Sometimes medical problems come at just the right time, like constipation before Thanksgiving. Usually this is just bad luck, but some situations often occur at the most inconvenient moments, for example before a public speech. Eczema can be attributed to this group. Just as the weather warms and we look forward to shorts and t-shirts, eczema flare-ups can make us worry about our skin.
Eczema is an inflammatory condition that usually causes itchy and rough skin. It usually affects children but can continue into adulthood. Eczema is also called atopic dermatitis and often runs in families when other family members also have atopic diseases, including eczema, allergic rhinitis or asthma.
Eczema is a chronic condition that can come and go, but like other atopic conditions, it tends to flare up during allergies. Blooming flowers and trees may be good for enjoying nature, but they can be bad for eczema. Atopic diseases run in my family, including eczema and asthma. Spring encounters can include nasty itchy skin, sneezing and breathing problems. This time of year is a good time to review your eczema treatment.
Before entering medical school, I didn't think much about why the skin was important to medicine. The function of the skin in terms of health is to create a barrier between the rest of the body and harmful substances in the environment. For the skin to do its job, it must block irritants without affecting them. Basically, you need a "thick skin". The problem with eczema is that the skin gets irritated, and when that happens, the barrier starts to break down. This leads to further stimulation, which can lead to an escape cycle.
Eczema home remedies and tips may work for dryness and itching, but not for eczema. So what is the difference? Eczema patients often have dry, itchy skin, but eczema often appears as an isolated rash and may be accompanied by skin discoloration (lightening, darkening, or reddening). Eczema starts in childhood and is a chronic or recurring disease. It often feels lumpy or crusty and may become crusty. Areas where the skin folds, such as behind the knees, elbows or neck, ankles or wrists, are often affected. Most people with eczema have a history of eczema, asthma or allergic rhinitis. However, it can be difficult to determine, so a diagnosis should be made by a healthcare professional, especially if more complex treatments are being considered.
Restoring the skin's protective barrier, or preventing it from breaking down, is an important first step to skin health. Natural oils on the skin's surface are part of this natural, healthy defense. Hot water dissolves oil, so people with a history of eczema can start using hot water for showers, baths, and hand washing instead of hot water. Strong soaps can have the same effect, so using a mild soap that protects more sebum and limiting the amount of soap you use at the right times can help prevent eczema flare-ups and restore a healthy skin barrier.
Replacing and supplementing the skin's natural oils with exfoliating ingredients is also an important strategy for maintaining skin health. I advise my patients to use creams like Cetaphil or Cervae, Vaseline or Aquaphor instead of lotions. Creams and lotions moisturize more effectively than lotions and are the best choice for eczema sufferers. It is recommended to use one of these products immediately after bathing, as this is when our skin loses its natural oils.
Avoiding hot water and using moisturizing creams or ointments are good practices to prevent or worsen eczema flare-ups, but are often not enough to treat eczema flare-ups. Since irritation and inflammation are involved in breaking down the skin barrier and perpetuating the cycle of eczema, break the cycle by addressing the irritation and inflammation.
This can be effectively done with topical steroids, some of which are available without a doctor's prescription, such as hydrocortisone. Ointment formulations are usually best for treating eczema because they form a good barrier. When prescription drugs are ineffective, I often prescribe stronger topical steroids.
Topical steroids are generally well tolerated, but they can cause side effects if used incorrectly. For new cases of eczema, it is recommended to use a topical steroid on the affected area twice a day for two weeks, but it is important to stop using it on the area at least once before using it. Week For long-term use of topical steroids, I recommend using them twice a day for a week, then, if necessary, take a week off before repeating the cycle. In general, topical steroids should not be used on the face. The bleaching effect of using topical steroid medications can cause discoloration of the surrounding skin. It can also cause skin irritation and minor damage. Proper use of topical steroids can reduce these effects.
If home and conservative treatments fail and eczema does not respond, there are more advanced treatment options. This can be light therapy, medication or injections. If you or a family member is having trouble managing eczema with conservative treatments, try talking to a healthcare professional. Recently, the FDA allowed a lower age of approval for some injectable treatments for eczema. Younger patients may now be eligible for treatments that were previously unavailable.
Remember that new doesn't always mean better. Injection treatments can be expensive and carry many risks. A discussion with your healthcare provider can help explain and understand the risks and benefits of all options.
In our family, we know that itchiness, dryness, and eczema rashes can be hard to deal with once we get back to sunbathing and swimming in shorts. It's a condition that most people can manage well by protecting the skin's natural barriers and dealing with flare-ups before they get worse, so get out and enjoy your blooms.
Dr. Peter Birch practices internal medicine at Kaiser Permanente Silverdale. He lives in Bremerton.
This article originally appeared in the Kitsap Sun; Your skin, allergies and summer eczema