Lifestyle Choices

The word eczema is derived from a Greek word meaning “to boil out”, a description of the family of itchy skin conditions which begin with redness and swelling, often followed by blisters and oozing, then scaling, and finally thick, leathery, frequently painfully cracked skin. Several categories of eczema exist, the most common of which are atopic dermatitis, hand dermatitis, and nummular dermatitis.

Atopic dermatitis is a common condition all over the world, affecting about three percent of the American population. It runs in families whose members also suffer from other allergies such as hay fever and asthma. Atopic dermatitis usually first appears in infancy with redness and chapping on the baby’s cheeks and scalp. The infant suffers intolerable itching and cries constantly. A consolation is that half of these babies recover before they are two.

If the atopy continues, the dermatitis affects the back of the arms and the front of the legs, then subsequently shifts to the skin in the folds of the elbows, knees, and neck. The affected skin becomes dry and scaly from the constant scratching.

Atopic dermatitis can be partially alleviated by avoiding irritants in the environment. Any clothing worn close to the skin should be soft cotton, silk or nylon — wool should never be worn. All new clothing should be washed before wearing. Feather pillows and wool blankets should not be used, and fuzzy or woollen toys must be avoided with children. If kept indoors, dogs, cats and birds can worsen atopic dermatitis. The child should be protected from dust as well as from irritating household cleansers, detergents, greases, oils, and harsh soaps. Humidifiers in winter protect against dry heat, and air conditioners in summer can alleviate sweating. Certain foods can provoke flareups: milk, eggs, fish, wheat, peanuts, chocolate, and citrus fruits.

Individuals with atopic dermatitis are very susceptible to infections such as the herpes virus. They are also likely to develop severe reactions to injections of penicillin and certain other drugs. A child should not be vaccinated when experiencing atopic dermatitis.

Fortunately, there are effective treatments which can alleviate the itching. Just bathing less frequently helps: children do not need to be washed daily! The application of topical steroid creams once or twice each day with emollients in between can also stop the inflammation-itch cycle. Sometimes oral antihistamines are needed.

Hand dermatitis in an adult might be the only remnant of childhood atopic dermatitis. This is a chronic dryness, itching, and painful fissuring of the skin on the hands that can lead to swelling and infection. It is usually a reaction to common irritants such as soap, detergents, and solvents, common in housewives (”dishpan hands“), food handlers, bartenders, nurses and dentists.

Hand eczemas of entirely different causes may closely resemble each other. Allergic contact dermatitis may be caused by contact with one specific chemical, but everyday hand contacts are so numerous that identification can be difficult. The pattern of the rash and patch tests determine the cause. Psoriasis on the hands is usually accompanied by psoriasis on the body and a family history of the disease. Dyshidrotic hand eczema is characterized by tiny, deep, itchy blisters, which appear suddenly on the sides of the fingers and palms, especially often in people who tend to perspire excessively on the palms and soles of the feet. Fungal infections may be diagnosed by doing a culture or looking for organisms in the microscope. ID reactions are allergic rashes on the hands associated with an infection elsewhere on the body (usually on the feet).

The precise cause of the hand dermatitis must be identified, often requiring a visit to your dermatologist. It is always advisable to avoid touching all irritants. Rings should be removed when washing the hands; mild soaps must be used and the hands should be dried thoroughly and an emollient applied afterwards. Whenever any irritant is encountered (including even newsprint), white cotton gloves should be worn. If solvents or household cleansers and detergents are used, rubber gloves should be worn over the cotton gloves. Severe cases should be treated medically, usually with topical steroids or tar preparations.

Nummular dermatitis is characterized by coin-shaped, itchy, dry patches that are scattered over the body or arms and legs. These occur most frequently in older people. This irritation may relate to a previous atopic dermatitis, a reaction to irritants, or just a reaction to dry environments and winter weather. Usually the condition improves in the summer but worsens under emotional stress. As with hand dermatitis, treatment involves eliminating contact with irritants and application of topical steroids. Keeping the skin well-moisturized is a must.

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