More on Acupuncture and Eczema

In an earlier post, I recounted my experience trying acupuncture to reduce eczema symptoms. Reuters has just reported on a study done by German researchers, which found that acupuncture can reduce itchiness if done immediately after exposure to an allergen and that exposure after acupuncture results in a less intense reaction. The researchers compared results when using true acupuncture points to both no treatment and the use of "placebo points," or acupuncture points that are not true points used in Chinese acupuncture. After being exposed to an allergen, those getting the "true points" treatment reported lower levels of itch. The abstract of the study, published in the journal Allergy, is online here.

For those interested in seeing if acupressure on the points would work, the two points used in the study are LI11 and SP10. The former is on the outer side of the elbow crease and the later is roughly above the knee and towards the inside of the leg.

More on nickle allergies

In an earlier post, it was noted that eczema is part of the atopic triad and thus people with atopic dermatitis often also have allergies or asthma. Contact dermatitis --an allergic reaction to something touching your skin--can often be confused with atopic dermatitis. After a round of allergy testing suggested by my dermatologist several years ago, I learned I had a nickel allergy, which was causing reactions that looked like eczema on my neck from the jewelry I was wearing. A devoted reader (full disclosure: the devoted reader is actually my step-dad!), brought to my attention a Wall Street Journal article that said last year, nickel was named the "Allergen of the Year"!

Apparently the number of people with nickel allergies had been growing and people can develop reactions even after years of having no problems with nickel. And it is not just jewelry that can cause problems. It turns out nickel is in some cell phones, leading to rashes on people's ears and faces. Due to the rise in allergies, the EU has actually placed restrictions on its use. If you are allergic to nickel, you can order a kit online to test jewelry and other objects. If it is something you just can't get rid of, coating it with clear nail polish can form a temporary barrier.

Book Review: The Eczema Solution

The Eczema Solution, by Sue Armstrong-Brown, outlines a program to stop scratching and thus heal the skin of chronic atopic eczema sufferers. The approach was developed at the Chelsea and Westminster Hospital. The underlying principle is that if patients can stop scratching, they can reduce their itching, as discussed in an earlier post, and reduce the rash, since this is triggered by the scratch. Severe eczema patients can tell you that even though a good scratch is satisfying in the moment, it simply leads to even more intense itching and much more severe rashing and inflammation of the skin. While this is known in theory, the trick is being able to actually keep your nails off your skin in the face of intense itching.

That's where this book comes in. The author notes that chronic eczema suffers have developed a habit of scratching, even when when they are completely unconscious of the behaivor. This continuous scratching is very damaging to the skin and prevents healing, exacerbating the condition. Each chapter in the book presents exercises that the reader does before moving on to the next chapter. The exercises are designed to break the habit of scratching. At the same time, you continue to use emollients and steroids to treat flare-ups (indeed, the author argues for using steroids for some period even after the skin looks healed.)

Breaking the habit of scratching begins with logging every time you scratch with a hand tally counter. This sounds a bit crazy--and it is. For weeks, I walked around with a little clicker that I had to press each time my hands moved to my skin. This is a truly eye-opening experience. I was scratching hundreds of times a day. The counting exercise really did make me aware of all the unconscious scratching. Once aware of it, you can being to slowly reduce the amount you scratch using some habit-changing exercises presented in the book.

The book is written by someone who has suffered from atopic eczema her entire life: she has coped with the itching, been hopitalized for her eczema more than once, and tried every treatment available. It is comforting to read a book about severe eczema that is written by someone who completely gets it. The one downside is that I personally found that the book over-promises the level of relief to expect from the program. This may be because I had already learned not to scratch hard at the itchy spots or else I'd have to face worse symptoms and devastatingly ugly flare-ups! I think this book could be more profound for those who are not yet able to stop scratching at any level. Learning to control the scratch reflex can improve the look of your skin (and therefore reduce anxiety) and does, to some extent, reduce itching. It does not, however, "cure" the eczema or completely eliminate itching and sleepless nights, as the author promised. But it does help some and is worth a try, at the very least for the awareness it brings about your own unconscious habits.

Some uncommon but potentially useful treatments?

Common treatments for eczema include moisturizers/emollients, steroids, calcineurin inhibitors (Elidel and Protopic), UV treatment, and antihistimines.

Some patients have found some less common treatments and approaches that improve their eczema. Some of these are mentioned by Adnana Nasis in his book, Eczema Free for Life. He cautions that there is not conclusive research on any of these (see his book for more information). Still, when you feel discouraged by traditional approaches try one of these:

• evening primrose oil supplements
• eliminating dust mites
• Chinese medicine
• massage with lotions and emollients that are known not to cause flare-ups
• biofeedback
• Ranitidine (antihistimine)
• salt baths
• oolong tea
• Gloves in a Bottle
  

Eczema and your Emotions

Dr. Nasir, in his book Eczema-Free For Life, discusses the emotional toll that eczema can have on patients. The unpredictability of flare-ups can be stressful, and as all patients know, the itching can be overwhelming and the lack of sleep can cause irritability. Stress also makes eczema worse. Dr. Nasir explains that when you are stressed, your blood vessels attract white blood cells, which cause inflammation. For eczema patients, stress leads to inflammation being triggerd inside and outside the body. Thus, finding ways to combat negative feelings is essential.

The first step is to take control of your eczema. Develop a careful skincare routine and stick to it. Make any lifestyle changes necessary to improve your condition. Learn about your disease. Read some of the great books written about it. Find a dermatologist you like and trust to help you manage your condition.

Second, accept your emotional responses as part of the disease. Dr. Nasir notes that patients may develop self-loathing about the way they look, anger at having to suffer from the condition, fear at facing a life having to cope with unending itching, stress about flare-ups, and also depression when it seems like no treatments help and the suffering has no end in sight. Accepting these emotions instead of suppressing them is critical.

Next, try ways to improve your emotional outlook when your eczema gets you down or angry. Maybe there is music that lifts your spirits or funny movies you enjoy. Make a list of positive things in your life. Perhaps guided meditation tapes or yoga classes can recenter you and take your mind off the eczema. Be kind to yourself. If your anger or depression becomes severe, be sure to find professional help. A professional that can help you improve your mental outlook will also improve your skin.

Finally, develop a support network of friends and family to help you cope. Educate them about eczema and about what you need from them to be able to handle your condition better. Be sure to explain to them the challenges you face in dealing with your eczema. Non-sufferers will not fully understand what it is like to live with the condition. Being clear and honest can be the most effective. Dr. Nasir recommends being able to say things like: "My rash is acting up, I feel uncomfortable and itchy. I'm sorry, I'll have to stay home, but I'd love to talk to you tomorrow."

Also, make sure you get enough sleep. This can really alter your emotional response and thus the condition of your skin. If you are having trouble sleeping, ask your doctor about an antihistamine to make you drowsy.

Can Acupuncture Cure Eczema?

After Western medicine failed to provide sufficient relief for endless itching and sleepless nights, I decided to try acupuncture. I did not know anyone in my city that had tried acupuncture before, so I went on Yelp and read reviews. I found an acupuncturist whose patients all said good things about him and who also had an MD, which made me feel more comfortable. I called his office. Before scheduling an appointment, he asked about what was bothering me. I described the itch and the eczema, and he thought he might be able to help. At his suggestion during the first consultation, I started with appointments twice a week for two weeks, then decreased to once a week for a few weeks, and then spaced it out to between 10 days and 2 weeks between appointments. He also gave me Chinese herbs, but they made me nervous and I ultimately did not take them.

First, the experience of acupuncture.
When I was called to a room, I would lie down on my back on a table that was like a massage table. I had to roll up any sleeves and roll up my pants to my knees so he could access certain points for the needles. My acupuncturist would put needles at my ankles, on the side of my shin just below my knees, right above my knees, in the crease between my thumb and second finger, at my wrist, to the side of the bend in my arm at my elbow, and then sometimes on top of my head and/or on my forehead. Inserting the needles never hurt, maybe just an occasional prick. After all the needles were in, however, he would manipulate them slightly. This could cause a range of sensations from tingling to slight pain - mostly at the site of the needles, but occasionally it would induce a shock of sorts up my arm or leg. He would then leave me lying on the table for 20 to 30 minutes. I would try to relax while I stayed very still. The needles could lead to a variety of sensations. Sometimes the site of the needles would tingle, sometimes it would burn, sometimes I would feel a dull ache. Most times I felt calm when the needles were in and tried to meditate or clear my mind. A couple times, the needles made me feel like I had nervous energy and those times I was more than ready when the doctor came back to take out the needles.

Did it help?
While the needles were in and I was lying on the table I experienced no itching (except, every so often, on the side of my nose). This was absolutely astonishing and marvelous. I think it is the only time in my life where I have been perfectly still, focusing on my skin, and actually NOT itched (even when I was on strong oral steroids my dermatologist claimed would get rid of the itch, they did no such thing). I loved going just for these few minutes of relief. After the needles came out, though, the results were more mixed. I think in general it probably did relive my itching somewhat, in the days after the treatment, but it certainly did not eliminate it. After the first two sessions I was still having trouble sleeping because the itch was so bad. I mentioned this to him and he added 3 new points to the treatment, 2 sort-of below and to the side of my ears that he did on both sides and one on my stomach. The first time after this, I was immediately very tired. I was glad it was an end-of-day session! The next few times did not have such a drastic effect, and I started going in the morning, but my sleep did noticeably improve.

The End Result
If acupuncture was free and acupuncturists made house calls, I'd have it done every night before sleep. It relieved the itching during the treatment and then left me relaxed (and actually tired when certain points were used). But, the treatments aren't free and my insurance did not cover them so it was a large out-of-pocket expense every month and when I had them in the morning, the effect was much reduced by the end of the day. So I have stopped going. But I am still very glad I tried it and I know it is there if I ever want to resume. There is also a physiological benefit to knowing that there is something that does relieve itch, even it costs $100 for 30 minutes and requires lying totally still with needles in you!

Recession Induced Flare-ups?

Most eczema patients will tell you that stress exacerbates their itching, scratching, and rash. I just came across an interesting news blurb that reports on recent research that claims the recession and the stress it causes has led to an increase in skin diseases like eczema. Apparently lots of people are suffering from economic anxiety induced flare-ups. In times of stress, be extra vigilant about maintaining good skin care routines and try hard not to unconsciously scratch as this breaks the skin and leads to the itch-scratch cycle. Common stress reduction techniques can help these types of flare-ups (just avoid other triggers, like scented bath oils or long hot showers!). Try:

• meditation tapes
• deep breathing
• focusing on things you are grateful for
• happy music
• quiet walks
• funny movies
• exercise (but shower off sweat quickly and apply moisturizers!)
• find support in friends and family
• biofeedback
• get enough sleep
  

Ceramides: A New Treatment?

I've recently tried a new product: CeraVe. It is a cream that contains ceramides. Ceramides are a type of lipid that are present in the top layer of the skin. People with eczema have less ceramides in their skin. They also have less cholesterol and free fatty acids. All three are essential to maintain the barrier function of the outermost layer of the skin by maintaining moisture.

I like CeraVe and I do think it has helped my skin a little, but not dramatically. That said, I have not used it consistently for an extended period of time. A study discussed on the American Academy of dermatology website found that use of creams with lipids twice daily for 4 weeks resulted in improvements in skin lesions, itching, and sleep.

Book Review: Tell Me more About Atopic Eczema

Tell Me More About Atopic Eczema
by John Berth-Jones and B. Roger Allen

Tell Me More About Atopic Eczema is a very user-friendly book. It can be read in one sitting. The text is easy to follow and there are helpful pictures and diagrams throughout. It is a great introduction to the subject but probably does not offer much new information to patients who have been reading about their condition for years. It does, however, provide a nice summary of information in one handy text.

The book begins with an overview of atopic eczema. The authors differentiate it from other types of eczema, discuss how it is diagnosed, and cover genetic and environmental causes/triggers. They then spend five sections on treatments, discussing emollients, steroids, tar, bandages, ultraviolet light, antihistamines, and systemic drugs for very severe cases. The authors address a few complications, including skin infections, and conclude with a section on "living with eczema." This section includes the traditional suggestions of not overheating your home in winter, avoiding triggers like dust mites, using soap substitutes, applying emollients after showering, and wearing light, cotton clothes.

Back to School Eczema Strategies

As the weather turns colder and kids head back to school, here are some tips for keeping eczema under control.

Cold Weather Troubles
The good news about cool weather is that itching is often less severe when it is cooler. But cold weather most often brings with it more troubles than relief for eczema patients. Moisture leaves the skin more rapidly, leading to dryness and irritation. Because of this, as fall approaches, be sure to moisturize often. Bring lotion and emollients to work and school and apply them regularly.

When the heaters kick on, this can be very drying to your skin. Running humidifiers through the winter can help or consider having one installed on your heater. Try bringing a small humidifier to the office if at all possible. Also, try not to overheat your home. An extra sweatshirt will be much nicer on your skin than another degree on your thermostat. And again, use lots of moisturizers!

Eczema-free Fashion
Winter clothing can also be trouble for eczema. Wool, for instance, causes flare-ups in many patients. It took me awhile to realize I was having this reaction to wool, but now that I have eliminated it from my wardrobe, it has reduced the number of flare-ups I get in the winter. Tighter, warm clothing can also lead to flare-ups. Try to wear loose cotton clothes whenever possible...even if this is just when you are at home!

Hair dryers can also be drying, not just for your scalp, but your hands and neck, as well. This can again irritate eczema. Try to minimize use and keep the heat away from your skin as much as possible. Certain shampoos and conditioners, such as Free & Clear are unlikely to have irritants. And DHS zinc shampoo has helped my itchy scalp before.

Sports and Your Skin
Back-to-school often means the start of fall sports. Sweat aggregates many eczema patients. Try to wipe of excess sweat and shower as soon as possible after work-outs. Immediately out of the shower, apply emollients. Drinking lots of water may also help hydrate your skin and reduce flare-ups. Try to exercise in cotton clothes that do not rub and irritate your skin anywhere. And if playing on a grassy field, try to avoid sitting stretches on the grass if the grass is a trigger for you, as it is for me.

More Strategies for Combatting Itching...Besides Scratching!

• Instead of scratching, press firmly on the itchy area for 30 seconds
• Lotions with menthol
• Wrap a washcloth around ice and hold on the itchy area
• Oatmeal baths
• Gold Bond Medicated Powder
• Apply a cool, damp cloth to the itchy area
• Lotion, lots of lotion
• Anti-histamines
• Calamine lotion
• Cortizone creams
• Lightly rub your fingertips over the itchy area - don't use your nails
• Vicks
• Watch TV - get your mind off it!
• Take a cool shower, pat yourself dry, apply moisturizers and emollients
• Sit in the sun

Keep Your Hands Busy

Since scratching can make itching worse (see this earlier post and an even earlier one), it is important for eczema patients to try and keep their nails away from their skin. This is hard enough when one is conscious of the itch and the scratch impulse but eczema sufferers often scratch without even realizing it. One way to help limit this type of scratching is to take up another activity with your hands when they would otherwise be idle. For instance, try squeezing a ball while thinking in front of the computer or knitting while watching TV. Activities like this that keep your hands busy can also keep them off your skin, which will ultimately reduce the rash and itching.

More Itch Research and A Few Home Remedies

The Independent recently reported on itch research from Washington University in my hometown of St. Louis. Apparently, it was previously thought that itch was simply a milder form of pain, but the Wash U research shows that itch and pain are conducted on separate nerve pathways. We can all hope that this will lead to drugs that can target and eliminate constant itching. But they suggest such treatments are decades away.

The article also offered some home remedies for relieving itching. Those that seemed potentially useful were rubbing ice on the area or a cold compress (the numbing from the cold can help, I've tried it), rubbing crushed mint leaves on the area (if it doesn't cause irritation, this might be similar to the benefit from menthol in lotions), oat baths, and calamine lotion (I've never seen calamine discussed for eczema, but it is recommended for the itch from poison ivy, so might be worth a shot).

Good Skin Care Routines

• Use lotions and emollients -- lots of them!
• Avoid hot showers. They feel good while you're in them, but then dry your skin out, making the eczema worse.
• But do shower off dirt, sweat, and irritants that can cause flare-ups.
  
• Avoid rubbing you skin with washcloths and avoid excess use of soap.
• Avoid very alkaline soaps. I use Dove Sensitive Skin, which seems to be okay.
• If you can avoid soap, and use a cleanser, such as Cetaphil,
  
• Put lotion on immediately after showering, bathing, or swimming.
• Lukewarm baths may be better on your skin than showers.
• Oatmeal baths help soothe itching for some patients.
• Do not use lotions with artificial dyes or perfumes. Many also contain alcohol, which is drying. I have Lubriderm Sensitive Skin works for me.
• Wear loose, cotton clothing.
• Avoid triggers.
• Run a humidifier in the winter.

Why You Shouldn't Scratch

"The more you scratch, the more itch nerve receptors you'll have in that area. The release of nerve growth factors from damaged nerves makes the skin more sensitive to itch and more itchy for less reason. If scratched enough, itch trigger substances can become embedded in the nerves, causing persistent burning and itching."
- Dr. Adnan Nasir, Eczema-Free For Life

DIY UV therapy?

The New York Times last week cautioned eczema sufferers against trying to do UV therapy yourself at a tanning salon instead of under the care of a doctor since tanning beds carry with them a risk of cancer. Apparently, the UV rays administered by a doctor are UVB and those in most tanning beds are UVA, which are thought to be more dangerous.

Unfortunately, phototherapy from a doctor may not be covered by insurance and/or getting to a hospital or doctor's office as frequently as needed may be inconvienent or just not possible. So many eczema patients turn to tanning beds.

I have tried doctor-administered phototherapy myself during the winter, when it is difficult to get UV rays the old-fashioned way by sitting outside. While it didn't eliminate my symptoms, it may have reduced them slightly. In the end, I decided the co-pays and constant shuttling to the hospital were not worth it. That said, in late spring and early fall and some summer days, when it is possible to soak up some sun but also not get very sweaty (which aggrevates my eczema), I can feel the improvement in the itch and the rash. But I have learned the hard way to be very careful about sun exposure. I got burned on my back a couple months ago and not only was it a bit painful, it triggered a bad flare-up as my skin peeled and new skin came in. Not helpful!

Avoiding Triggers

People with eczema are overly sensitive to anything that triggers itching. Identifying what triggers itching and flare-ups of the rash is important for any eczema patient. Once identified, avoidance is the best policy. The things I have found that trigger my eczema are: wool, grass, dust, pets, hot showers, dry air, and sweat. Certain soaps, lotions, shampoos, and detergents have also triggered itch for me. Right now I use Dove Sensitive Skin soap, Tide Free and Clear detergent, Lubriderm Sensitive Skin lotion, and generic brand Vaseline. I've found these do not bother my skin.

Eczema sufferers can also interpret sensations as itch that others would not. Hair brushing across your face, for instance, may make someone with eczema itch when it is unlikely to make someone without eczema itch. Mild pain can also be interpreted as itch by eczema patients.

Itch Survey

A study published in the British Journal of Dermatology this year (160: 642-644) reports on a "characteristics of itch" survey. The survey was available on the National Eczema Association for Science and Education website. 304 eczema-suffers answered.

They asked patients how many times a day they itch. 91% said at least once a day, 68% said at least 5 times a day, and 38.3% said more than 10 times a day.

Not surprisingly, respondents reported experiencing itch more frequently at night, in the evening, and in the winter.

Over half of respondents reported feeling pain and heat with itch.

A quarter of respondents reported itching with sweat.

New York Times Interview with Dr. Gil Yosipovitch

The New York Times has an interview with Dr. Gil Yosipovitch, a dermatologist at Wake Forest University who studies itch.

He is very understanding of the chronic itch associated with eczema, which is comforting for anyone who suffers from pruritus (techincal word for intense itching). Interestingly, he notes that the number one cause of itching is eczema. But he says that only 10% of eczema patients have severe itch. This may explain why I've seen several dermatologists who are very dismissive of the persistant itch and how disruptive to you life it can be. It is nice to see someone who understands how terrible it is!

He discusses how scratching can make the itch worse, leading to terrible itch-scratch cycle:
"So, now we can understand that brain-wise, it could feel like scratching helps for a couple of hours. But in chronic eczema the more you scratch, the more you damage the upper layers of the skin barrier, the protective layer. And the more you damage it, the nerve fibers are — I would call them wacky, they are not functioning as they are supposed to. They become overactivated, so that scratching actually intensifies the perception of itch, causing more itch. So that can explain why we have that itch-scratch cycle."

On treatments, he notes that the use of steriods can be essential for eczema patients and that anti-histimines at night can have a sedating effect to help patients sleep. He mentions new reasearch they may lead to anti-itch medications but they appear many years off still -- sadly for those of us suffering now.

Staph Infections

Eczema patients have been found to suffer from staph (staphylococcal bacteria) infections on the skin more than others.

Eczema patients do not make enough antibacterial proteins called magainins. These proteins kill bacteria in the skin but those of us with eczema are in short supply. Staph infections will usually manifest themselves as pustules. One type of staph infection that I had several years ago was folliculitis. This is a staph infection in which red pimple-looking bumps appear around the hair follicles. I had them all up and down my legs. I know, gross.

Treatment: If you have a staph infection go to your doctor immediately for antibiotics. Oral antibiotics cleared up my folliculitis in a couple days (for more of folliculitis from the Mayo clinic, click here). Oral antibiotics, though, are only given for severe infections since they can also build up resistence. The doctor also told me to wash with an antibacterial soap in the shower. Usually, eczema patients are told to avoid harsh soaps since they can be very drying, but when staph is getting out of control, it is best to use them. For less severe outbreaks, topical antibiotics can be used. One that my doctor has given me is a cream called Mupirocin. When I get a postule that appears to be infected, I just put some of this on right away.

Prevention: Since eczema patients have more staph on them than others, when an eczema patient gets a cut or scrape, it is best to wash with soapy water quickly to prevent the spread of staph. And keep cleaning it regularly. Also, use emollients often because staph likes dry skin better than well-moisturized skin.

More on Your Skin

Nasir's book Eczema-Free For Life provides some insight on how the skin of eczema patients is different from those who do not suffer from the itch that rashes.

Your skin is made up of three layers: epidermis (this is what itches and flares), the dermis (where blood vessels, glands, and hair follicles are), and the subcutis (fat layer with blood vessels).

New cells in the epidermis push older ones out and off. This is an ongoing cycle. When the older cells are pushed to the top of the skin, they form a layer called the cornified envelope. As Nasir notes, in eczema patients, this layer does not have as many lipids as in non-eczema people. This lack of lipids leads the the epidermis to dry out and crack. Irritants can enter the skin through the cracks, causing flare-ups. Essentially, the barrier function of the skin has broken down.

This is why emollients like Vaseline are great for those with eczema. The Vaseline provides needed moisture and also acts as a barrier over the cracks to prevent irritants from entering the skin.

Vicks? Really?

I got a tip that Vicks Vapo Rub can really take away an itch. To a certain extent, it's true! For itches that are very localized (for me that usually means associated with a rashy spot) as opposed to that all-over, crawling itch that eczema patients can get, Vicks does provide some relief. It is also less useful when you have many, many spots. But it is still a good tool to have in the fight against itch.
Rub a generous amount over the itchy area, and the menthol, camphor, and eucalypus can sometimes overwhelm the itch. The itch is replaced with a mildly pleasant cool, tingling sensation. This can help curb the scratching, which really does then reduce the itch as it breaks the itch-scratch-itch cycle. It is also useful if there is one or two itchy spots that are keeping you awake a night. Usually the cool tingling keeps the itch down long enough to fall asleep. The downside to using Vicks is that is not the most pleasant perfume. When I put it on, my husband can smell me coming, saying "itching again?"

Sleepless Nights

The persistent itching from eczema can lead to many sleepless nights. Sometimes the itch seems worse at night than during the day. This could be because the mind has nothing else to occupy itself with while lying in bed and focuses on the itch. Research has found, though, that cortisol levels are lowest while sleeping and that low cortisol levels is associated with more inflammation. So there might be more to nighttime itching than just a mind focused on the discomfort.

I remember reading somewhere that eczema patients often get an hour to two less sleep a night due to inability to fall asleep and waking up in the night from the itching. Lack of sleep can make you irritable and lead to frustration and anxiety -- I know, I've been there. And lack of sleep can make the itching and the flare-ups even worse. So finding ways to get a good night's sleep are especially important for eczema patients.

I've found the best way to try and get sleep is to take an anti-histamine before bed. I haven't found the anti-histamine to do anything for the itch, but some make me really drowsy - enough to fall asleep despite the itch. I used to take over-the-counter benadryl but often the itch would outmatch any drowsiness induced by the benadryl. My doctor then prescribed hydroxyzine HCL in 25 mg tablets. One tablet can put me to sleep on most nights despite chronic itch. It does make me groggy in the morning, but I much prefer grogginess and 8 hours of sleep to tossing and turning and scratching all night.

Atopic Triad

Eczema is part of what is often called the atopic triad of eczema, allergies (rhinitis), and asthma. Patients often suffer from more than one of these or they may run in families. They are all characterized to some extent by the immune system reacting to things that it shouldn't - or doesn't in non-atopic people.

At a time of a serious flare of my eczema I underwent comprehensive allergy testing. My dermatologist wanted to make sure that contact allergies were not making my eczema worse. I found out that I had a number of allergies that gave me hives or triggered my eczema. A big one was nickel. What I had thought was eczema around my neck was actually an allergy to several necklaces I had that were made of nickel. I now have a nickel testing kit to avoid exposure. I also discovered a serious allergy to dust mites and have dust mite-proofed my home. This has had no noticeable effect on my eczema, however.

I have also always suffered from rhinitis and as I paid attention, I have noticed that some things I am allergic to also trigger my eczema. Cats, for instance, and grass. After being around cats or sitting in the grass I am very likely to have a bad flare-up. Other allergies cause a runny nose but no change in my eczema. I think it just takes a lot of time paying attention to what you are exposed to and how your body reacts. Once you notice patterns that lead to flare-ups, you can start to avoid those triggers.

Eczema on your eyes?

A couple years ago, I had trouble with eye irritation. My eyes would itch. When it was very severe, they would feel like there was something in my eye that would not come out. It could get so bad that I would have to lie down with a cold washcloth on my eyes for long stretches at a time. After weeks of suffering with these symptoms, I went to see an eye doctor. He was certain it was not an infection and gave me antihistamine drops. We tried two types of antihistamine drops that did little good. Then he prescribed me Alocril - that solved the problem. They are bright yellow drops. A couple in each eye twice and day and symptoms went away.

I learned later from Nasir's book that eczema can inflame the conjunctiva. The conjunctiva is tissue covering the eyeball. When inflamed, it feels like there is something in your eye. This could be what I was experiencing. If it happens to you, ask for Alocril.

Treatment: Ointment

Ointments -- my husband fondly calls them goop -- are an eczema patient's best friend. I just use Vaseline and apply it liberally morning, noon, and night.

Some patients may dislike ointments because they leave you feeling sticky. They can then also get on sheets, clothes, or furniture. Ointments do wash off in the laundry but will stand out on fabrics as discoloration until they are washed. I find that applying them liberally and then putting on cotton pants and a long sleeve cotton shirt for protection is very helpful for my skin. Doing this as a bedtime routine can be a good alternative for those who do not want to be sticky during the day.

Why are ointments good?
Patients with eczema get tiny cracks in their skin. These cracks let irritants into the skin and moisture out. Nasir, author of Eczema-Free for Life, calls this "leaky skin." Ointments are doubly good because they keep moisture in and keep irritants out. Use them often!

Book Review: Eczema-Free for Life

Eczema-Free for Life
Adnan Nasir, M.D.

In Eczema-Free for Life, Nasir comments that eczema is not an allergy or a disease but a vulnerability. In this readable and informative book, he explains to the reader exactly what this means. The first section of the book covers diagnosis, management of the condition, physiology and genetics, and the itch-scratch cycle. The next two sections of the book are divided into chapters for adults living with eczema and chapters for parents of children living with eczema. In each of these two sections, Nasir covers daily routines, preventing flare-ups, and dealing with the emotional toll living with eczema can have on patients and their families.

I would highly recommend this book to anyone suffering from eczema or for those who have loved ones suffering from eczema. Nasir clearly describes what eczema is and how to best manage it. He is keenly aware of the impact eczema can have on one's life and offers empathetic suggestions for coping.

The book is available at Amazon.

What is eczema?

Eczema, also called atopic dermatitis, refers to skin conditions characterized by dry skin, rash, and persistent itch. It can affect people of all ages. Eczema has been called the itch that rashes, because the persistent itch leads to scratching, which causes the rash. Eczema is a terrible cycle of itch and scratch that is difficult to break.

Why so dry?
In patients with eczema, the skin loses its moisture rapidly, causing chronic dry skin. Lipids hold skin cells together. As discussed in Your Guide to Eczema by Sarah Wakelin, in some patients with eczema, not enough lipids are produced, leading skin cells to dry out and be lost more easily. This makes the barrier layer of the skin thinner and thus even more likely to dry out and crack. The cracks can let irritants into the skin, exacerbating the eczema.

Further, eczema patients do not produce enough of the oils made by the sebaceous glands. This also leads to very dry skin.

Why so rashy?
The dermis is the deeper layer of the skin. In the dermis are many blood vessels. White blood cells that fight infection come to the skin through these vessels. In patients with eczema, the natural barrier function of the skin has broken down. This allows irritants to enter the skin, which trigger more white blood cells being sent to the skin. These white blood cells trigger inflammation, releasing antibodies and cytokines to fight off bacteria or infections, even when they don't need to be fighting. Steroids are anti-inflammatory drugs to help limit this response.

Why so itchy?
When the white blood cells get to work in the cell, they can trigger nerve endings in the skin, causing the sensation of itch.