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  Eczema: The Itch That Rashes

Eczema: The Itch That Rashes

By Ronald B. Vender MD FRCPC

Eczema, also known as atopic dermatitis, is an intense itch that can lead to insomnia, irritability and stress. When you scratch, it aggravates the rash and creates an itch-scratch-rash cycle that can lead to a thickening and roughness of the skin (lichenification), dryness (xerosis) and occasionally a secondary infection.

It could be eczema if:

  • Your itch seems never-ending (chronic)
  • It affects an infant or child (although it affects all ages)
  • You have a personal or family history of "atopy" which is a combination of the following three conditions: asthma, hayfever or allergic rhinitis and eczema.

Common locations of eczema include:

  • The backs of arm, front of legs and faces of children
  • The inner folds of arms, back of knees and neck folds of adults.

What to do about your eczema:

  1. Educate yourself about your condition so that you understand the nature of the disease. There are many websites and support groups that provide an extensive amount of information to help you.
  2. Don't scratch or rub - this only irritates the skin and can lead to other side-effects.
  3. Avoid irritants that may trigger the itch-scratch cycle. Common irritants to avoid may include: harsh soaps, wool clothing, labels on clothing collars or waistbands, pet soaps or shampoos, frequent hand washing or wet work, sweating, exercise, hot or cold weather.
  4. Have a patch test. Sometimes allergies may exacerbate eczema so having a special type of skin allergy test performed by dermatologists may determine what you are allergic to. Common allergans that you may want to avoid include metals such as nickel and chrome, perfumed products, preservatives in certain moisturizers or cleansers, lanolin, and rubber or latex products.
  5. Watch what you eat. Sometimes, but rarely, a food allergy can exacerbate your eczema. Foods most frequently implicated in food-allergic reactions in children are cow's milk, eggs, peanuts, soy, wheat, tree nuts, fish and shellfish.
  6. Manage the itch. Repeated use of moisturizers, antihistamines, gentle soaps or non-soap cleansers and prescription creams or ointments can help. See Mild for more information.
  7. Mange the dryness. You can help prevent the dryness hydrating your skin with oilated baths or baths with oatmeal powder, then apply an unscented moisturizer to restore the skin barrier function.
  8. Ask your doctor about medications like:

    -   Topical corticosteroids are used to control inflammation and itch
    -   Topical and oral antibiotics eliminate secondary bacterial infection that can be associated with severe cases or flares of moderate cases
    -   Phototherapy including ultraviolet B, or psoralen plus UVA (PUVA) can also be valuable as a steroid-sparing option.

  9. -   Systemic corticosteroids are highly effective in controlling eczema, but should be avoided except in rare instances of severe cases for only short courses
    -   Other therapies include leukotriene inhibitors such as zafirlukast and montelukast
    -   New therapies include topical immunomodulators (calcineurin inhibitors) such as tacrolimus ointment and pimecrolimus cream

About the author:
Dr. Ronald Vender is affiliated with Hamilton Health Sciences Corporation. He is Associate Clinical Professor of Medicine in the Department of Dermatology at McMaster University. He is also Active Staff and Head of the Service of Dermatology at St. Joseph's Hospital, Department of Medicine.