Understanding Eczema

Eczema can start in infancy and continue into adulthood which may be thought to be the allergic variant. It may over the years improve or eczema can progress and develop into respiratory symptoms such as asthma as well as allergic rhinitis. This progression in a person is most often described as the “atopic march”.

People can have all of these medical problems, some of them or none of them.

The importance is to adequately determine whether or not there is an allergic component to any person’s eczema.

How would you be able to detect this? Does the rash usually present in the flexural areas of skin specifically around the neck, the back of the knee and the creases of the forearm? If so, then it is very important to be allergy tested to environmental allergens to determine what environmental allergens may exacerbate a person’s eczema. It is also important to know, that eczema frequently is exacerbated with the changes of season and in almost all instances is extremely itchy.

Treatment for allergic eczema or more often termed atopic dermatitis, may involve intense skin care precautions . Treatment usually may be itemized as follows:

1–frequent moisturizing.

2-decreasing taking long and hot showers or baths as this will cause further dehydration and exacerbate a person’s eczema.

3-consider using bleach baths to decrease the likelihood of developing superimposed skin infections(cellulitis).

4-using topical steroids on the affected areas usually twice a day for no more than a 2 week duration.

5-using non-topical steroids such as Elidel or tacrolimus. These can be used for longer periods of time as a source of prophylaxis.

6-using for a more severe outbreak oral corticosteroids for a short period of time to help “calm down” the skin and ultimately control the outbreak.

7- If one due to intense itching and subsequent scratching develops excoriated skin this can be a cause for infection and may require the use of topical antibiotics and oral antibiotics.

8-Antihistamines have often been a source of debate as to whether or not it will decrease a patient’s itching and promote some levels of sedation allowing sleep. Though, the literature is less compelling, the consensus of most people is that antihistamines do in fact provide some relief of symptoms.

9-Phototherapy-some believe that this usually done in a dermatologist’s office may provide some symptomatic relief.

10–What is new on the horizon? This is the use of biologic therapy. At present, with regard to atopic dermatitis, biologic therapy is in stage III clinical trials and may be available in the near future as a significant addition to the above armamentarium.

What happens when a patient who has a rash turns out not to be allergic?
It is very important to realize that there are many causes for a rash.
A rash may be caused by a contact allergy. If you suspect that you had a possible contact allergy then patch testing would provide you with an appropriate means to determine what particular allergens may be exacerbating your rash.

Patch testing may be done by either an allergist or a dermatologist.
Not all patch testing is the same. I caution you to ask your allergist or dermatologist what type of patch testing they do. In my coming blogs, I will go over with my followers what are the important points that everyone should know with regard to patch testing.

Another source of rash may be secondary to a systemic problem. This may be an underlying malignancy, and autoimmune related problem and a drug allergy just to mention a few differential causes.

It is important, when a rash has been existing for lengthy periods (years vs. months so to say) that a clinician “think out of the box” as to a possible etiology.

In our coming blogs, I will hope to provide you insight into not only patch testing but other important modalities that should be considered if you have a long time rash.

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