrinkles.
RECOMMENDED PRODUCTS FOR ECZEMA:
» Cortizone-10 Hydratensive Anti-Itch Lotion for Hands and Body, Healing Natural Aloe Formula (this is medicated with 1% hydrocortisone and best for mild eczema)
» Eucerin Eczema Relief Body Crème
» Eucerin Skin Calming Dry Skin Body Wash
» Gold Bond Ultimate Eczema Relief Skin Protectant Cream
» Paula’s Choice Clinical Ultra-Rich Soothing Body Butter