Introduction:

Eczema is a chronic, inflammatory skin disorder. Its main features are blisters that dry to become scaly, itchy rashes. The skin becomes dry and itchy because too much moisture is lost from its upper layer. This leaves the skin without protection, making it easy for bacteria and viruses to penetrate. The disease occurs episodically; in other words, there may be periods when symptoms are severe (flares) and times when there are no symptoms at all (remission). Although eczema is not contagious, it is very common -- estimates are that more than 15 million people in the United States have eczema. People with eczema often have a personal or family history of allergic conditions like asthma or hay fever. There is no cure, but treatments can reduce symptoms and help prevent outbreaks.

Signs and Symptoms:

Symptoms of eczema occur repeatedly. The most common signs of eczema are:

• Dry, extremely itchy skin
• Blisters with oozing and crusting 
• Redness of the skin around the blisters
• Raw areas of the skin from scratching which may even lead to bleeding
• Dry, leathery areas with more or less pigment than their normal skin tone (called lichenification)

Eczema in children under 2 years old generally begins on the cheeks, elbows, or knees. In adults, it tends to be located on the inside surfaces of the knees and elbows.

Causes:

The cause of eczema is thought to be a combination of hereditary (genetic) and environmental factors. This means that factors such as allergies can cause eczema in susceptible people. Exposure to certain irritants and allergens in the environment can worsen symptoms, as can dryness of the skin, exposure to water, temperature changes, and stress.

Risk Factors:

• Young age -- infants and young children are most affected by eczema (about 65% of cases occur before age one, and about 90% occur before age 5)
• Skin exposure to harsh conditions
• Living in a climate with low humidity
• Personal or family history of allergies to plants, chemicals, or food
• Deficiencies of certain vitamins and minerals (for example, zinc)
• Stress can make eczema worse

Irritants that may worsen eczema include:

• Wool or synthetic fibers
• Certain soaps and detergents as well as perfumes and some cosmetics
• Dust or sand
• Cigarette smoke

Diagnosis:

Your doctor will most likely base a diagnosis on both the appearance of the skin and on personal and family history. To find the cause of your rash, your doctor may ask about stress in your life, your diet, drugs you are taking, soaps and detergents you use, and chemicals or materials you may be exposed to at work. A skin lesion biopsy (removal of a small piece of skin for examination in a laboratory) may be performed, but is not always required to make the diagnosis.

Prevention:

Control of stress, nervousness, anxiety, and depression may help prevent flares of eczema. Mind-body techniques that have shown some success include cognitive-behavioral therapy and autogenic training. These two techniques can also be combined with learning about eczema.

Dietary restrictions that may help avoid flare ups include eggs, fish, peanuts, and soy. This is very individual and should be discussed with your health care provider. A doctor, dietitian, or naturopath, for example, can help you make these dietary changes and determine if the lack of these foods in your diet is reducing the incidence and severity of your eczema.

Although somewhat controversial, some studies have shown that children who are exclusively breast-fed for at least 4 months are less likely to get eczema. This is particularly true when the nursing mother has avoided cow's milk in her own diet.

Similarly, recent studies suggest that babies whose mothers used probiotics during pregnancy and while breastfeeding were less likely to have eczema at up to 2 years of age.

Preliminary studies suggest that pretreatment of skin with creams containing omega fatty acids can reduce the severity of eczema or prevent eczema entirely.

Treatment:

The goals when treating eczema are to heal the skin, reduce symptoms, prevent skin damage, and prevent flares. Treatment may vary depending on age, symptoms, and general health. Developing skin care routines, identifying factors that trigger flares, and avoiding these triggers are a large part of any treatment plan.

Lifestyle

• Avoid anything that aggravates the symptoms, such as allergens (substances to which the immune system overreacts) and irritants to the skin. Common allergens include pollen, dust mites, and animal dander. Common skin irritants include wool, synthetic fibers, soaps and detergents, perfumes, cosmetics, lanolin, certain chemicals such as chlorine and solvents (including mineral oil), cigarette smoke, dust, and sand.
• Avoid scratching or rubbing affected areas.
• Protect skin from rough clothing and irritants.
• Be aware of emotional stress, and try stress-reducing techniques.
• Keep your environment cool, with stable temperature and humidity.

Dry skin often makes the condition worse. Remember to:

• Avoid hot baths or showers; lukewarm water is best.
• Wash or bathe as quickly as possible to lessen water contact.
• Use a mild soap or a nonsoap cleanser, or less soap than usual.
• Moisturize. After bathing, it is important to trap the moisture in the skin by applying lubricating cream on the skin while it is damp (within 3 minutes of bathing).

Parents can help their children by:

• Providing distractions to prevent them from scratching.
• Keeping fingernails short to reduce chances of infection from scratching.
• Being aware that there may well be social and emotional stress associated with visible skin lesions; additional support and encouragement may be needed.

Medications

• Mild anti-itch lotions (Caladryl or Calamine) or topical corticosteroids (hydrocortisone) may soothe less severe or healing areas, or dry scaly lesions.
• Chronic thickened areas may be treated with ointments or creams that contain tar compounds (such as Psoriasin), corticosteroids (medium to very high potency), and ingredients that lubricate or soften the skin.
• Systemic corticosteroids may be prescribed to reduce inflammation in some severe cases. Examples include prednisone (Deltasone) and methylprednisolone (Medrol). In very rare instances, medications that suppress the immune system (called immunosuppressants), such as cyclosporine, may be considered in adults with extremely severe eczema who do not respond to oral steroids.
• Antihistamines, such as diphenhydramine (Benadryl), may be recommended for nighttime use to prevent scratching. These medications may cause drowsiness. Topical (on the skin) antihistamines preparations are also available.
• New treatments -- the latest treatment for eczema is a new class of skin medications called topical immunomodulators (TIMs). These medications are steroid-free. The most common are tacrolimus (Protoptic) and pimecrolimus (Elidel). Clinical studies have reported as high as an 80% success rate using these new medications.

Surgery and Other Procedures

Phototherapy and Photochemotherapy

Treatment with ultraviolet light waves may effectively treat mild-to-moderate cases of eczema in children over age 12 and adults. If phototherapy is ineffective alone, it may be combined with a drug called psoralen. It is then called photochemotherapy.

Nutrition and Dietary Supplements

Nutritional deficiencies may be addressed with the following supplements:

• Eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities. Identifying and treating hidden food allergies along with stress management are often the cornerstones of effective complimentary medical treatment of eczema.
• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil (1 - 2 capsules or 1 tablespoonful oil 2 - 3 times daily), to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources, but supplementation is recommended.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Some probiotic supplements may need to be refrigerated for best results. Your child may also take probiotic supplements. Consult with your health care provider before giving your child any dietary supplements.
• Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
• Vitamin C, 500 - 1,000 mg 1 - 3 times daily, as an antioxidant and for immune support.
• L-glutamine, 500 - 1,000 mg 3 times daily, for support of gastrointestinal health and immunity.
• Grapefruit seed extract (Citrus paradisi), 100 mg capsule or 5 - 10 drops (in favorite beverage) 3 times daily when needed, for antibacterial, antifungal, and antiviral activity, and for immunity.
• Resveratrol (from red wine), 50 - 200 mg daily, to help decrease inflammation and for antioxidant effects.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant and anti-inflammatory effects. Use caffeine free products. You may also prepare teas from the leaf of this herb.
• Cat's claw (Uncaria tomentosa) standardized extract, 20 mg 3 times a day, for inflammation and antibacterial, or antifungal activity.
• Reishi mushroom (Ganoderma lucidum), 150 - 300 mg 2 - 3 times daily, for inflammation and for immunity. You may also take a tincture of this mushroom extract, 30 - 60 drops 2 - 3 times a day.
• Olive leaf (Olea europaea) standardized extract, 250 - 500 mg 1 -3 times daily, for antibacterial or antifungal activity and immunity. You may also prepare teas from the leaf of this herb.
• Evening primrose (Oenothera biennis) standardized oil extract (EPO), 500 mg - 8 grams daily in divided dosages, depending upon severity of symptoms. Ask a health care provider for more information on proper dosages of EPO.
• Milk thistle (Silybum marianum) seed standardized extract, 80 - 160 mg 2 - 3 times daily, for detoxification support.

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of eczema based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. Any remedy that causes aggravation of symptoms should be discontinued right away.

• Calendula -- applied to the skin, particularly if the affected area is inflamed; this remedy soothes but does not cure the skin condition.
• Sulphur -- for redness, burning, itching, and hot skin that tends to worsen with washing and scratching.
• Urtica urens -- for large, red rashes (particularly those related to allergies) that itch and burn intensely.
• Rhus toxicodendron -- used as a remedy for inflamed skin resulting from direct contact with an irritating substance; some homeopaths use it to treat eczema.

Massage and Physical Therapy

One clinical study evaluating essential oils for treating children with eczema concluded that massage with and without essential oils was effective in improving the dry, scaly skin lesions. Children with this scaly, itchy skin problem seem to experience less redness, scaling, and other symptoms if receiving massage between flares. Massage should not be used when this skin condition is actively inflamed. The essential oils most often chosen by the mothers in the study included sweet marjoram, frankincense, German chamomile, myrrh, thyme, benzoin, spike lavender, and Litsea cubeba.

Exercise

In one clinical study it was found that regular group sporting activities improved symptoms in those who participated for 3 weeks. The therapeutic effect of exercise may be related to the positive impact it has on the emotions. Sports should be avoided during the worst stages of an outbreak.

Climatotherapy

Climatotherapy is the use of sunlight and water (such as the ocean) as therapy. The Dead Sea in Israel is known for its healing properties, and many people with eczema go there to sit in the sun and swim in the water. Clinical studies suggest that this is a successful treatment for eczema. One clinical study looked at the experience of more than 1,500 people with eczema and found that 95% of skin was cleared in people who had previous stays at the Dead Sea and stays longer than 4 weeks.

Mind-Body Medicine

Flares of eczema are associated with anxiety and stress. Several clinical studies have shown that relaxation techniques to reduce stress and anxiety can successfully decrease the number of occurrences and relieve symptoms of eczema. Biofeedback seems to be a particularly useful technique.

Other Considerations:

Starting an infant on solid foods conservatively and gradually may help prevent the food sensitivities that can cause eczema. Those who are allergic to ragweed, chrysanthemums, asters, echinacea, or feverfew should avoid chamomile because it is in the same plant family.

Pregnancy

Avoid the use of burdock and sulfur during pregnancy.

Warnings and Precautions

Although Chinese herbal treatments for eczema have been gaining popularity in both the United States and the United Kingdom, caution must be exercised when considering such remedies for this skin condition. Many of the Chinese herbal creams available in these two countries have been tested, and high amounts of steroid medications have been discovered. This is worrisome and potentially dangerous because the amount of the medication in such creams is not standardized or regulated. In a few rare instances, the use of oral Chinese herbs (like a tea) for eczema has led to kidney damage.

Prognosis and Complications

Although there may be complications of eczema, such as bacterial infections of the skin and permanent scar formation, eczema is usually just an annoyance that is easily controlled with treatment and by avoiding irritants. Call for an appointment with your health care provider if it does not respond to treatment or if signs of infection (such as fever, redness, pain) occur. Children with eczema, after a certain period of time, often go into remission for the rest of their lives, although skin may remain sensitive and dry.

Alternative Names:

Atopic dermatitis; Dermatitis - atopic; Skin disorders - eczema