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What exactly is Eczema/Atopic Dermatitis?

The word eczema is used to describe all kinds of red, blistering, oozing, scaly, brownish, thickened, and itching skin conditions. Examples of eczema include dermatitis, allergic contact eczema, seborrheic eczema, and nummular eczema. This pamphlet will describe and discuss a special type of eczema that is called Atopic dermatitis or Atopic eczema.

Atopic Dermatitis or Atopic Eczema

The word “Atopic” describes a group of allergic or associated diseases that often affect several members of a family. These families may have allergies such as hay fever and asthma but also have skin eruptions called Atopic dermatitis. While most people with atopic dermatitis have family members with similar problems, 20% may be the only one in their family bothered by this problem. The disease can occur at any age but is most common in infants to young adults. The skin rash is very itchy and sometimes disfiguring. The condition usually improves in childhood or sometime before the age of 25. About sixty percent of patients have some degree of dermatitis and some suffer throughout life. These cases can cause frustration to both the patient and the physician. When the disease starts in infancy, it’s sometimes called Infantile eczema. This itching, oozing, crusting condition tends to occur mainly on the face and scalp, although spots can appear elsewhere. In attempts to relieve the itching, the child may rub their head and cheeks and other affected areas with a hand, a pillow, or anything within reach. Parents should know that many babies improve before two years of age. Proper treatment can be helpful, sometimes controlling the disease until time solves the problem. If the disease continues or occurs beyond infancy, the skin has less tendency to be red, blistering, oozing and crusting. Instead, the lesions become dry, red to brownish–gray, and the skin may be scaly and thickened. An intense, almost unbearable itching can continue, becoming severe at night. Some patients scratch at their skin until it bleeds and crusts. When this occurs, the skin may become infected. In teens and young adults, the eruptions typically occur on the elbow bends and backs of the knees, ankles and wrists and on the face, neck and upper chest. Although these are the most common sites, any body area may be affected.

Recognizing Atopic Dermatitis

An itching rash as described above, along with a family history of allergies, may indicate atopic dermatitis. Proper, early and regular treatment by a dermatologist can bring relief and also may reduce the severity and duration of the disease. The disease does not always follow the usual pattern. It can appear on the palms or backs of the hands and fingers, or on the feet, where crusting, oozing, thickened areas may last for many years.

Since this condition is associated with allergies, can certain food be the cause? Yes, but only rarely (perhaps 10 per cent). Although some foods may provoke attacks, especially in infants and young children, eliminating them rarely will bring about lasting improvement or a cure. If all else fails, foods such as cow’s milk, soy, eggs, fish, wheat, peanuts and other foods that are suggested by your dermatologist can be avoided at least for one to two weeks on a trial basis.

Are environmental causes important, and should they be eliminated?

Rarely does the elimination of contact or airborne substances bring about lasting relief. Occasionally dust and dust–catching objects like feather pillows, down comforters, kapok pillows and mattresses, carpeting, drapes, some toys, and wool along with other rough fabrics, can cause the condition to worsen.

Are skin tests, like those given for hay fever or asthma, of any value in finding the causes?

Sometimes, but not as a rule. A positive test signals allergy only about 20 per cent of the time. If negative, the test is good evidence against allergy. If these tests are desired, ask your dermatologist to recommend someone who has experience doing them.

Is suffering from regular acne in addition to Rosacea common?

Rosacea and regular acne, called Acne Vulgaris, usually appear separately but some patients can be affected by both. While both conditions in adults are often informally referred to as “Adult Acne”, they are two separate diseases, each requiring different therapy. Acne vulgaris is associated with increased stimulation of the oil glands, resulting in oiliness, blackheads and pimples on the face, and sometimes the back, shoulders or chest.

Rosacea seems to be linked to the vascular network of the facial skin and causes redness, bumps, pimples and other symptoms that rarely go beyond the face. Special care is necessary in treating patients with both conditions because some standard medications for acne vulgaris can make rosacea worse.

I have heard that foods high in histamine may aggravate rosacea. What kinds of foods should I be watching out for?

Histamine is a natural substance produced by the body. It is also found in numerous foods that some rosacea sufferers may find aggravating to their condition. Foods containing histamine include cheeses, fermented foods and beverages such as wines, beer, vermouths, ciders and vinegars, some Oriental foods, processed beef and pork, and canned fish products such as anchovies, tuna, herring, mackerel and sardines.

Persistent, unexplained itching? You may need a test for Hepatitis C.

Many experts are suggesting that people with unexplained itching be tested for the presence of Hepatitis C. Hepatitis C is an infectious disease that causes inflammation of the liver. It is caused by a virus. It is regarded as a “Blood borne” disease which means that it can be acquired as the result of transmission or use of contaminated needles.

Not everyone who carries the virus is sick. Itching is not the only manifestation in the skin of Hepatitis C infection. If an individual is affected with the Hepatitis C virus, this would be important to know. Steps could be taken to improve the Hepatitis C condition and also to enhance longevity by taking steps to ensure that the individual infected with the virus is not exposed to liver damaging substances such as alcohol or certain drugs and medications.

Why is it said “Better wear your sunscreen in the car!”?

Conventional wisdom used to say that glass used in buildings and automobiles filtered most of the ultraviolet light that could damage the skin. Now researchers aren’t so sure. The windshield of the car provides the most protection reducing exposure to UVB (the wave length in sun light that causes sunburn and skin cancer) to a significant degree as well as protection against ultraviolet A (long wave radiation that causes tanning and premature aging). The other windows provide significantly less protection.

Children are particularly at risk since they ride in the back where the windows provide little protection from ultraviolet radiation. UVB is present in sunlight during the spring and summer months. UVA is present all year long. Special film sheeting can be applied to automobile glass which will effectively filter out most UVA and UVB. The ideal window glass anti–UVA film will filter out the ultraviolet light without compromising visibility through the window.

Attention is now being paid to the possibility of protecting windows in homes and businesses with UV filtering sheets. Because few of us are likely to drop everything and run out and have all of our windows surfaced with protective sheeting, the use of sunscreens, sun blocks and sunglasses are important for anyone exposed to ultraviolet light whether it is coming directly from the sky or through window glass.