Departments
Health Matters
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Week of 15 January 1999 |
Vol. II, No. 19 |
Health Matters
Itching for a solution: eczema treatment
My hands and wrists are scaly and itchy all the time. Do I have eczema, and is there anything I can do about it?
The word eczema is used to describe a variety of itching, scaly, red or brownish skin conditions. You could well suffer from atopic dermatitis, an eczema associated with allergies and characterized by an intense, almost unbearable, itching, dry red to brownish-gray lesions, and scaly, thickened skin. The itching is particularly severe at night, causing some patients to scratch at their skin until it bleeds and crusts.
The condition affects about 3 percent of adults and approximately 10 percent of infants in the United States. While atopic dermatitis doesn't have a cure in the traditional sense, early and regular treatment by a physician should bring relief and also may reduce the severity of the disease and prevent more serious complications.
"Our skin protects the body from infectious and harmful agents," says Steven Ugent, M.D., instructor of dermatology at Boston University School of Medicine and staff dermatologist at Boston Medical Center. "Breaks in the skin caused by scratching at sores can let bacteria and viruses that would otherwise be harmless penetrate the skin and cause infections."
The cause of atopic dermatitis -- which can occur anywhere on the body -- is not fully understood, but researchers have a few good theories. "It's probably an exaggerated immune response to certain environmental stimuli, such as dust mites," Ugent says. "The same stimuli may cause asthma in some people and allergic rhinitis, also known as postnasal drip or hay fever, in others." The problem tends to affect several members of a family, although not all family members necessarily suffer from the same disorder. The weather can sometimes affect atopic dermatitis -- typically, people experience flare-ups in colder climates or during the winter.
In some cases, elimination of environmental causes, such as dust mites, and certain foods that cause allergic reactions, such as eggs, soy, or peanuts, may be helpful. There also are many nonprescription methods to keep a mild condition of atopic dermatitis under control. In addition to using over-the-counter creams, which you should apply liberally, especially after a bath or shower, moisturizing soaps may help. An over-the-counter "tar soak," such as Balnetar™ can also help relieve the itching. Take no more than one shower or bath a day, avoiding excessively hot water. When you finish bathing, pat your skin dry instead of rubbing, since rubbing tends to irritate the skin.
If these preventive measures aren't enough, your physician can prescribe anti-inflammatory ointments containing topical steroids. Prescription antihistamines may be used to control itching, and prescription tar creams also are available.
Severe atopic dermatitis is rare. Treatments include phototherapy -- the brief application of ultraviolet light to the affected areas, which reduces itching and inflammation. One method uses a type of energy known as ultraviolet B (UVB), administered three times a week for several weeks. The other method involves taking a drug called psoralen just over an hour before treatments with ultraviolet A (UVA) light. This process, known as PUVA (the P is for psoralen), is used only in the most resistant cases.
Will you find some relief with one of the above treatments? Probably. Most adults with atopic dermatitis fight an ongoing battle with the itching and experience regular flare-ups. But remember, the more you scratch, the more likely you will develop an infection. Then you'll be fighting a battle of a more serious nature.
"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information on atopic dermatitis or other health matters, call 638-6767.