Q: What’s the deal with this eczema? It’s even on my face.
A: Eczema, the “itch that scratches”, is a chronic inflammatory skin problem that causes a characteristic red, itchy rash. It commonly occurs on skin overlying joints and other areas that stretch and fold, but can occur anywhere on the body.
The cause of eczema remains a mystery. We know a couple of things, though. It often occurs in families. When one identical twin is affected there is an 80% chance the other will have eczema too. Overall, about 20% of the population in the US has eczema. It typically starts before five years of age, affects city folk more than rural inhabitants, and females a little more than males.
Eczema can be mild and limited or there can be diffuse involvement over a lot of the skin surface. Often eczema is worse in the winter, when skin tends to be drier by virtue of the harsh environment. While we don’t know what causes eczema, we know that the top layer of the skin-the thin epidermal line that protects you from the environment-becomes disrupted. The tissue can’t retain moisture effectively and leaves you susceptible to infection.
The mainstays of therapy to protect the barrier involve both medication and lifestyle modification. Steroid creams are first line treatments. They work like a charm but can be tricky to use in the long run: they make skin thinner (which restricts their use on the face and neck where skin is already thin); they can cause a rash that looks like acne; can leave skin discolored and can also cause stretch marks. When we have to use a steroid, we try to use one with the lowest potency for the shortest amount of time necessary to keep the eczema under control.
The other equally important part of treatment has two parts: avoiding triggers and adding moisture to the skin.
- Anything that might make already inflamed skin more irritated should be avoided. For example, perfumes, lotions with alcohol base and fragrance, certain detergents, deodorant soaps, or wool clothes can be quite irritating to somebody with eczema.
- Long hot showers dry the skin (especially in the winter) and they release histamine from the mast cells in the dermis, making you itch and scratch like a fiend, which further disrupts the barrier.
- Use bland soap without lye base. As noted above, avoid deodorant soaps.
- A good, thick emollient is key. Petroleum jelly is the gold standard, but it’s hard to use. It stains clothes and bedding and covering your whole body in it is, well, icky and sticky. The thicker the emollient, though, and the sooner you use it after bathing the better. Ointments are generally better than lotions at moisturizing. Eucerin, Cetaphil, and Nutraderm are good products.
- Antihistamines like loratadine (Claritin) or diphenhydramine (Benadryl) are sometimes helpful in controlling the itch during severe exacerbations.
- Phototherapy (light treatments) or oral immune-modulators (i.e. chemotherapy) under a physician’s supervision can be helpful with severe chronic disease.
Schedule an appointment here at Student Health Services if you’ve having problems with your eczema, or any other skin problem.
John A. Vaughn, MD
Student Health Services
The Ohio State University