Eczema

Eczema is a general term encompassing various inflamed skin conditions. One of the most common forms of eczema is atopic dermatitis (or "atopic eczema"). Approximately 10 percent to 20 percent of the world population is affected by this chronic, relapsing, and very itchy rash at some point during childhood. Fortunately, many children with eczema find that the disease clears and often disappears with age.

Who gets eczema?

Eczema occurs in both children and adults, but usually appears during infancy. Although there is no known cause for the disease, it often affects people with a family history of allergies.

Those who are genetically predisposed and then exposed to environmental triggers may develop eczema. Many people who have eczema also suffer from allergic rhinitis (hay fever) and asthma, or have family members who do.

One of the most important components of an eczema treatment routine is to prevent scratching. Because eczema is usually dry and itchy, the most common treatment is the application of lotions or creams to keep the skin as moist as possible. These treatments are generally most effective when applied directly after bathing (within three minutes is a common recommendation) so that the moisture from the bath is "locked in." Cold compresses applied directly to itchy skin can also help relieve itching. If the condition persists, worsens, or does not improve satisfactorily, another effective treatment is the application of nonprescription corticosteroid creams and ointments to reduce inflammation.

Alternatives to nonprescription corticosteroids include more potent prescription corticosteroid creams and ointments, which are effective, but which may have some side effects. To prevent side effects such as skin thinning, your doctor may limit the length of treatment time and locations where you can apply treatment. For severe flare-ups, your doctor may prescribe oral corticosteroids, but be aware that side effects including new flare-ups can develop when treatment is discontinued (this treatment is not recommended for long-term use).

Skin affected by eczema may frequently become infected. If this happens to you, your doctor may prescribe topical or oral antibiotics to kill the bacteria causing the infection.

For severe itching, sedative antihistamines are sometimes used to reduce the itch and are available in both prescription and over-the-counter varieties. Because drowsiness is a common side effect, antihistamines are often used in the evening to help a person restless from eczema get to sleep. Because of the same sedative effect, though, persons taking these agents should not drive. Tar treatments and phototherapy are also used and can have positive effects; however, tar can be messy. Phototherapy requires special equipment (lights). Finally, in cases while eczema is resistant to therapy, your physician may prescribe the drug cyclosporine A, which modifies immune response; however, this is used only in extreme cases because of its association with serious side effects.

Topical immunomodulators (TIMs) is a new class of drugs for the treatment of eczema. One drug in this class—tacrolimus—has been approved by the Food and Drug Administration (FDA) for treatment of moderately severe eczema. TIMs are topical drugs that modulate the immune response (alter the reactivity of cell-surface immunologic responsiveness). Studies have shown that this class of drugs will improve or completely clear eczema in more than 80 percent of treated patients, with a side-effect profile comparable with topical steroids.