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U n d e r s t a n d i n g e c z e m a a n d w h a t yo u c a n d o a b o u t i t
Introduction
This book, along with the web site www.eczemacanada.ca, is a part of
the Eczema Awareness, Support and Education (EASE) Program, which
provides free educational resources to help patients understand eczema
better. Developed in collaboration with leading Canadian dermatologists,
these resources will help teach you about current therapies as well as new
treatments that could make a difference to your skin. You will gain a better
understanding of the chronic nature of eczema, as well as tips to help you
manage your skin on a daily basis, so you can take control of your eczema
– right now!
Introduc ti o n
If you think you have eczema or if your current treatment does not seem
to be helping, the first step is to get a correct diagnosis. See your doctor;
if a referral to a dermatologist is necessary, your family physician can help
you get one. Once you know what type of eczema you have, you and your
doctor can choose the treatment that is right for you.
•
But there is hope.
•
Eczema can be very different for everyone who has it. Yet no matter how
severe your eczema, everyone shares the same basic symptoms: dry skin,
terrible itching, and rashes. lf you or your child has eczema, then you know
all too well the frustration and discomfort these symptoms can cause.
Because there is no cure, it can be a life-long struggle to keep eczema 'flareups' under control and a daily challenge to manage the dry, itchy skin.
Often, people suffering from eczema do not really understand the disease
or how to manage their condition. Some people have even stopped seeing
their doctor because they are frustrated with their current treatment.
Contents
• What is eczema? .................................................. 4
The itch-scratch-rash cycle .............................................. 5
Eczema and your skin .................................................... 5
Eczema and the immune system ...................................... 6
How is eczema diagnosed? ............................................. 6
Eczema 'flare-ups' ......................................................... 7
Myths and facts about eczema ........................................ 8
What triggers your eczema? ........................................... 10
• Managing childhood eczema ............................. 12
Learn your child’s eczema triggers ...................................
How can I stop my child from scratching? ..........................
Tips to help manage your child’s eczema ...........................
Managing your child’s eczema at school ............................
Tips for managing eczema at school .................................
Answers to common questions. ......................................
12
12
13
14
15
16
• Managing adult eczema ......................................18
Moisturizers ..............................................................
Bathing and showering ................................................
The itch ....................................................................
Know your triggers ......................................................
Clothes, towels, and bedding .........................................
Make-up ..................................................................
Soap and perfume ......................................................
Stress ......................................................................
Medication ................................................................
Tips to manage your eczema ..........................................
How to talk with others about your eczema ........................
18
19
19
19
20
20
20
20
21
21
21
Antibiotics .........................................................................
Antihistamines ....................................................................
Coal tar preparations .............................................................
Herbal remedies, alternative treatments .....................................
Phototherapy .....................................................................
Topical Calcineurin Inhibitors ..............................................
Cortisone creams .................................................................
Treatment progress chart .......................................................
22
22
23
23
24
24
25
26
•
• How is eczema treated? ............................................... 22
Contents
• Resources and support ................................................ 28
•
Books ............................................................................... 28
Web resources .................................................................... 29
Notes ............................................................................... 30
What is eczema?
Although we often associate eczema with only one type of skin
condition, it really describes a whole group of skin problems that
can affect anyone, at any age. There are a number of different types
of eczema that can look very similar to each other, but are not the
same. Each different type of eczema requires a different kind of
treatment.
Atopic dermatitis is only one kind of these
skin conditions, but because it is the most
common, it is usually just called 'eczema'. In
this book, eczema will be used to describe
atopic dermatitis.
Eczema =
Atopic
Dermatitis
Eczema is a chronic, recurring and long-term inflammation of the
skin. Although the exact cause of eczema is unknown, it’s believed
to run in families. At its most severe, eczema can cause serious
health problems and profoundly affect daily life. And while eczema
can sometimes look unpleasant and can feel very uncomfortable it is
not contagious. So you can’t give it to
someone by touching him or her or
Eczema comes from
wearing their clothes or sitting next
the Greek word for
to them.
'weeping skin', which
aptly describes the
Most often eczema begins in childhood,
moist, red areas that
before five years of age, and although
usually appear on
some children may eventually outgrow
the skin.
their eczema, they usually battle dry,
irritable skin their whole lives. Asthma
and hay fever often accompany eczema. Around the world, eczema
affects about 10-15% of adults and 12-25% of all children. Men and
women are affected equally by the disease, but women tend to
experience more severe symptoms. City dwellers and people
living in low-humidity climates seem to be at a greater risk for
developing eczema. Over the past few decades, the number of
cases of childhood eczema has increased significantly.
The itch-scratch-rash cycle
Wh at is eczema?
Some research suggests that people who have this disease appear to have
a reduced threshold for the itch sensation. This means that when your
skin gets itchy, it’s very hard to resist the urge
to scratch. But when you scratch, your skin
becomes inflamed to protect itself.
•
The constant itch makes eczema very different from any other skin condition. lt’s often called the 'itch that rashes' rather than the 'rash that itches'.
This itch can lead to a lot of scratching which causes a red rash to appear.
Sometimes it becomes a completely unconscious habit and you are not
even aware you are scratching.
This inflammation causes the skin to
itch more, which makes it even harder
to resist scratching. This vicious circle
(known as the itch-scratch-rash
cycle) can become so severe that
it causes sleeplessness, irritability,
stress, thickening skin, and pain.
Your skin is quite amazing. It’s the largest
organ of your body; it’s flexible, relatively
waterproof, keeps you warm or cool, and
protects you from tiny organisms and infections.
•
Eczema and your skin
Normal skin usually takes care of itself without
causing us too much trouble. Unfortunately,
skin affected by eczema is often dry and
cracked and the protective outer layer of skin
is damaged. As a result, your skin loses a lot
of water. This water loss interferes with the
natural healing process of your skin.
Eczema and the immune system
Our immune system is very complex and it works very hard to protect
us. A major part of our immune system is the white blood cells
that help defend the body against various foreign invaders
or microorganisms. When they are set into action they release
substances that cause inflammation. This inflammation causes
redness to appear and releases other substances that can cause
itching.
Scratching damages your skin, causing more inflammatory
substances to be produced that in turn causes more white blood
cells to respond to this reaction. This increases the redness and
itching, which makes it harder to resist scratching.
This process is known as the itch-scratch-rash cycle and it can become
so severe that it causes sleeplessness, irritability, stress, thickening
skin, and intense pain. Scratching can tear or scrape the skin, causing
it to bleed and ooze, allowing bacteria to enter which can cause
secondary infections to develop.
Generally, treatments like cortisone creams and antihistamines
work to relieve the symptoms of eczema once they have already
appeared. Recently a new treatment became available in Canada
that doctors are considering an advance in eczema therapy. This
treatment appears to prevent the release of the inflammatory
substances that cause the red, itchy skin associated with eczema.
This new treatment works to calm and control the skin’s reaction.
Talk with your doctor for more information about eczema treatments.
How is eczema diagnosed?
Your doctor cannot diagnose eczema by a blood test, urine sample,
or by any other laboratory tests. The only way to tell if you have
eczema is by having a physical examination.
Your doctor may ask if:
• You have a family history of allergic diseases such as hay fever or asthma.
It is not unusual for people suffering from eczema to have asthma or
hay fever, or have a close relative with eczema, asthma, or hay fever.
• You have trouble sleeping or concentrating because of pain or itchiness.
• Your skin condition comes and goes or is always present somewhere
• You have a rash in the folds of your elbows, behind your knees, on the
•
on your body.
Wh at is eczema?
fronts of your ankles, on your hands, wrists, or neck.
Mild Eczema
Moderate Eczema
Severe Eczema
•
• You have frequent skin infections.
The signs and symptoms of eczema vary from person to person and can
range from mild - where skin is dry, hot and itchy – to its most severe,
when the skin becomes broken, sore, and bleeding.
Eczema 'flare-ups'
Eczema symptoms come and go. At times, the symptoms can become
more severe. Alternatively, the rash and itching can completely disappear
for a long time. However, when symptoms suddenly reappear or become
worse, it’s called a 'flare-up'.
A number of different factors seem
to trigger eczema 'flare-ups'. They
can happen when your skin comes
in contact with irritants like soap,
detergents, abrasive clothing (e.g.
wool or synthetic fibers), perfume,
carpet fibers, or dust. Overheating,
excessive sweating or low humidity
can also trigger a 'flare-up'.
The chart found on pages 10 and 11 can help you identify irritants
that may trigger your eczema and cause 'flare-ups'.
Myths and facts about eczema
Unfortunately, there are a lot of misconceptions about eczema.
It’s important that you understand your condition so that you can
help others understand it as well. Here are a few common myths
about eczema and the truth about each one.
• Eczema is just like acne.
Eczema is not like acne – they are completely different conditions.
However, it is true that some medications may cause acne and
complicate your eczema. Talk to your doctor, as there are different
medications that may help.
• Eczema is caused by an emotional disorder.
Although doctors did at one time
believe that eczema was caused by
an emotional disorder, we now know
that emotional factors, like stress,
do not cause eczema, but, can make
the eczema worse. There are techniques that can help you manage
the stress, anxiety, anger, or frustration
that can lead to increased instances
of eczema 'flare-ups'.
• You can 'catch' eczema from someone who has the disease.
Eczema is absolutely not contagious. This
means that you can’t 'catch' the disease
from another person and you can’t give it
to someone by touching him or her.
Wh at is eczema?
Most people with eczema can go swimming.
However, some people who have severe
eczema find that the chemicals used in
swimming pools or the salt in sea water
makes their eczema worse, so they choose
not to go in. Make sure that before and after
you go swimming you rinse your skin and
put on a moisturizer.
•
• You can’t go swimming if you have eczema.
• People who have eczema do not wash properly.
Of course this isn’t true.
Generally, no. Although your eczema can be very uncomfortable and
unpleasant, it is very unusual for it to leave any permanent marks on
your skin. However, some conventional treatments can cause skin
discolouration, striae (white, shiny stretch marks), and skin thinning. Talk
to your doctor if you are concerned about any unusual side effects from
your current treatment.
•
• Eczema will leave permanent scars.
• Eczema can be cured with steroids.
Unfortunately, there is no cure for eczema. Although steroids have been
used for a long time to treat eczema, they are not a cure and they do have
limitations for treatment.
What triggers your eczema?
TriGgering factor
Stress
Anger
Frustration
Anxiety
Hot weather
Cold weather
Humidity
Dry weather
Sun
Sweat
Wool
Synthetic fibers
Latex
Rubber
Plastic
Hot baths
Hard water
Chlorinated water
Salt water (oceans,
mineral spas)
10
Yes/No
Eczema symptoms
Eggs
Milk
Wheat
Soy
Seafood
Nuts
Food additives
Citrus fruits
Strawberries
Soaps
Detergents
Lotions, creams
Perfumes
Make-up
Hair shampoos, styling aids,
conditioners
•
Eczema symptoms
Wh at is eczema?
Air-bourne pollutants:
Dust mites
Animal dander
Pollen
Smog/air pollution
Yes/No
•
TriGgering factor
Other:
11
Managing childhood eczema
There are two things you can do to help. The first is preventive; the
second is the day-to-day management of symptoms. Here’s what
you can do to help prevent eczema from becoming worse than it
already is.
Learn your child’s eczema triggers
Contact with irritants such as soap, detergents, abrasive clothing
(e.g. wool and synthetic fibers), carpet, heat, sweat, and low
humidity can trigger itching that leads to 'flare-ups'. The chart
found on pages 10 and 11 will help you keep track of what affects
your child so you can eliminate or manage their effects.
How can I stop my child from scratching?
Scratching is an instinctive reaction to itching, and it is particularly
hard for babies and children to resist the urge to scratch. Unfortunately,
not only does scratching not stop the itching, it aggravates the
skin and makes the condition worse. The skin becomes sore and
inflamed, and eventually cracks and bleeds. It may then become
infected.
You can help by keeping your child’s nails short and by covering
their hands with cotton mittens whenever necessary.
With older children, it’s vital to explain to them how scratching will
make the condition worse, not better. Talk to your child; explain
why it’s important not to scratch.
You may notice your child developing a habit of scratching at a
particular time of day, or during a particular activity, such as watching
television. If so, try to break the habit by making that the time to
apply a moisturizer to relieve the itching.
12
The only effective way to stop a child from scratching is to stop the
itch. There are medications to control the itch. Talk to your doctor
about which treatment is best for your child.
• Keep the skin moist. Even when the rash is not present, one of the most
important things you can do is keep your child’s skin well moisturized.
Moisturizers create a barrier against water loss.
• Keep him/her cool. Use light bedding and loose clothing. Keep the
bedroom somewhat cool in temperature.
• Use cotton clothes and bedding. Sweating can lead to itching, so use
clothes made of soft 'breathable' materials like cotton. Avoid nylon and wool.
• Skin irritants. Some detergents or fabric softeners can remain in clothing
and make eczema worse. Rinse clothing and bedding twice, and try to
stay away from scented fabric softeners.
• Pets. If your child has eczema try to avoid pets – contact with fur and
feathers can irritate the skin.
• Pests. Dust mites, fungus, and mould can irritate eczema. Use special,
Man aging childho o d eczema
Tips to help manage your child’s eczema
•
Bathing: Frequent bathing is essential. Bathe children in lukewarm, not
hot, water. Although there are conflicting opinions regarding the amount
of time a child should remain in the bath, a good rule of thumb seems to
be about 5 to 10 minutes daily, before bedtime. Use mild soaps or soap-free
cleansers. Pat skin dry, then immediately apply a moisturizer to seal in water.
•
Moisturizers: Moisturizers are the single most important aspect of
managing eczema on a day-to-day basis. Sometimes called emollients,
moisturizers are mixtures of oils, fats and water that help to restore the
oil and moisture content of the skin. Use moisturizers regularly on your
child’s skin.
high-powered vacuums and cover mattresses and pillows with allergen/
dust covers. Having hardwood floors and washing bedding frequently
at high temperatures can also help.
13
• Keep fingernails short and clean. If necessary, use cotton gloves
or mittens at night to prevent scratching during sleep.
• Diet. Changes to diet may be effective for some children if food
has been identified as a trigger factor. Follow the advice of your
doctor or dietician.
• Be patient. Eczema is a chronic disease. This means that until a
cure is found, the disease must be managed daily. Find a routine
both you and your child can live with and stick to it. Remember,
you are not alone, and there is support.
• Involve your child in caring for their own skin. It’s important for
your child to feel involved in their own care. It helps them
achieve a sense of control over their disease and feel good
about managing the awful itch.
Managing your child’s eczema at school
14
For some parents, the severity of
their child’s eczema may require
special care at school, as well as at
home. Parents may find it helpful to
involve teachers and administrators in the daily management of the
disease. It is important to remember that eczema can change quite
dramatically in a short period of time and may require treatment or care. Discuss your child’s condition with their teachers
at the beginning of the school year and check in with up-dates
when necessary. The pain and constant itch of eczema can interfere
with school, cause low self-esteem, cause sleeplessness, and make
kids feel self-conscious about their appearance. Some children even
avoid social situations because of how their eczema looks to others.
Unfortunately, children with eczema often endure terrible teasing
from other students because of the way their skin looks. Educating
teachers and students about eczema may help them to better deal
with the disease. Parents may find it helpful to meet and discuss the
child’s eczema with school nurses, teachers and classmates.
Tips for managing eczema at school
• Ask that your child be seated away from sunny windows, air vents, or
• Children may be sensitive about exposing their affected skin. Be sure to
stress that eczema is not contagious and, if possible, educate classmates
and friends about your child’s skin condition.
• Swimming in saltwater or chlorine may irritate the skin. Applying a
moisturizer before swimming and after showering can help.
• School activities that involve paste, paint, clay, food preparation, wood
or metal shop, or outdoor activities may cause irritation. Find alternative
activities your child can do instead, so they won’t feel left out.
• Some foods may make your child’s eczema worse. Inform the school
of any food triggers and make sure your child understands which foods
they should stay away from.
While certain activities such as sports or arts
and crafts may not be possible in severe cases, it’s
important to encourage your child to pursue as
normal a life as their condition permits.
Encourage your child to talk to other children
about their condition, and speak openly
about eczema with other parents and teachers
who have contact with your child.
You can help your child cope with their condition by helping them
understand the importance of a daily routine to keep their eczema under
control. Smaller children and toddlers also benefit from a good skin care
routine and proper treatment.
Man aging childho o d eczema
Sore or cracked skin may also prevent your child from taking part in some
sports. Work with the school’s gym teacher to develop a fitness program
that meets your child’s needs.
•
• If school uniforms are required, ensure that a cotton alternative is acceptable.
• Over-heating from school activities and sports may aggravate eczema.
•
radiators.
15
Answers to common questions
Where does eczema usually appear? What is the incidence?
• The inner creases of the elbows and knees in children.
• The face and neck in babies.
• Up to ¼ of all children may develop eczema.
At what age does childhood eczema occur?
• Childhood eczema usually appears before 5 years of age.
• ¾ of children develop eczema before 6 months of age.
• 80-90% of cases appear by 5 years of age.
Do children grow out of eczema?
• < 50% outgrow eczema by the time they are 6 years old.
• About 6 out of 10 children will have eczema into their teens.
What happens as my child gets older?
• 10-15% of adults maintain their childhood eczema.
• Children and adults, who have outgrown their childhood eczema,
will always have somewhat dry, sensitive skin.
• The eczema may reappear at any time in later life, especially
during times of stress.
Why do some children suffer from eczema?
Eczema is thought to be a hereditary condition, so it tends to run
in families where there is a history of eczema, asthma or hay fever.
About 80% of children born to parents who have a history of
atopic disease (eczema, asthma or hay fever) will also have
eczema. However, it can also affect children in a family where there
is no known history of these conditions. Interestingly, it will not
necessarily affect all the children in a family. If you already have
one child who has eczema, there is a 1 in 4 chance your next child
will have it, though if both parents are affected, the risk is greater.
16
Is a child with eczema likely to suffer from other diseases?
What is asthma?
Asthma is a chronic disease in which airflow in and out of the lungs may
be hindered. Patients with asthma may respond to factors in the environment,
called triggers, which do not affect non-asthmatics. In response to a trigger, an
asthmatic’s airways become narrowed and inflamed, resulting in wheezing
and/or coughing symptoms.
Is it possible to catch eczema?
Eczema is not contagious, so it cannot be passed from one person to
another. If you have one child with eczema and others who do not have it,
they are in no danger of 'catching' it.
Is childhood eczema caused by an allergy?
As we understand eczema today, it has not been proven to be caused by
an allergy. However, children with eczema are often hypersensitive to
allergens such as grass pollen, house dust mites, household pets, and so
on. These may aggravate the eczema and make it 'flare-up'.
Man aging childho o d eczema
Hay fever is the name given to pollen allergy. Other terms for hay fever
include 'seasonal allergic rhinitis' or 'pollinosis'. Symptoms include repeated
and prolonged sneezing, stuffy and watery nose, redness, swelling, and
itchy eyes, nose, throat, and mouth, and itchy ears or other ear problems.
Breathing difficulties at night may occur because the nose may be blocked.
•
What is hay fever?
•
Because eczema is closely related to asthma and hay fever, it is quite common
for children with eczema to suffer from one or both of these conditions. About
40-50% of kids with eczema have asthma, hay fever, or both.
Can certain foods cause childhood eczema?
Although some skin conditions can cause an 'allergic reaction', like hives,
very few children with eczema suffer from food allergies. However, some
foods can trigger an eczema 'flare-up'. Milk, eggs, soy, wheat, and nuts
have been known to aggravate eczema and increase symptoms.
17
Managing adult eczema
For many people, eczema is a life-long struggle to control the
itchy, red, weeping and often times painful condition of their skin.
Although a number of treatments have been successful in managing
the terrible discomfort of eczema, no one treatment has safely or
effectively worked for everyone, every time. Even after your skin
has healed and the eczema has 'disappeared', it is important that
you follow a skin management program. It can help to reduce
‘flare-ups’ and help you control your eczema. There are a number of
things you can do to help control the day-to-day effect of eczema.
Moisturizers
Keeping water in your skin is the best way to manage your eczema.
Eczema causes the outer layer of your skin to lose water more easily
than normal, so it is vitally important to keep your skin moisturized.
You can help your skin retain water by using moisturizers anytime
you feel dry or itchy. Moisturizers are often called emollients and
they generally all work the same way. They provide a surface
barrier which slows down the escape of water from your skin. This
layer also provides a barrier that protects against external irritants
that may cause eczema 'flare-ups'.
Creams, lotions, and ointments all
have different degrees of oil/water
combinations. Creams tend to be
made primarily of water with oil
added. Lotions are watery creams.
Ointments are different from creams
and lotions because they are generally
made of oil alone and are generally
considered to be the most effective
moisturizers. You can help you skin
look and feel better by getting into
the habit of applying moisturizers
after you wash or any time you feel
that your skin needs it.
18
The itch that goes with eczema can be very difficult to tolerate and manage.
Scratching is difficult to resist because it can make you feel better in the shortterm. But, it seems that the more you think about not scratching, the worse
the itch gets. However, there are some practical things you can do.
• Keep cool. Over-heating can trigger the itch. Try to keep your body
temperature as constant as you can, wear light layers of clothes, and
keep your bedroom cool at night.
• Use moisturizers whenever you feel like scratching. Try keeping them in
the fridge, as cool moisturizers can help to soothe the itch.
• Keep your nails short to avoid tearing the skin if you scratch.
• Rub or pinch the area instead of scratching.
• If you absolutely have to scratch, be quick and then apply a moisturizer.
Managin g adult eczema
The itch
•
Bathing and showering helps to hydrate your skin. Soaking in the tub can
be good for your skin because it can help the skin’s outer layer absorb
water and become less dry. Keep the water temperature cool or warm,
not hot. Soak for 5 to 10 minutes then use a soft towel to pat dry without
rubbing. Immediately after drying, apply a moisturizer to your skin to help
seal in the moisture. You can bathe as often as you like, as long as you
use a moisturizer immediately after. Depending on where you live, you
may find that you need to hydrate your skin more or less often. Petroleum
jelly has no moisturizing properties and should only be used after a bath
or shower because it acts as an occlusive agent to seal in water.
•
Bathing and showering
Know your triggers
Managing your environment can be a frustrating and time-consuming job
but certain foods, pollen, air pollution, animal dander, mould, dust and
dust mites have all been linked to eczema 'flare-ups'. If you suspect that
your eczema may be triggered by any of these irritants, talk to your doctor.
19
Clothes, towels, and bedding
Fabrics made of cotton seem to provide the best comfort for
people suffering from eczema. The harshness of synthetic fibers,
wool, hemp, or rough linen can irritate skin and cause a 'flare-up'
of symptoms. Residual detergent, bleach, or fabric softener left on
clothes after washing can also cause itching. Wash clothes in a very
mild detergent and rinse twice.
Make-up
There’s no make-up that is 100% safe to use on your skin if you
have eczema. There are a number of products for sensitive skin;
unfortunately, it’s trial and error to discover which products are
best for you. Ask your health care provider what they recommend,
and you can talk to the staff at the make-up counters. Always test
the product before using it all over. Apply a small amount on
eczema-clear skin - usually under your jaw line is a good place.
Allow the product to remain on the test area for at least 24 hours,
and then check for a reaction. You should avoid putting make-up
onto weeping or very irritated skin.
Soap and perfume
Commercial soaps, hair products, perfumes, scented lotions, or
shaving cream may cause irritation to your skin. Again, there is a
bit of trial and error to discover which products are less irritating
for your skin. It’s best to bathe with a mild soap and use as little as
possible. Non-soap cleansers may be a good alternative, as they
can be less irritating than soaps for some people.
Stress
Eczema 'flare-ups' can occur when you are under stress, feel anxious,
angry, or worried. You can learn to recognize and cope with these
emotions through stress reduction techniques. Changing your
activities to reduce daily stress can also be helpful.
20
Medication
• Don’t scratch, moisturize!
• Follow a daily skin routine, even if there is no visible eczema.
• Bathe and shower often and always moisturize after.
• Keep cool and calm.
• Wear cotton, sleep on cotton.
• Find out what triggers your 'flare-ups'.
• Test it first! Before using any new product on your face or body try it on
a small area of eczema-free skin.
How to talk with others about your eczema
•
• Be patient.
• Follow your doctor’s treatment advice.
Managin g adult eczema
Tips to manage your eczema
•
When your eczema 'flares-up', use the medication prescribed by your doctor. Ask what to expect from the medication and what to do if you don’t
see the results you expect. Make sure you follow-up with your doctor.
It’s important that you follow your doctor’s directions for using the medication and check the label for proper use.
Often, eczema appears on the face or hands, and this is the first thing that
people usually see. Unfortunately, those with no experience with eczema
don’t know anything about the disease and are not always as sensitive as
they should be. Most people just need to be educated about eczema; you
can help your family, friends and co-workers understand your condition
by talking to them about it. Tell them how it affects you, what it is, and
more importantly, what it is not. Show them this book and ask them to
check out the www.eczemacanada.ca website. There are a lot of myths out
there about eczema, and generally, once people understand the disease,
they can be quite understanding and supportive.
21
How is eczema treated?
Unfortunately, there is no cure for eczema. But there is hope, and
there are treatments.
A number of treatments introduced in the past 40 years have come
a long way in managing the terrible discomfort of eczema. These
treatments have worked to manage eczema symptoms once they
have already appeared. However, no one single treatment
works for everyone, every time. There are new treatments available
that work to control the root cause of the eczema before the
symptoms start. These new treatments do not have the same
potential limitations that current treatments have. If you have any
concerns or questions about treatments prescribed for you or your
child, it is important to talk to your doctor.
To help you manage your treatment and monitor your progress, a
Treatment Progress Chart is located at the end of this section for
use with your current treatment.
Antibiotics
Antibiotics should be used to treat the secondary skin infections
that may occur when the skin has been broken from scratching or
dryness. Bacterial infections (e.g. staphylococcal and streptococcal)
are common in the skin of people suffering from eczema.
Cautions: Nausea, diarrhea, and allergic skin rashes are the
most common side effects of antibiotics. It is important to notify
your doctor if any unexpected effects happen.
Antihistamines
These are sometimes prescribed to aid sleep and relieve itching.
However, histamine does not appear to play a major role in the
itching caused by eczema. A doctor should always be consulted
before giving antihistamines to children.
22
Cautions: Overuse can produce excessive sedation. Use only
when absolutely necessary.
Coal tar preparations
Herbal remedies, alternative treatments
Evening primrose oil: A number of studies have looked at the effect of
evening primrose oil in treating eczema. Unfortunately, the results have
not been conclusive – some trials have shown an overall improvement in
the eczema of those patients studied, while others have not.
Cautions: There is no proof that evening primrose oil is of any benefit
to children suffering from eczema. As with all supplements, vitamins, or
herbal remedies, it is best to consult your doctor before you add them to
your child’s treatment. This form of treatment is not suitable for children
with epilepsy.
Alternative treatments: There are a number of alternative treatments that
have been advertised as a 'cure', or which claim to reduce the symptoms
associated with eczema. These remedies are usually herbal, dietary
supplements, over-the-counter creams, lotions or ointments, healing touch
therapies, or homeopathy.
•
Cautions: Coal tar should not be used for acute dermatitis because it
may cause stinging and irritation. As well, folliculitis (inflammation of the
hair follicle) and sensitivity to light have been reported.
How is ec zema treated?
•
Crude coal tar extracts have been used to treat the inflammation and
itch of eczema. Coal tar treatments have a soothing effect on inflamed
skin. Tars contain hundreds of chemicals, most of which have never been
identified, but seem to have a medicinal effect. However, most people shy
away from these preparations because they tend to be messy, timeconsuming, smelly, and inconvenient.
Cautions: These therapies have no data to support many of the claims
they make and are generally not regulated by any governmental agency.
If you are taking anything not prescribed by your doctor for your eczema
be sure to tell your doctor.
23
Phototherapy
Sunlight has been known to have
a beneficial effect on certain skin
disorders. Ultraviolet light waves
found in sunlight were discovered
to be the source of this therapeutic
effect. Phototherapy uses these
ultraviolet light waves for the
treatment of eczema.
Most short course phototherapies like ultraviolet A (UVA), ultraviolet B (UVB), ultraviolet A and B (UVAB), and psoralen plus UVA
(PUVA) have shown to be beneficial for adults with severe atopic
dermatitis. UVAB and PUVA appear to be the most effective.
Cautions: UVB light is the portion of sunlight responsible for
changing skin colour, or tanning. However, with prolonged exposure
there is a risk of sunburn, eye damage, skin cancer, dry skin, freckling
of the skin and premature skin aging. Some patients actually
experience a worsening of their condition when light therapy is
applied. As well, light therapy requires several trips to the doctor’s
office or clinic. This can be time consuming and inconvenient.
Topical Calcineurin Inhibitors
A unique class of therapy has recently been introduced that
appears to target the origin of the inflammation and itching
associated with eczema. These therapies are steroid-free and are
applied directly to the skin. They work very quickly, often within a
few days, to reduce eczema symptoms. They can be used safely on
all parts of the body, including the face and neck.
Cautions: Some patients have reported a mild to moderate
burning sensation on the skin after the ointment is applied, but
any discomfort is usually short-lived and is limited to the area of
application. As with any prescription medication, follow a doctor’s
advice and use only as directed.
24
How is ec zema treated?
Caution: When cortisone creams are correctly used under the supervision
of a doctor, they can be safe and effective for the treatment of eczema.
However, certain side effects have been documented, such as the thinning
of the skin, increased fine hair growth, and skin discolouration. These side
effects are related to the potency of the treatment, where it is being used
on the body, and the condition of the skin. As well, cortisone creams have
been shown to be less effective when used over a long period of time.
There is also a risk that they could be absorbed into the blood through the
skin. In rare instances, this could slow growth in children by suppressing the
adrenal gland. Generally, cortisone creams are only prescribed for short
periods of time. Bear in mind that steroids are only used to control 'flareups' of eczema. It is important not to confuse topical steroids with those
steroids used illegally for body building or those used in the contraceptive
pill; they are completely different.
•
Cortisone creams (steroids that are applied
directly to the skin) are anti-inflammatory
treatments to bring the itch of eczema
under control. They should only be used
under the supervision of a doctor and it is
essential to use the appropriate strength
and quantity as prescribed by your doctor.
Only one cortisone cream can be bought
from a pharmacist without a prescription.
This is hydrocortisone, a mild steroid,
which is sold as a cream or ointment.
•
Cortisone creams
25
Treatment Progress Chart
Where treatment
is applied
on the body
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
26
RESULTS
RESULTS
Week 7
Week 8
Week 9
•
Week 10
How is ec zema treated?
•
Where treatment
is applied
on the body
Week 11
Week 12
27
Resources and support
Books
Atopic Dermatitis:
The Epidemiology,
Causes and Prevention
of Atopic Eczema
Hywel C. Williams
2000
Baby Skin: A Leading
Dermatologist’s Guide to
Infant and Childhood
Skin Care
Nelson Lee Novick
Published by Crown Publishing
Group, Incorporated, 1991
Coping with Eczema
Sheldon Press Staff
Published by Milestone
Publications, Limited, 1996
Eczema in Childhood:
The Facts
David J. Atherton
Published by Oxford University
Press, 1994
Eczema & Psoriasis
Stephen Terrass
Published by HarperCollins
Canada, Limited, 1995
28
The Psoriasis and Eczema
Solution: New Hope for
Physical and Emotion Relief
Michael F. Holick
Published by Transmedia, 1999
The Skin Book
Dr. Colin A. Ramsay
Published by Linacre’s Books, 2001
To order a free copy of this
book, please enclose a cheque
or money order of $5.00 CDN
payable to Communications
MECA (to cover shipping and
handling costs) and mail with
your request to:
EASE
P.O. Box 964
Stn Place d’Armes
Montreal, QC H2Y 3J4
National Eczema Society – UK
http://www.eczema.org
Penny’s World
http://www.pennysworld.ca
The Skin Care Guide Network
http://www.eczemaguide.com
Canadian Dermatology Association
http://www.dermatology.ca
Association des Dermatologistes
du Québec
http://www.adq.org
The Eczema Society of Canada
http://www.eczemahelp.ca
National Eczema Association for
Science and Education
http://www.nationaleczema.org
American Academy of
Dermatology
http://www.aad.org
•
EASE Program
http://www.eczemacanada.ca
Res ources and suppo r t
•
Web resources
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This information has been provided by the EASE® Program, solely funded by an educational
grant from Astellas Pharma Canada, Inc. ©2006
EASE (Eczema Awareness, Support and Education) is a national public education program to
provide eczema sufferers, families, healthcare professionals and the general public with accurate
and comprehensive information about eczema.
www.eczemacanada.ca
1 866 432-0362
PRT0806025EN