Finding Treatment for Eczema

Doctors use eczema and dermatitis interchangeably to describe almost any itchy rash. Contact dermatitis describes an irritation or allergic reaction that results from touching a specific substance. Poison ivy, the ingredients in certain cosmetics, or the nickel in some jewelry can cause it. Dandruff is a form of seborrheic dermatitis, although the term is a misnomer since the sebaceous glands, tiny, oil-secreting skin glands, aren't involved.

When people go to the doctor for eczema or dermatitis, it is usually because they have atopic dermatitis. (The terminology is confusing because atopic dermatitis often is referred to simply as eczema.) Atopic dermatitis is a chronic, hereditary condition that mainly affects children, but can persist into adulthood. It presents as a red, scaly rash, but its cardinal feature is itchiness -- so much so that it's been called the "itch that rashes."

Often the condition first appears in infants 2-6 months old. It begins on the face and spreads to the trunk and limbs. In older children, it often involves the flexures, thin creases in the skin -- inside the elbows, behind the knees, where the buttocks meet the thighs, and so on. Often, in adults, only one area of the body -- typically the hands or wrists -- will be affected.

In the United States, atopic dermatitis has become increasingly prevalent; it now afflicts about 12%-15% of American children. Some studies have shown that about half of the young children who have widespread cases of the disease will develop asthma by age 13. People with atopic dermatitis often have family members who suffer from asthma or other allergy-based atopic disorders, such as allergic rhinitis (hay fever), allergic conjunctivitis, or urticaria (hives).

In some respects, atopic dermatitis resembles an allergic reaction. In some infants and children, it seems to be triggered by specific foods. And most people with atopic dermatitis have IgE antibodies that become hypersensitive to otherwise innocuous substances -- the classic model for allergy. However, a significant number of sufferers lack IgE hypersensitivity and have eruptions without a specific trigger. Stress can also bring on an attack. Because of this ambiguity, many clinicians see atopic dermatitis as a mysterious entity -- part allergy, part autoimmune disorder.

Eczema Treatment

You can often treat mild atopic dermatitis yourself with a combination of moisturizers to alleviate dryness and over-the-counter steroid creams to reduce itching. It also makes sense to avoid irritants and common allergens. As with many skin conditions, it may help to bathe in warm, not hot, water and to limit the use of soap. Antihistamines can be helpful, not so much because they affect histamine, but because they make people drowsy and less likely to scratch. Possibly for this reason, non-sedating antihistamines, such as Claritin, are not effective.

For difficult cases, the mainstay treatment has been topical steroids. When used at the appropriate strength, they are quite effective in quieting inflammation. Oral corticosteroids are used sparingly and only for severe flare-ups of the disease. They are powerful drugs with potentially severe side effects. Also, after people stop taking them, their atopic dermatitis can come back and be worse than it was before the treatment.

Researchers have long sought alternatives to steroid-based treatments. Two recent contenders are cyclosporine and tacrolimus. Both are used to suppress the immune responses of transplant patients to prevent rejection of the new organ. Unfortunately, cyclosporine can cause kidney damage, and it isn't effective as a topical cream or ointment. However, dermatologists have high hopes for a new tacrolimus ointment (Protopic). Tacrolimus is more potent than cyclosporine, works when applied topically, and doesn't have harsh side effects. The 12-week studies that won its recent FDA approval showed 90% improvement in about a third of the patients. A study in the August 2000 Archives of Dermatology found that adults using the drug intermittently over a year had no adverse effects besides temporary burning and stinging. If it proves to be effective for atopic dermatitis, doctors may begin prescribing tacrolimus for other kinds of irritations and rashes.

Last updated Jan 4/07