Allergy and Asthma Source


Atopic Dermatitis/ Eczema
January 8, 2007, 4:25 pm
Filed under: Allergic Skin Conditions, Allergies, Childhood Allergies

eczema
From the American Academy of Allergy, Asthma, and Immunology patient tips:
Atopic dermatitis/eczema
Also see: Allergic Contact Dermatitis
A common allergic reaction often affecting the face, elbows and knees is atopic dermatitis, also known as eczema. This red, scaly, itchy rash is usually seen in young infants, but can occur later in life in individuals with personal or family histories of atopy, meaning asthma or allergic rhinitis (”hay fever”). Eczema may at times ooze, or at times may look very dry. A physician will rarely have difficulty diagnosing atopic dermatitis, based on three factors: an 1) itchy, 2) “eczematous” or bubbly rash in an 3) atopic individual. If one of these three features is missing, your physician should consider other causes.

Identifying the cause of the itch is essential in managing symptoms. Common triggers include overheating or sweating, and contact with irritants such as wool, pets or soaps. In older individuals, emotional stress can cause a flare-up. For some patients, usually children, food can also trigger eczema. Secondary staph infections also can cause a flare-up in children. These patients usually have very dry skin and “allergic shiners”-an extra crease, called a Dennie’s line, across their lower eyelids. They are also more susceptible to other skin infections.

Preventing the eczema itch is the primary goal of treatment. The patient must stop scratching and rubbing the rash. Applying cold compresses is helpful, and lubricating the dry skin with cream or ointment, especially during dry seasons, is essential. Patients should remove all “irritants” that aggravate the condition from their environments. If a food is identified as the culprit, it must be eliminated from the diet.

Topical corticosteroid cream medications are most effective in treating the rash once all preventative measures are taken. Rarely, antihistamines or oral corticosteroids are also prescribed, and if a secondary infection has been introduced by scratching, antibiotics are required.

When to see an allergy/asthma specialist
Whenever you have an unusual rash, make sure to contact your allergist, who will work with you to determine its cause-whether allergies, irritants, or another trigger. Most importantly, your physician and other health care providers can offer a support system and assist you in managing your skin condition.

The AAAAI’s How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines Citing the Evidence provide information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist. Patients should see an allergist/immunologist if they:

Need to confirm the diagnosis of atopic dermatitis or contact dermatitis in a patient with dermatitis.
Need to identify the origin of contact dermatitis.
Have atopic dermatitis that responds poorly to treatment.
Need to identify the role of mite allergy in patients with atopic dermatitis.
Need to identify the role of food allergy in patients with atopic dermatitis.

Your allergist/immunologist can provide you with more information on allergic skin conditions.

Links:

Key Therapy Points for Patients with Atopic Dermatitis/ Eczema
Allergy and Asthma Consultants of Rockland and Bergen


15 Comments so far
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Hi I have eczema and nobody seems to be able to help although I have not gone to an allergist. I believe what is happening at this stage of my life is that I (56 year old female) excerise alot and sweat alot. My eyes are very itchy as is other facial parts and around my mid section. I try washing right after sweating an I use a topical cream but nothing is working. Do I have to stop excercising? Please recommend a physician in the Washington DC area. Thanks

Comment by wendy February 7, 2007 @ 3:48 am

You can go to the Allergy links on the right hand side of the home page and click on “Find an Allergist” or go to: http://www.aaaai.org/physref/ which take you to the physician finder page of the American Academy of allergy, Asthma and Immunology.
I don’t think you need to stop exercising, but if the rash is worse in the areas where you sweat, a lot of eczema patients also have a fungal superinfection because the immune defenses of their skin are not normal. You may want to discuss with your physician if a trial of antifungal cream for a few weeks would be beneficial.

Comment by Dr. de Asis February 7, 2007 @ 9:33 am

I HAVE A SKIN RASH. IT STARTED ON MY LOWER LEG,WHERE I BRUISED MY SHIN THREE MONTS AGO. IT BEGAN AS VERY ITCHY,WITH PATCHES OF DRY, RED ITCHY SPOTS. NOW, MY TORSO IS ITCHY, MY UPPER AND LOWER ARMS ARE ITCHY, AS ARE MY LEGS. IT ALMOST FEELS LIKE I HAVE THE ITCH SENSATION ALL OVER MY BODY. COOULD THIS RASH BEAN ALLERGIC REACTION? I HAVE JUST MOVED INTO A NEW HOUSE. OUR BEDROOMIS NOT COMPLETED, SO IHAVE BEEN SLEEPING ON A MATTRESS THAT WAS STORED IN THE BASEMENT FROM THE TIME IT WAS BOUGHT. I HAVE NOT CHANGED DETERGENTS OR SOAPS,AND I AM AT A LOSS. I THOUGHT IT WAS A REACTION TO NIZORAL, BUT I STOP THAT MEDICATION ALMOST TWO WEEKS AGO AND THIS RASH HAS ONLY GOTTEN WORSE. HELP! THANK YOU

Comment by Tara February 11, 2007 @ 8:33 pm

Hi Tara, it is difficult to tell at this point what is causing the rash. Have you seen an allergist or a dermatologist? You may still have the skin fungal infection or you may be reacting to the dust in the mattress. A physician needs to see the rash and you may need further tests. To find an allergist in your area, you can go to http://www.aaaai.org/physref/ or ask your primary care physician.

Comment by Dr. de Asis February 12, 2007 @ 9:50 am

Hi! I was born with eczema in the creases of my elbows and behind my knees. It went away, but I developed allergies and asthma as a child. I still have the allergies and asthma, but now the eczema is back. Two years ago I noticed some eczema on my fingers. Lately it has spread to the palm of my hands and to the back of my hands. Now I’m noticing it in the creases of my wrists as well. I’ve been to a dermatologist who gave me super potent steroid cream which only helped a little. When I stopped using the cream, the rash came back worse than before. The eczema stays the same even when I change laundry detergents, soap and shampoo. I’ve tried cutting soy, dairy, eggs and wheat out of my diet but it doesn’t seem to be helping. Any suggestions?

Comment by Amy February 26, 2007 @ 12:16 pm

Hi Amy,
It seems you have what is called the “Atopic/ allergic triad” of allergic rhinitis, asthma, and eczema. Have you seen an allergist or undergone skin/ blood allergy testing?
Many eczema patients also have allergies to house dust mites or foods which may be exacerbating their eczema. Upper respiratory infections or skin infections can also aggravate eczema. All these factors should be evaluated.

You should also be using a hypoallergenic, dye and fragrance free soap (such as Dove White or Ivory) and a hypoallergenic, dye and fragrance free moisturizer such as Aquaphor, Vaseline, or Vanicream after bathing and several times a day. See an allergist or a dermatologist who specializes in eczema for a full evaluation and treatment.

Comment by Dr. de Asis February 26, 2007 @ 3:18 pm

I have been battling a red, scaly, itchy rash for 6 months. I have seen 3 dermatologists and have been diagnosed with nickel allergy, but my shins continue to be red, raised, itchy and scaly. They don’t think it’s from the nickel, as I have eliminated nickel, but they can not seem to get rid of the rash. I have been treated with 3 steroidal creams and 3 steroid shots and multiple rounds of prednisone. I’ve quit shaving and use hypoallergenic soap and lotion. Can you offer any advice or hypothesis?

Comment by Dawn May 1, 2007 @ 9:34 pm

There are several possibilities. One is that you may have eczema/ atopic dermatitis which can be aggravated by ongoing upper respiratory infections such as sinusitis or food allergy. You may need to see an allergist or ENT to rule these out. Second, is it might be a fungal infection. A simple KOH prep by your dermatologist would have told them this. Third, you might need more extensive patch testing. Most dermatologists only do the True test which as 24 allergens instead of the North American Contact Dermatitis panel, which has over 50 allergens tested. Look for a dermatologist/ allergist who specializes in contact dermatitis. Fourth, how’s your circulation? I’ve had elderly patients with poor circulation develop what is called stasis dermatitis in that area. Have you had a skin biopsy? This may tell you if it’’s something else completely, like some weird nummular dermatitis. Hope this was helpful.

Comment by Dr. de Asis May 2, 2007 @ 8:56 am

Hi, almost 3 years ago my sister contracted scabies and passed it along to myself by sharing living arrangments. Both of us were treated and both cases are now gone Shortly after on numerous occations of not feeling any less itchy in my legs, I again returned to the dermatologist who finally did an allergy patch test. She determined that I had developed an allegry to nickel and sent me on my way by telling me to “avoid” nickel?! Nothing ever bothers me on my body except my legs a day after I shave. Being summer time and needing to use a ravor, I’m at a loss. I’ve got one spot in particular that is troublesome and is rough, scaley, and itchy. The rest of my legs just itch. Is this REALLY an allergy to nickel or could it be something else as I can’t avoid a razor on my legs forever?!

Comment by Katrina June 21, 2007 @ 1:22 pm

Avoiding nickel when you have a nickel allergy means avoiiding prolonged contact with objects containing nickel such as jewelry, buttons, zippers, etc. Using a razor for a few minutes isn’t enough to trigger a nickel reaction. What you are currently experiencing may be irritation or folliculitis from shaving. Have you considered other means of hair removal like waxing?

Comment by Dr. de Asis June 22, 2007 @ 2:56 pm

Hi, I recently developed red bump, itchy and burning rash on both of my wrist. They spread to my shoulder. I also start having it on my neck and legs. They burn and itch!!! It’s killing me.

Comment by Janet July 27, 2007 @ 6:57 pm

Eye glasses can also cause dermatitis from a reaction to the metal or the finish. Also the area around the plastic nodes can collect bacteria if not cleaned often

Comment by NaturalAllergyRelief April 23, 2008 @ 11:30 pm

I’m 15 with atopic eczema, stasis dermatitis, and seborrhoeic dermatitis. I feel so depressed because I can’t lead the life of a normal person. Can any of these be cured?.

Comment by Nam April 28, 2008 @ 8:40 pm

There are treatments for all these conditions. Seborrheic dermatitis is usually treated with selsun and/or antifungal cream. Atopic eczema may be triggered by food or dust mite allergies, infection, and dryness. All these factors should be evaluated and addressed. I’m not sure why a teenager would have stasis dermatitis, but if you see an allergist and a dermatologist and address the issues I mentioned above, your skin should improve.

Comment by Dr. de Asis April 29, 2008 @ 1:20 pm

I like your website, very informative! The fungus problem may be partly solved by using strobe light eg., from a studio flash setup. I have read, but typically lost the URL that the use of strobe light can be used to safely treat food. The light although not apparent to us boils the DNA in the fungus/ mould organism and would of course penetrate camera lenses and probably by reflection any organisms that would be invisible to sunlight or UV. I have also looked at medical sterilisation units- but these are…

Comment by Skin Fungus - Index April 29, 2008 @ 5:28 pm



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