Eczema: Gale Encyclopedia of Alternative Medicine

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Gale Encyclopedia of Alternative Medicine

http://www.findarticles.com/cf_dls/g2603/0003/2603000336/p1/article.jhtml

 

Eczema

 

 

Author/s: Judith Turner

 

 

Definition

Eczema, also called atopic dermatitis (AD), is a noncontagious

inflammation of the skin that is characteristically very dry and itchy.

The condition is frequently related to some form of allergy, which may

include foods or inhalants.

 

Description

Atopic dermatitis is sometimes described as " the itch that rashes " --the

scratching of the irritated areas may very well initiate the rash in

some patients. The skin of those affected by AD is abnormally dry

because of excessive loss of moisture. Chronic or severe cases of it can

cause the affected areas to form thick plaques (patches of slightly

raised skin), develop serous (watery) exudates, or become infected.

 

The areas of the body that are affected by AD tend to vary with age.

Children under five years old most commonly have AD, but it can occur at

any age. It can be mild and intermittent, or severe and chronic. Infants

frequently experience it on the face and other areas of the head. They

frequently rub their heads with their hands or on the crib bedding. The

stomach and limbs may also become involved. Older children commonly have

the worst spots on flexor surfaces, namely the inner wrists and elbows,

backs of knees, and tops of ankles. The hands and feet are other common

sites. The knees, elbows, hands, and feet may continue to be a problem

into adulthood.

 

Causes & symptoms

Genetic predisposition plays a large role in who will get AD or other

allergies. The condition is not contagious. A child who has one parent

with some form of allergic, or atopic, disease has somewhere between a

25-60% chance of also experiencing allergies, whether AD or some other

form. There is approximately a 50-80% chance that a child of two parents

with allergies will also develop some form of atopy. The genetic

predisposition of the individual, combined with such factors such as

early exposure to strong antigens, will determine whether and to what

extent that person will develop allergies.

 

The hallmark sign of AD is a red, itchy rash. The age of the patient

determines what regions are most likely affected, as described above,

but exceptions do occur.

 

Diagnosis

No laboratory test can reliably diagnose AD, although some patients will

be reactive to tests designed to diagnose allergy. These would include

skin tests by intradermal injection, scratch, or patch tests. There is

also a blood test available that measures levels of antibodies to

suspected allergens. Diagnosis is generally made by the appearance and

location of the rash. A personal or family history of allergy of any

type, including food allergy, asthma, or hay fever also supports the

diagnosis of AD.

 

Other types of dermatitis that may be described as eczematous include

contact dermatitis, nummular dermatitis, and stasis dermatitis. The

stasis type is related to poor circulation, which may also be a factor

in nummular dermatitis. These forms generally occur in older adults,

whereas AD is primarily a disease of children. Contact dermatitis can

occur at any age. It results from skin contact with either an irritant

or an allergen. The area affected is limited to the area in contact with

the offending substance.

 

 

 

 

 

Treatment

The basis of treatment for AD is keeping the skin moist and clean, as

well as avoiding irritants and known allergens as much as possible.

Further measures become necessary if the case is particularly severe, or

if the skin becomes infected.

 

Conventional wisdom has been that minimal bathing of the patient with AD

is ideal. The rationale was that bathing would break down the natural

oil barrier of the skin and cause further drying. It actually appears

now that frequent long, tepid soaks are beneficial to hydrate the very

dry skin that this condition produces. Adding a muslin bag filled with

milled oats or the commercially available preparation Aveeno bath to the

water can be soothing. The bath water should cover as much of the skin

as possible. Wet towels may be draped around the shoulders, upper trunk,

and arms if they are above the water level. The face should be dabbed

frequently during bathing to keep it moist. The use of soap should be

minimized, and limited to very mild agents such as Cetaphil. The bath

must followed within two or three minutes by a gentle patting dry, and a

thick application of a water barrier ointment, such as Aquaphor,

Unibase, or Vaseline. Lotions are not generally recommended as they

almost universally contain alcohol, which is drying and may burn when

applied. Soaking in plain water can be painful during severe episodes of

AD. Adding one-half cup of table salt to one-half tub of water creates a

normal saline solution, similar to what is naturally present in the

tissues, and may relieve the burning. Commercial Domeboro powder may

also be helpful.

 

One alternative to bathing is to use soaking wraps. For this method,

cotton towels or other cloths are soaked in tepid water, with table salt

or Domeboro powder added for comfort if desired. The patient's bed is

covered with something waterproof, and the bare skin is covered as

thoroughly as possible with the wet wrappings. The body should then be

covered by a waterproof covering to slow evaporation. Vinyl sheeting and

plastic wrap are two alternatives. The wraps should be left in places

for as long as possible, but at least for 30 minutes, before the water

barrier and any topical medications are applied.

 

Environmental improvement affords some relief for many patients. Pet

dander and cigarette smoke are potential aggravating factors. Keeping

these out of the home is probably for the best, but at minimum, they

should not be allowed in the room of the allergic person. Clothing and

bedding should be 100% soft cotton, and laundered in detergent with no

perfumes. These items should also be washed before the initial use in

order to rid them of potentially irritating residues. Clothes should fit

loosely to prevent irritation from rubbing. Washing bedding in hot water

will help to kill dust mites. Running laundry through a double rinse

cycle will help to remove any vestiges of detergent. Avoid the use of

fabric softener or dryer sheets, as these are frequently scented and may

be irritating. Do not dry clothes or bedding outdoors, because pollen

and other potential allergens are likely to cling to it. The mattress

and pillowcase can be covered by special casings that are impervious to

the microscopic dust mites that infest them. Under normal circumstances,

these mites cause no problem, but they can be a major irritant for the

individual with asthma or AD.

 

 

 

 

Temperature extremes can make AD worse, so heating and cooling should be

employed as appropriate, along with adding humidity if needed. Patients

tend to have abnormal regulation of body temperature, and are sometimes

feel warmer or colder than other people in similar circumstances.

Sweating will frequently aggravate AD. Room temperature should be

adjusted for comfort. Central air conditioning is the best option for

cooling the home. Evaporation cooling brings a large amount of potential

irritants into the house, as do open windows. Air conditioning rather

than open windows should also be used to cool the car. Electrostatic

filters and vent covers are available to remove irritants from the air

in the house. These should be frequently changed or cleaned as

recommended by the manufacturer.

 

In the patient's room, dust-collecting items such as curtains,

carpeting, and stuffed animals are best minimized. Vacuuming and dusting

should be done regularly when the affected person is not in the room. A

HEPA filter unit, and a vacuum with a built-in HEPA filter remove a high

percent of dust and pollen from the environment.

 

Some simple mechanical measures will reduce the amount of skin damage

done by scratching. It is important to keep fingernails short. Using a

nail file will produce a smoother nail edge than scissors or clippers.

It is particularly difficult to keep children from scratching irritated

and itchy skin, but using pajamas and clothing with maximum skin

coverage will help to protect the bare skin from fingernails. Mittens or

socks may be used to cover the hands at night to reduce the effects of

scratching. Infant gowns with hand coverings are useful for the very

young patient.

 

In addition to the skin care and environmental measures to relieve

eczema, there are some complementary therapies that may prove helpful.

 

Acupuncture

Any type of therapy that relieves stress can also help to manage AD.

Acupuncturists also claim to be able to treat blood and energy

deficiencies, and to counteract the effects of detrimental elements,

including heat, damp, and wind.

 

Autogenic training

Autogenic training is similar to methods of meditation and

self-hypnosis. Instructors help the patient to achieve and maintain a

relaxed state of positive concentration. This is eventually done

independently. Even ten minutes of practice per day can produce

beneficial results for mind and body. Research has shown AD to be one of

the conditions that is improved by this technique.

 

Aromatherapy/massage

Massage is another therapy that can be effective in reducing stress. The

oils that are used in the treatment can also make a difference in AD.

Some patients get relief from the topical use of evening primrose oil

(EPO) diluted in carrier oil. Aromatherapists may use small amounts of

essential oils from lavender, bergamot, and geranium. These are promoted

to decrease both itching and inflammation. Improper dilutions, however,

can worsen the condition.

 

 

 

 

Herbal therapy

Some herbal therapies can be useful for skin conditions. Among the herbs

most often recommended are:

 

Calendula (Calendula officinalis) ointment, for anti-inflammatory and

antiseptic properties.

Chickweed (Stellaria media) ointment, to soothe itching.

Evening primrose oil (Oenograceae) topically to relieve itching, and

internally to supplement fatty acids.

German chamomile (Chamomilla recutita) ointment, for anti-inflammatory

properties.

Nettle (Urtica dioica) ointment, to relieve itching.

Peppermint (Menta piperita) lotion, for antibacterial and antiseptic

properties.

Chinese herbal medicine. In traditional Chinese medicine, there are

formulas used to treat eczema that nourish the blood, moisten the skin,

stop itching, and encourage healing. Some formulas are used topically

and others taken internally.

There is individual variation in the effectiveness of the topical

treatments. Some experimentation may help to find the combination that

most benefits an individual. When the condition is chronic, severe, or

infected, guidance from a health care professional should be sought

before attempting self-treatment.

 

Hypnotherapy

Hypnotherapy has the potential to improve AD through using the power of

suggestion to reduce itching. Since mechanical damage to the skin done

by scratching may irritate, or actually cause, the rash, any measure

that reduces scratching can prove helpful.

 

Nutritional supplements

There are several nutrients that can prove helpful for treating AD. Oral

doses of EPO, which contains gamma-linolenic acid, have been shown to

significantly reduce itching. The amount used in studies was

approximately six grams of EPO per day. Fish oil has also been shown to

improve AD, at an approximate dose of 1.8 g per day. Vitamin C can

affect both skin healing and boost the immune system. Doses of 50-75 mg

per kilogram of body weight have been proven to relieve symptoms of AD.

Additional copper may be required in supplemental form when high doses

of vitamin C are taken. Vitamin E is reportedly useful, but there are no

documented studies of its benefits.

 

Reflexology

The areas of the foot that receive attention from a reflexologist when a

patient has AD include the ones relating to the affected areas of the

body, as well as those for the solar plexus, adrenal glands, pituitary

gland, liver, kidneys, gastrointestinal tract, and reproductive glands.

 

Allopathic treatment

Allopathic treatment involves use of oral antihistamines to decrease

itching, topical water barriers as mentioned above, mild topical

corticosteroids when indicated, and topical antibiotics if needed. The

water barrier should be applied generously; the corticosteroids and

antibiotics used sparingly, and only on areas where indicated. The

person applying the topical medications can wear gloves to minimize

exposure to the steroids and antibiotics. Oral antibiotics may also be

used when widespread infection is present. On rare occasions, oral

corticosteroids are prescribed to reduce severe itching and

inflammation, but this course is best avoided due to its potential side

effects.

 

 

 

 

Expected results

There is no cure for AD, although most patients will experience

improvement with age. Perhaps half of children will have no further

trouble with it past the age of five years. However, as many as 75% of

those who have AD in childhood will go on to have other allergic

manifestations such as asthma, food allergies, and hay fever. Diligent

daily care of the skin and avoidance of known triggers will control most

cases of AD to a large extent.

 

Prevention

One of the best things a mother can do to help keep her child from

getting AD is to breastfeed. It is best for the baby to have breast milk

exclusively for at least six months, particularly when there is a family

history of AD or other types of allergy. There also appears to be an

advantage to the breastfeeding mother avoiding foods known to be

commonly allergenic, particularly if there is a family history. This

would include wheat, eggs, products made from cow's milk, peanuts, and

fish. If breastfeeding is not possible, a hypoallergenic formula should

be used if there is family history of allergy. Consult a health care

provider for help with determining the best type.

 

The patient already diagnosed with AD can minimize flare-ups by avoiding

known triggers and following the skin care program outlined above.

Eczematous skin is also more susceptible to infections. Patients should

try to stay away from people with chicken pox, cold sores, and other

contagious skin infections.

 

Key Terms

Atopy

A group of diseases, including eczema, that develop in people with an

inherited tendency to develop immediate antibodies to common

environmental allergens.

Corticosteroids

A group of synthetic hormones that are used to prevent or reduce

inflammation. Toxic effects may result from rapid withdrawal after

prolonged use or from continued use of large doses.

Dermatitis

An irritation or imflammation of the skin.

Nummular dermatitis

A skin infection in which the areas of irritated skin are coin-shaped.

Further Reading

For Your Information

Books

Chevallier, Andrew. The Encyclopedia of Medicinal Plants. New York: DK

Publishing, Inc., 1996.

Editors of Time-Life Books. The Medical Advisor: The Complete Guide to

Conventional and Alternative Treatments. Alexandria, VA: Time-Life,

Inc., 1996.

Gottlieb, Bill, editor. New Choices in Natural Healing. Emmaus, PA:

Rodale Press, Inc., 1995.

Shealy, C. Norman. The Complete Illustrated Encyclopedia of Alternative

Healing Therapies. Boston: Element Books, Inc., 1999.

Other

Food Allergy Network. Food Allergy and Atopic Dermatitis Fairfax, VA:

Food Allergy Network, 1992.

Hollandsworth, Kim et. al. Atopic Dermatitis. Pediatric Clinical

Research Unit, 1994.

 

 

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Gale Encyclopedia of Alternative Medicine. Gale Group, 2001.

in association with The Gale Group and LookSmart.

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