Atopic Dermatitis/Eczema Page

2008-05-29T00:08:00.000-07:00

Biological washing powders 'don't cause eczema'

Biological washing powders do not irritate the skin or cause eczema, according to new research.
The idea that bio detergent can trigger skin reactions is a myth that has no scientific basis.
The powders and liquids contain enzymes that "digest" dirt and stains at low temperatures.
But Dr Sarah Wakelin, a dermatologist at St Mary's Hospital, London, said: "We have found that laundry detergents are not a cause of skin irritation or allergy."

Source: www.mirror.co.uk

2008-05-29T00:06:00.000-07:00

Preventive treatment curbs eczema flare-ups

NEW YORK (Reuters Health) - Among adults with eczema, otherwise known as atopic dermatitis, "proactive" long-term treatment with tacrolimus ointment applied twice-weekly safely reduces exacerbations of the condition, European investigators have shown.
Conventional "reactive" treatment of atopic dermatitis involves applying anti-inflammatory medication to skin lesions only while they are visible. With a proactive approach, intensive treatment until lesions are no longer visible is followed by low-dose treatment of previously affected skin areas to prevent flare-ups, the researchers explain in the medical journal Allergy.
Dr. Andreas Wollenberg, from Ludwig-Maximilian Universitat in Munich, Germany, and members of the European Tacrolimus Ointment Study Group conducted a clinical trial in which 247 adult patients with atopic dermatitis initially applied tacrolimus ointment twice daily for up to 6 weeks to visible lesions.
Patients who responded well were then randomly assigned to apply tacrolimus or placebo ointment twice-weekly for 12 months. If exacerbations occurred, they were treated with daily tacrolimus until the flare-up subsided.
The average time to a first exacerbation was substantially longer for the proactively treated patients (142 days) than for the reactively treated patients (15 days), the investigators report.
The proactive group also had a lower percentage of days in which their condition flared up, the report indicates, and more of them had no exacerbations .
Proactive treatment with tacrolimus ointment "prevented, delayed and reduced the occurrence of atopic dermatitis exacerbations," Wollenberg and his associates conclude.

SOURCE: Allergy, June 2008.

2008-05-04T10:41:00.000-07:00

Bacteria in Babies May Help Prevent Atopic Dermatitis

Sunday April 27, 2008
There's been a lot of research lately into ways to prevent children from getting atopic dermatitis. Studies have looked at the foods a breast-feeding mom eats, whether infants are breast or bottle fed, when babies start eating solid food, and feeding prebiotics or probiotics to babies to prevent or lessen the symptoms of atopic dermatitis. At best, these studies show further study is needed.
Along this line, recent studies presented at the International Symposium on Early Nutrition Programming found that bacteria in babies guts may be an area to focus on. These studies showed that babies who have a family history of atopic dermatitis have a higher chance of not developing it themselves if they have certain bacteria in their intestines.
It makes sense that the right balance of bacteria could be helpful. Soon after birth bacteria colonize babies' guts and their immune systems start to work developing what is known as gut immunity. Gut immunity is important because it's the first line of defense against absorption of substances that could trigger allergies.
The investigators are hoping that the risk of atopic dermatitis can be lessened by giving babies the right bacterial strains and prebiotic mixtures to boost their immune systems.

Source:
http://dermatology.about.com

2008-05-04T10:38:00.000-07:00

Probiotics and dermatitis: A review in infants and kids

Researchers from Alfa Institute of Biomedical Sciences (AIBS) in Athens, Greece reviewed the evidence for probiotics in treating or preventing atopic dermatitis in children.
First, the details.
The results of 13 studies were reviewed.
10 evaluated probiotics as treatment of atopic dermatitis.
3 for prevention of atopic dermatitis.
The main outcome measure in 9 studies was SCORAD (SCORing Atopic Dermatitis) — a tool developed by the European Task Force on Atopic Dermatitis to evaluate the severity of this condition.
And, the results.
4 studies reported a significant decrease in SCORAD using probiotics in infants or children with atopic dermatitis for 1 or 2 months vs placebo.
But there was no consistent response in the various immunological/biochemical laboratory studies used to study atopic dermatitis.
In 2 studies, mothers given Lactobacillus rhamnosus GG with or without other probiotics during the time before birth, followed by treating the infants with the same probiotics for the first 6 months of life developed atopic dermatitis significantly less frequently during the first 2 years of life vs placebo.
However, another study reported no difference in frequency nor severity of atopic dermatitis using this treatment.
The bottom line?It appears that probiotics — especially L. rhamnosus GG — prevents atopic dermatitis. The probiotics studied also reduced the severity of atopic dermatitis in approximately half of the studies, although they didn’t change most of the inflammatory markers of this condition.
The findings are not conclusive, however. According to the authors, “More… [studies] need to be conducted to elucidate whether probiotics are useful for the treatment or prevention of atopic dermatitis.”

Source:
www.thecamreport.com

2008-05-04T10:36:00.000-07:00

Relationship between disease severity, scratching and sleep quality in atopic dermatitis

April 30, 2008
The relationship between sleep quality and disease severity in atopic dermatitis (AD) was examined in a 2-night pilot study in 20 adults (<50 years). Sleep efficiency was measured by polysomnography (PSG) and actigraphy. Disease severity was assessed by the Dermatology Life Quality Index (DLQI) and itch by a visual analogue scale (VAS). Tumor necrosis factor (TNF), interleukin 6 (IL-6) and IL-10 were assayed from a subset of 9 participants. The sleep measures of PSG and actigraphy were strongly associated with each other. Decreased sleep efficiency was associated with increased disease severity, scratching and IL-6 levels. However, self-reported sleep quality and quality of life were not significantly correlated with objective PSG or actigraphy measures. These data suggest a relationship between decreased sleep quality and increased AD severity. IL-6 also appears to have an important role in the sleep-wake cycle (Bender, B.G. et al. J Am Acad Dermatol 2008, 58(3): 415-420).

Source: www.accessdermatology.com

2008-04-02T18:19:00.000-07:00

Omega-3 can help eczema

A diet rich in omega-3 can help eczema sufferers reduce the severity of their symptoms, according to new research.
Patients with the most common atopic, or allergic, form of eczema given purified fish oil supplements cut their symptoms by almost a fifth.
Eczema, also known as dermatitis, is a group of skin conditions that causes dry, itchy inflammation of the skin. It affects approximately three per cent of the population, including as many as one fifth of children of school age.

Experts have suggested recent changes to Western diets which have reduced consumption of omega-3 and an increased that of omega-6 fatty acids may have played an important role in the increased prevalence of eczema.
German researchers, whose work was published in the British Journal of Dermatology, gave 44 patients with atopic eczema aged between 18- and 40-years-old daily tablets of either 5.7g Omega 3 supplements or placebos for eight weeks.
Those on the supplements recorded an average 18 per cent reduction in their symptoms, measured on a standard scale known as Severity Scoring of Atopic Dermatitis (SCORAD), by the end of the trial.
Nutritionists recommend people should consume omega-6 and omega-3 essential fatty acids in a ratio of two or three to one.
Too much Omega-6 prevents the body metabolising omega-3 into the fatty acids that form the structure of brain cell membranes and carry electrical signals between brain cells.
Co-author Prof Margitta Worm, from the Charité Department of Dermatology and Allergology, said: "The results of this trial are extremely interesting as the data clearly demonstrates that dietary DHA could be bioactive and may have a beneficial impact on the outcome of atopic eczema.
"These positive results will be investigated in further clinical trials to improve the management of atopic eczema which is a growing problem."
The richest sources of omega-3 are oily fish, particularly mackerel, herring, salmon, fresh tuna and trout. It is also found in walnuts and hazel nuts. Omega-3 essential fats have been shown to protect the body against heart attacks and strokes.
Official advice recommends people eat two portions of fish per week, one of which should be an oily fish. The average Briton consumes a third of a portion per week.

telegraph.co.uk

2008-03-06T02:29:00.000-08:00

Does Infant/Mother Nutrition Affect Allergy-Related Problems?

1. The idea that egg, fish, and foods containing peanut protein should not be introduced before 1 year of age is not based on good science.
2. Maternal dietary restrictions during pregnancy do not appear to play a significant role in the prevention of atopic [allergy-related] disease in infants.
3. There is no convincing evidence for the use of soy-based infant formula for the purpose of allergy prevention.
4. For infants beyond 4-6 months of age, there is insufficient data to support a protective effect of any dietary intervention for the development of atopic disease.
5. In Infants who are at risk of developing atopic disease, the current evidence does not support the hypothesis that exclusive breast-feeding protects against allergic asthma occurring beyond the age of 6 years.
6. For a child who has developed an atopic disease that might be precipitated or exacerbated by ingested proteins (via human milk, infant formula, or specific complementary foods), treatment could require specific identification and restriction of causal food proteins .

2008-03-06T02:18:00.000-08:00

Dust mites, roaches can weaken skin barrier: study

HONG KONG (Reuters)
Dust mites and cockroach allergens can weaken defense mechanisms of the human skin, making it more permeable and vulnerable, a study in South Korea has found.
In an article in the latest issue of the Journal of Investigative Dermatology, researchers said it was important, especially for people with eczema, to protect themselves from such microscopic bugs and filth.
Cockroach allergens are particles of feces, saliva and other matter found on the bodies of these insects.
In the study, the researchers disrupted the skin barrier function of a group of volunteers by repeatedly sticking cellophane tape on a part of their forearm and then stripping it off. They were then exposed to roach allergens and dust mites.
These particles were later found to have triggered a receptor in the skin, known as PAR-2, which delayed the skin repair process.
"The skin barrier function is already damaged in eczema patients and it has to repair itself. But allergens like dust mite and cockroach allergens will delay the repair function," said Jeong Se Kyoo, senior researcher at Neopharm Co. Ltd.
"Then more allergens will penetrate the skin, it's a vicious cycle," he said in a telephone interview.
Over 15 million Americans suffer from eczema, a chronic skin condition characterized by dry patches of very itchy skin. The most common form, atopic dermatitis, affects between 10 and 20 percent of the world's population at some point during childhood.
(Reporting by Tan Ee Lyn; Editing by Sugita Katyal)

2008-02-08T03:09:00.000-08:00

AAD: Genetic Defect in Skin Barrier Tied to Eczema
Mutations in fillagrin gene leads to defect in outer layer of skin, allowing irritants to penetrate

Feb 4, 2008
(HealthDay News) -- A genetic defect in the skin's protective outer later that allows microbes, allergens and other irritants to penetrate the skin likely underlies atopic dermatitis and may contribute to the development of food allergies, according to research presented this week at the American Academy of Dermatology's 66th Annual Meeting in San Antonio, Texas.

Jon M. Hanifin, M.D., of Oregon Health and Science University in Portland, Ore., discussed new data on the genetic basis of atopic dermatitis, the relationship to childhood allergies, and implications for the management of childhood eczema.
The researchers gained insights into atopic dermatitis by studying another genetic skin disease, ichthyosis vulgaris. In both conditions, mutations in the filaggrin gene, necessary for the integrity of the skin's outer barrier layer, lead to breaches in the epidermis. When food allergens pass through this defective skin barrier, very elevated levels of IgE antibodies and allergic reactions to food can result. Thus, in contrast to the common misconception that food allergies cause eczema, it is rather the broken skin barrier of eczema that leads to food allergies.
Hanifin comments on the implications of this research: "Strong evidence linking a broken skin barrier to the development of future allergies offers an important prevention opportunity. Babies with eczema need early therapy with measures directed at repair and maintenance of the skin's barrier."

http://www.modernmedicine.com

2008-02-08T03:06:00.001-08:00

Methotrexate Effective and Safe for Children With Severe Atopic Dermatitis: Presented at AAD

By Bruce Sylvester SAN ANTONIO, TX -- February 4, 2008

Methotrexate is an effective treatment for children with severe atopic dermatitis, researchers reported here at the American Academy of Dermatology 66th Annual Meeting (AAD). "Overall, we found that the vast majority of patients improved significantly," said presenter and lead investigator Christopher Rouse, MD, Senior Resident, Department of Dermatology, St. Louis University School of Medicine, St. Louis, Missouri, United States. In their poster, Dr. Rouse and colleagues indicated that atopic dermatitis is the most common cause of severe skin disease in children. Research on systemic treatments is limited. "Case reports have documented the efficacy of methotrexate for the treatment of severe atopic dermatitis in adults, but no information is published on treatment in children with this disease," Dr. Rouse said in a presentation on February 3. The investigators retrospectively reviewed data on 30 children with severe atopic dermatitis who had been treated with methotrexate. Patients ranged in age from 2 to 16 years and all had failed topical therapy. Many had been treated with cyclosporine and were successfully crossed-over to methotrexate. All subjects received an initial dose of 0.5 mg/kg/week (maximum 15 mg). Most of the children tolerated the tablet formulation. Of those who received a liquid formulation, most received the concentrated 25 mg/cc parenteral formulation. Supplemental folic acid (1 mg) was added after the first month of treatment and was taken on non-methotrexate days. Followup in the clinic and laboratory assessments took place at baseline and monthly for 3 months, followed every 3 months thereafter if the dosing remained stable. Laboratory parameters included complete blood counts with red blood cell indices and a comprehensive metabolic panel. The investigators reported that elevations in hepatic transaminases were transient and unusual, and were found in blood obtained within 1 to 2 days after methotrexate administration, or following a presumed viral illness. No child underwent liver biopsy. Dose adjustments occurred every 2 to 3 months as needed. The investigators found that the majority of methotrexate-treated subjects achieved a partial to complete response, with no serious adverse events occurring among the subjects during an average of 12 months exposure. "Methotrexate is a useful systemic treatment option for children with severe atopic dermatitis," the authors concluded. [[Presentation title: Methotrexate for Atopic Dermatitis in Children. Abstract P608]

2008-01-16T02:17:00.000-08:00

SkinMedica Introduces Desonate(R) (desonide) Gel 0.05% TwinPack for Treatment of Mild to Moderate Atopic Dermatitis

January 8, 2008

CARLSBAD, Calif., Jan. 8 - SkinMedica, Inc., a specialty pharmaceutical company focused on dermatology, announced the availability of the Desonate (desonide) Gel 0.05% 120g TwinPack for the treatment of mild to moderate atopic dermatitis. Desonate is a low-potency prescription
topical steroid formulated in Dow Pharmaceutical Sciences’ proprietary water-based Hydrogel vehicle.

The new economical Desonate TwinPack contains two 60-gram tubes of Desonate Gel for greater coverage of affected areas during the cold-weather season when atopic dermatitis tends to flare most. With the Desonate TwinPack, patients have the added convenience of keeping their medication in two accessible locations. With one prescription, patients can receive twice as much therapy for the same pharmacy co-pay as the smaller tube.

“The Desonate TwinPack provides added value and flexibility to an already effective Desonate therapy,” said Dr. Rebecca Smith, Pediatric Dermatologist from a Charlotte, NC suburb. “I have many younger patients cared for by parents in more than one household, and having two tubes of Desonate allows both households to keep Desonate on hand when flares occur.
With the new TwinPack, Desonate with Hydrogel continues to provide effective therapy in a cosmetically acceptable, well tolerated formulation.”

Clinical studies with Desonate show significant reduction in itching and other symptoms of atopic dermatitis, and Desonate is clinically proven to moisturize and help skin maintain essential hydration by improving the skin barrier.

Additional Information about Desonate

As with other corticosteroids, therapy should be discontinued when control is achieved. Unless directed by a physician, the treated skin area should not be bandaged so as to be occlusive. Systemic absorption of topical corticosteroids, including Desonate Gel, has produced HPA axis
suppression, for which pediatric patients are more susceptible.

In clinical trials, the most frequent adverse events included headache (2%), application site burning (1%), rash (1%), and application site pruritus (<1%).>

About Desonate

Desonate is approved by the US Food and Drug Administration (FDA) for the treatment of mild to moderate atopic dermatitis in patients aged 3 months and older for up to 4 consecutive weeks. Formulated with desonide, the leading low-potency corticosteroid used in dermatology, Desonate is the first and only treatment for atopic dermatitis delivered via Hydrogel
technology. The versatile formulation can be used on small and large affected areas and is free of alcohol, fragrance, or surfactants that can be irritating or drying to the skin.

Desonate is jointly promoted by SkinMedica and Galderma Laboratories, L.P.

About Atopic Dermatitis

Atopic dermatitis affects more than 15 million patients, resulting in skin rash, redness, swelling, crusting, and scaling. The disease affects nearly 20% of infants and young children, some of which continue to experience symptoms as adults. The exact cause of atopic dermatitis is
unknown; however, genetics and environmental factors are considered key factors. Topical corticosteroids are the gold standard of treatment for atopic dermatitis, with more than $1 billion in prescriptions written annually by US physicians for inflammatory dermatoses.

For More Information on Desonate

For information about Desonate, including its approved labeling, please visit http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm or contact SkinMedica Customer Service at (877) 944-1412.

About SkinMedica

SkinMedica is a privately held pharmaceutical company marketing both prescription and aesthetic dermatology products. SkinMedica’s Desonate(R) (desonide) Gel 0.05% is indicated for the treatment of mild to moderate atopic dermatitis; EpiQuin(R) Micro (4% hydroquinone) cream is indicated for melasma and postinflammatory hyperpigmentation; VANIQA(R) (eflornithine hydrochloride) Cream, 13.9%, is the only FDA-approved prescription product
for the treatment of unwanted facial hair in women; and NeoBenz(R) Micro Cream and NeoBenz(R) Micro SD (single dose) are the only benzoyl peroxide prescription products that contain a patented gradual-release formulation of benzoyl peroxide to treat acne. The company’s full line of physician-dispensed skin care products includes TNS Recovery Complex(R) with NouriCel-MD(R) to help improve the health and appearance of aging
skin. SkinMedica is based in Carlsbad, California. For more information, visit http://www.skinmedica.com/.

2008-01-16T02:15:00.000-08:00

Breast-Feeding Seems to Protect Against Some Allergies

It helps high-risk infants prone to eczema, asthma and food allergies, report suggests

By Amanda Gardner

Posted 1/7/08

MONDAY, Jan. 7 (HealthDay News) -- Atopic disease -- which includes eczema, asthma and food allergies -- may be delayed or even prevented in high-risk infants if they are exclusively breast-fed for at least four months or fed infant formula without cow milk protein.

That's the conclusion of a new clinical report from the American Academy of Pediatrics (AAP) that's published in the January issue of Pediatrics. The report replaces an earlier policy statement from the AAP.

"Basically, it probably does not matter what pregnant or lactating women eat," said Dr. Frank Greer, an author of the report, professor of pediatrics at the University of Wisconsin and chairman of the AAP Committee on Nutrition.

"The best prevention for atopic [allergic] disease is exclusive breast-feeding for four months," he added. "And if your infant comes from a family with significant atopic disease, then weaning from breast milk to a partially or extensively hydrolyzed [hypoallergenic] formula [without cow milk protein] may delay or prevent the onset of atopic disease, especially atopic dermatitis [eczema]."

Greer added that this recommendation would also apply to formula-fed infants who are at risk for atopic disease.

The timing and introduction of solid foods has no protective effect on the prevention of atopic disease, according to the new report.

"With the increase in asthma and food allergies that we've seen recently, we had hoped that maternal diet, breast-feeding and early childhood diet might all have some factor in decreasing incidence," said Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital in New York City. "Unfortunately, it doesn't seem to significantly impact, according to studies already done. The only one that seems to be impacted is the atopic dermatitis, which is decreased by about one third by breast-feeding. But the studies that have been done so far have not proven that breast-feeding will significantly impact childhood asthma or food allergies."

The incidence of allergic diseases such as asthma, food allergies and various skin conditions has exploded during the past few decades. In children 4 years of age and younger, the incidence of asthma has risen 160 percent, while the incidence of atopic dermatitis has almost tripled. And the incidence of peanut allergy has doubled just during the past decade, according to the report.

While genetics certainly plays a role in the development of these diseases, environmental factors such as diet are also strongly related.

The new report reviewed different evidence on nutrition during pregnancy, breast-feeding and the first year of life that might affect the development of allergic disease. Its major findings are as follows:

Currently, there is no evidence that what a mother eats during pregnancy or breast-feeding plays a major role in preventing atopic disease in infants. There is some evidence, however, that avoiding certain foods during breast-feeding may help prevent atopic eczema.
Exclusive breast-feeding for at least four months for infants at high-risk of developing atopic disease decreases the risk of developing eczema and cow milk allergy during the first two years of life.
In high-risk infants who aren't breast-fed exclusively for four to six months, the use of hydrolyzed infant formula (as opposed to formula containing cow milk) may delay or prevent the onset of atopic dermatitis.
Exclusive breast-feeding for at least three months protects an infant against wheezing in early life.
There is no good evidence to support the use of soy-based infant formula to prevent allergies.
There is no evidence to suggest that delaying the introduction of solid foods before the recommended 4 to 6 months of age will have an effect on the development of atopic disease.
There is no convincing evidence to suggest that any dietary intervention will prevent atopic disease after 4 to 6 months of age.

"It's a mixed picture," Wu said. "We don't have proven efficacy for breast-feeding. It may mean that we need more robust studies and a longer-term follow-up for kids."

The new report is titled "Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas.

2008-01-16T02:13:00.000-08:00

Effects of wet-wrap dressing on the epidermal barrier in atopic dermatitis

January 7, 2008

The therapeutic efficacy and mode of action of wet-wrap dressing was investigated in 10 patients (mean age 22 years) with severe form atopic dermatitis (AD). Wet-wrap dressings (4-5 layers of gauze hydrated with 0.9% saline) were applied for 8 h/day for 7-14 days. Immediately and 7 days post-treatment, SCORing Atopic Dermatitis (SCORAD) index, corneum water content, transepidermal water loss (TEWL) and the lipid amount of the skin surface were measured.

Post-treatment SCORAD scores were significantly lower after wet-wrap dressing (p<0.01> vs. pretreatment). Moreover, epidermal water content significantly increased and TEWL was significantly decreased after wet-wrap dressing. There was a significantly increased release of lamellar body and recovery of damaged lamellar structures post-treatment. Neither keratinocyte differentiation nor changes in calcium ion gradient were detected (Lee, J.H. et al. JEADV 2007, 21(10): 1360-1368).
Source:
http://www.accessdermatology.com/

2007-12-29T06:12:00.001-08:00

Hypersensitivity to aeroallergens in adults with atopic dermatitis

December 28, 2007

A study in 109 atopic dermatitis (AD) patients attempted to determine the allergic mechanisms of hypersensitivity to selected aeroallergens. The highest incidence of positive results was to house dust mite allergens; allergic mechanisms were found in 85.3% of patients. In terms of immunological mechanisms, type I reactions were found in 30.2%, types II and IV in 9.2% and type IV only in 1 patient. In 14.7% of patients all the tests were negative. The percentage of positive results to birch pollen, grass pollen and cat dander was 45%, 44.1% and 53.2%, respectively (Samochocki, Z. et al. Eur J Dermatol 2007, 17(6): 520-524).

2007-12-16T02:41:00.001-08:00

NICE support bath emollients for eczema

The National Institute for Health and Clinical Excellence has released new guidelines that recommend the use of nonperfumed emollients for children with atopic eczema.

The guidelines, produced for NICE by the National Collaborating Centre for Women and Children's Health, include the most comprehensive review on ways to improve the quality of life for those with eczema.

Despite recent controversy surrounding the use of bath emollients, NICE say nurses should offer children with atopic eczema a choice of emollients to use every day for moisturising, washing and bathing.

They add that treatments should be tailored to suit children's needs and preferences and may include a combination of products.

NICE recommend that healthcare professionals should adopt a "holistic approach" when assessing children with eczema, taking into account the eczema severity and children's everyday activities and sleep, and psychosocial well being.

Nurses should also spend time educating children with atopic eczema and their parents or carers about the disorder and its treatment.

Peter Littlejohn, NICE clinical and public health director, said: "The publication of this guideline will improve the management of atopic eczema in children from birth up to the age of 12 years in primary, secondary and community care.

"For the first time, people suffering from this condition will benefit from a consistent approach to managing their condition, regardless of where they live."

NICE

2007-12-16T02:36:00.000-08:00

Today's Kids Slower to Outgrow Milk and Egg Allergies

By Judith Groch, Senior Writer, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.

BALTIMORE, Dec. 14 -- Children don't always outgrow milk and egg allergies as quickly as predicted by common wisdom and the conditions may persist well into adolescence

So found two retrospective studies, one on milk and the other on egg, with some overlap, reported Johns Hopkins investigators online in the Journal of Allergy and Clinical Immunology.

The prognosis for a child with a milk or egg allergy appears to be worse than it was two decades ago, said Robert A. Wood, M.D., a co-author of both studies, and colleagues.

Rather than outgrowing the allergies by the time they start school, only about 20% to 40% of children do so with milk and about 4% to 26% with egg. Twenty percent of patients with milk allergies and 30% of those with egg allergies don't develop tolerance till age 16, found the researchers.

"We may be dealing with a different kind of disease process than we did 20 years ago," Dr. Wood said. "Why this is happening we just don't know."

Cow's milk allergy, the most common allergy, affects 2% to 3% of infants and young children, and egg allergy, second after milk, affects 1% to 2% of young children, the researchers wrote.

The purpose of both studies, which followed children for more than 13 years, was to define the rate of allergy resolution over time and identify the clinical and laboratory features that may predict the outcome with passing years. In both studies the children came from pediatric allergy clinics.

In the milk study, the investigators collected a clinical history, test results, and final outcomes for 807 children (a 2:1 male:female ratio) with IgE-mediated cow's milk allergy. Data collection began in 1993.

The findings of this study are in marked contrast to an often quoted study that suggested that three-quarters of children with milk allergy outgrew their condition by age three, the researchers said.

In the Hopkins study, only one-fifth of the children outgrew the milk allergy by age four.

Patients were considered tolerant after they passed a challenge or experienced no milk reaction in the previous 12 months and had a cow's milk IgE of <3 kU/L.

When tolerance was defined in this way, resolution rates were 19% by age four, 42% by age eight, 64% by age 12, and 79% by age 16. Although it took time, most, but not all, children did outgrow their milk allergy, the investigators said.

Further analysis found that patients with persistent allergy had higher cow's milk IgE levels at all ages up to 16. The highest IgE for each patient, defined as peak cm-IgE, was found to be highly predictive of long-lasting outcome (P<0.001), the researchers said.

In addition, coexisting asthma (P<0.001) and allergic rhinitis (P<0.001) were also significant predictors of outcome, they reported.

Discussing the multiple criteria for establishing tolerance, and a possible study limitation, the researchers said that children who cannot pass a milk challenge may actually be tolerant.

The authors suggested that the poor prognosis in this study may result from the highly atopic referral population. Thus, they wrote, "other markers of the high degree of atopy in our population include 91% having at least one other food allergy, 49% with asthma, 40% with allergic rhinitis, and 71% with eczema."

However, it may also be that the character of milk allergy has changed over time, Dr. Wood said.

Similar trends were seen for 881 patients (68% male) in the egg-allergy study. When tolerance was defined with the most conservative criteria (egg IgE <2 kU/L), 4% outgrew their allergy by age four, 26% by age eight, 48% by age 12, and 68% by age 16.

Individuals with persistent egg allergy had higher antibody levels at all ages up to 18, the end of the period studied.

Egg allergy is generally considered to have a good prognosis, and parents are typically counseled that their children will outgrow it by early school age, the researchers said.

Indeed, this study supports the idea that a majority of atopic children with IgE-mediated egg allergy will develop tolerance -- but not by early school age as once thought.

Furthermore, an egg IgE level greater than 50 kU/L is a marker of persistent egg allergy, as well as the presence of other food allergy, and other atopic disease, they said.

A limitation of the egg study, the researchers wrote, is that many patients being evaluated for atopic dermatitis or other food allergies before egg was added to their diets were diagnosed on the basis of IgE alone and did not have a history of reaction to egg. However, Kaplan-Meier survival curves suggested that these children did in fact have a true egg allergy.

The researchers concluded that antibody tests are highly predictive of allergy outcomes and should be used in counseling patients on prognoses of egg or milk sensitivity. Because some patients do not develop tolerance until adolescence or later, follow-up and re-evaluation of these patients is important in their care.

2007-12-12T00:49:00.000-08:00

Repetitive scratching and noxious heat do not inhibit histamine-induced itch in atopic dermatitis

Authors: Ishiuji, Y.¹; Coghill, R.C.²; Patel, T.S.¹; Dawn, A.¹; Fountain, J.¹; Oshiro, Y.²; Yosipovitch, G.

Source: British Journal of Dermatology, Volume 158, Number 1, January 2008 , pp. 78-83(6)

Publisher: Blackwell Publishing

Repetitive scratching is the most common behavioural response to itch in atopic dermatitis (AD). Patients with chronic itch often report that very hot showers inhibit itch. We recently reported that scratching and noxious heat stimuli inhibit histamine-induced itch in healthy subjects. However, no psychophysical studies have been performed in AD to assess the effects of repetitive heat pain stimuli and scratching on histamine-induced itch.

Objectives

To examine the effects of repetitive noxious heat and scratching on itch intensity in patients with AD using quantitative sensory testing devices.

Methods

Itch was induced with histamine iontophoresis in 16 patients with AD in both lesional and nonlesional skin as well as in 10 healthy subjects. Repetitive noxious heat and scratching were applied 3 cm distal to the area of histamine iontophoresis. Subjects rated their perceived intensity of histamine-induced itch with a computerized visual analogue scale.

Results

Our results demonstrate that repetitive noxious heat and scratching do not inhibit itch intensity in lesional and nonlesional AD skin but do so in healthy skin. Of note, both these stimuli increase itch intensity in lesional AD skin. Conclusions Our results strongly suggest that scratching and noxious thermal stimuli have a different effect upon histamine-induced itch perception in patients with AD when compared with healthy controls. This difference may be associated with both peripheral and central sensitization of nerve fibres in AD.

2007-12-06T21:44:00.000-08:00

Hold the Peanut Butter, Please

Med Headlines - Peanut allergies in children seem to be getting more common and they seem to be developing at an earlier age than in recent years. Todd D. Green, MD, of the Children’s Hospital of Pittsburgh, reports these findings in the December issue of Pediatrics.

The American Academy of Pediatrics recommends abstaining from peanuts until a child is three years old if a parent or sibling has been diagnosed with a peanut allergy. Mothers with peanut allergies in the family are also urged to avoid peanut intake during pregnancy and breastfeeding. The retrospective study suggests these precautions aren’t being widely followed.

Studies of pediatric allergy records indicate the age of first introduction to peanuts in the 1990s was 22 months. Records of children’s peanut allergies for the period 2000 to 2006 indicate first exposure at age 14 months is more common now.

The age of adverse reaction to peanuts has dropped from 24 months to only 18 months of age over the last ten years.

Increased public awareness of the possibility of allergies is cited as one reason for the earlier diagnoses. The availability of serum and skin tests are also considered a possible factor.

Atopic dermatitis, a form of eczema related to food allergies, was the first symptom in almost all the children brought in for medical treatment. Gastrointestinal and respiratory symptoms were other reasons for seeking medical care. In most cases, symptoms developed within ten minutes after eating peanuts.

A family history of atopy associated with peanuts is call for caution, especially when asthma and allergic rhinitis are also experienced.

Many children eventually outgrow their peanut allergies. Children also develop stronger immune systems as they grow. By waiting until a susceptible child is at least three years old before introducing him or her to peanuts, it is likely any allergic reactions can be avoided or minimized.

2007-12-05T00:06:00.001-08:00

Sensory profile of children with atopic dermatitis

December 4, 2007
The sensory profile of 53 children with atopic dermatitis (AD) and 61 healthy children (aged 3-10 years) was determined using the Short Sensory Profile. AD severity was assessed using the SCORing Atopic Dermatitis (SCORAD) index. The patients had significantly higher sensory sensitivity than controls (p=0.013). These results were seen on all sensory modalities except “movement disorders”, which is related to vestibular function. These findings may help focus on the patients’ needs in future but larger studies are needed (Engel-Yeger, B. et al. J Am Acad Dermatol 2007, 57(4): 610-615).

2007-12-03T02:31:00.000-08:00

Unnecessary Milk Elimination Diets in Children with Atopic Dermatitis

Milk elimination diets are frequently adopted in the treatment of atopic dermatitis, although the real prevalence of clinically relevant food allergy remains unclear and reports from different authors are often in disagreement. We investigated the percentage of children allergic to cow's milk compared with the rate of milk exclusion diets in a group of patients with atopic dermatitis.

We enrolled 206 children (79 girls, 127 boys), mean age 45.8 (4–68) months, affected by atopic dermatitis into our study. All children underwent radioallergosorbent test for casein, alpha-lactalbumin and beta-lactoglobulin, prick test, atopy patch test, and oral provocation test.

Children were followed up at 1, 3, 6, and 12 months. Of the 206 patients, 20 were excluded from statistical analysis, leaving 186. Forty-five (24.2%) were on a milk elimination diet and 141 on a normal diet. Four patients on the milk-free diet (8.9%), accounting for 2.2% of all patients, were found to be allergic. In the others, milk reintroduction did not cause the disease to worsen during the follow-up period. No children on a normal diet were found to be allergic. Our results demonstrated an actual prevalence of cow's milk allergy in patients on milk elimination diets (4%) to be significantly lower than the number of patients prescribed such diets (24.2%)—confirming that this measure is being applied excessively.

Full text:
http://foodallergies.about.com/gi/dynamic/offsite.htm?zi=1/
XJ&sdn=foodallergies&cdn=health&tm=212&f=00&su=p284.8.150.ip_&tt=11&bt=1&bts=1&zu=http%3A//www.blackwell-synergy.com/
doi/full/10.1111/j.1525-1470.2007.00323.x

2007-11-30T01:31:00.000-08:00

Treating Eczema During Pregnancy

Some women see their eczema suddenly flare and want to know if there is anything they can do to treat it. Others are concerned about continuing to use medication while pregnant or nursing. Here’s what dermatologists recommend.

1. Talk with a dermatologist before continuing to use eczema medication. Women who are pregnant or breastfeeding should not use eczema medication before discussing this with a dermatologist or obstetrician. Some medications can cause birth defects or harm a nursing child. For this reason, the U.S. Food and Drug Administration (FDA) requires that all medication be classified according to its potential effects on a pregnancy. Some medication is safe to use during pregnancy; others should be stopped. Some medication should not be used while nursing. A dermatologist can help a woman weigh the risks and benefits of the medications and other eczema treatment options.

2. Communicate openly with the dermatologist. While dermatologists are the experts when it comes to weighing the risks and benefits of each treatment option for eczema, you know best how the eczema is affecting your life. For example, if the eczema is keeping you awake at night or interfering with your life in any other way, be sure to tell your dermatologist. Open communication can help the dermatologist develop a treatment plan that best meets your needs.

3. Consult a dermatologist or obstetrician before trying any remedy advertised as “herbal” or “all natural.” While “all natural” or “herbal” may sound like a safe alternative to medication, some of these products have proven extremely harmful, even lethal. The FDA cautions women not to take any herbal product before consulting a healthcare provider. Some of these products have been linked to miscarriage, premature birth, and even birth defects. Others can harm the mother’s health.

4. Follow a skin-care plan designed specifically for skin with eczema. Taking good care of your skin while pregnant and
nursing can minimize flare-ups. Good skin care practices for a person with eczema include:

· Avoiding hot water. The water should not feel hot nor redden the skin because hot water dries skin. Dry, irritated skin can cause a flare-up or worsen existing eczema.

· Taking short lukewarm showers or baths. A lukewarm shower or bath once a day for 5 to 10 minutes can hydrate skin effectively. Staying in the water longer can dry the skin. For best results, be sure to apply moisturizer within 2 to 3 minutes of bathing.

· Using a gentle cleanser. A recent survey found that 29% of adults living with atopic dermatitis, a type of eczema, say they do not use a cleanser. For anyone who has eczema, a gentle cleanser is essential. It is vital that dirt, bacteria, and other substances be washed away without causing further irritation. When looking for a cleanser, be sure to select one that is free of fragrances, antibacterial agents, and other chemicals that can irritate the skin. Cleansers should not be used on skin that has flared as even the mildest cleanser can be quite irritating.

· Eliminating washcloths, mesh sponges, and similar products. Dermatologists recommend that their patients with eczema avoid all products that rub, scrub, or exfoliate the skin. This irritates the already sensitive skin and can cause a flare-up. To wash, dermatologists recommend using your fingertips to gently apply the cleanser and using your hands to gently rinse.

· Moisturizing frequently. Dermatologists consider moisturizer the first line of defense when treating eczema because it can help relieve dry skin and the associated itch. Moisturizer should be applied immediately after bathing, hand washing, and as needed to keep the skin moist.

5. Grab a cool compress to relieve that itch. Scratching can lead to infection. Applying a cool — not cold — compress can help lessen the itch.

6. Reduce stress. Decreasing stress can be a challenge, especially with the anticipation of a baby. However, finding ways to unwind are essential during pregnancy. Research shows that stress can increase the risk of a pre-mature birth, delivering a low-birth-weight baby, as well as the child developing learning and behavioral problems. Stress also exacerbates eczema.

7. Know your triggers and take extra steps to avoid them. Do you know what causes your eczema to flare? If not, a dermatologist can help you identify everyday activities and objects that may trigger your eczema. Some common triggers are fragrances, immersing your hands in water often or for long periods of time, bubble bath, laundry detergents, wool, and pet fur. However, different people have different triggers, so it is important to learn what triggers your eczema and avoid those objects and activities.

8. Try to avoid sweating and overheating. These are common triggers that can cause itching and lead to scratching and flare-ups.

9. Wear clothing made of cotton or another fabric that feels smooth to the touch. Wool and other fabrics that feel rough to the touch often irritate the skin and can trigger a flare-up. Cotton, cotton-blends, and other fabrics that feel smooth to the touch usually make skin feel better.

10. Get regular medical checkups. Regular checkups with your obstetrician play an important role during each and every pregnancy. Women who have eczema should be sure to tell their obstetrician. Skin affected by eczema is more susceptible to infection, and it is important that any skin infection that develops during pregnancy be properly treated.

If you want specific medical advice about how to treat your eczema during pregnancy or while nursing, be sure to see a dermatologist. By considering a number of factors, such as your overall health and the trimester of your pregnancy, a dermatologist can develop a treatment plan to help you effectively manage your eczema. This may include identifying your triggers and providing you with a skin-care plan.

Reference:
Berson D. “Recommendation of Moisturizers and Cleansers: A Study of Unmet Needs Among Dermatology Patients.” Cutis. 2005 December;76(6S):3-6.

2007-11-30T01:23:00.000-08:00

Eczema sufferers test water softeners

More than 300 families are being recruited to find out if water softeners can help in the treatment of childhood eczema.

Researchers from the University of Nottingham will focus on hard water areas in the Soft Water Eczema Trial (SWET) to discover whether eczema can be improved by deliberately softening all water used in the home (except one kitchen tap for drinking water).

The trial follows on from earlier research that found that eczema is more common in primary school children living in hard water areas in the UK, compared with children living in soft water areas.

Professor Hywel Williams from the Centre of Evidence-Based Dermatology said the first study did not explain why children living in hard water areas were more susceptible to eczema. However he said this could be because hard water contains high levels of calcium and magnesium, leading to increased use of soaps which can act as a skin irritant.

“If ion-exchange water softeners are found to improve the symptoms of eczema, this will be an extremely important finding for both patients and doctors. Many patients worry about the possible side effects of the usual treatments for eczema, so this would be a welcome addition to their treatment options,” Prof Williams said.

The trial will run until the end of next year and the results won’t be known until the end of 2009 when all the information has been analysed.

Source:
www.irishhealth.com

2007-11-28T22:25:00.000-08:00

The Frequent Usage of Manuka Honey for Eczema Treatment and More

After the breakthrough discovery of the benefits of Manuka honey in eczema treatment, more and more companies are using it in their products for eczema treatment.
London, 28^nd November 2007: Following the discovery of Manuka Honey and its benefits in eczema treatment, most of the manufacturers of health care products have started including natural ingredients in their eczema treatment skin care products.
Eczema is a common disease in UK. Infants are the most affected ones due to this skin disease. Research proved that out of every five children, one suffers from some form of eczema. There are basically two forms of eczema – atopic dermatitis and contact dermatitis. About 10 – 20 percent of the total population in the world is suffering from eczema. The most common symptoms of eczema are dry, itchy and red skin that may also bleed in worse cases.

According to recent breakthrough discovery, Manuka honey is found to be quite beneficial in healing eczema and skin rashes. The antibacterial, antimicrobial, antiviral, antiseptic, anti-inflammatory and anti-fungal properties of Manuka honey makes it effective on skin afflicted by this condition. Manuka honey also is great for moisturising and soothing dry and damaged skin. And, therefore, some of the skin care products companies are also using Manuka honey, especially in their winter care products.

Source: Freepressreleases

2007-11-28T01:29:00.000-08:00

Results of the Relieva® Clinical Trial in Eczema Treatment Published

Study results showed significant improvements in Erythema, Infiltration, Excoriation and Lichenification scores. In addition, subjects responding to a post treatment evaluation questionnaire indicated a substantial benefit when rating effectiveness, itching and appearance. This study indicates that Relieva® is useful in adult patients with atopic dermatitis.
Oldsmar, FL (PRWEB) November 28, 2007 -- The results of the study conducted in the USA. to determine the efficacy and tolerability of Relieva® in adult patients with Atopic Dermatitis (eczema) were just published in the September issue of the American Journal of Therapeutics (14:442-446, 2007).
Previous laboratory studies showed that Psorberine®, the active ingredient of Relieva®, a non-corticoid, non- immunosuppressant but potent anti-inflammatory compound might be effective in atopic dermatitis. A clinical trial was conducted to determine if indeed Relieva® is efficacious in these patients.

Patients enrolled in this 12 week trial carried out by Global Clinicals Inc. were treated with Relieva®, a topical preparation containing Psorberine in Novasome®, a proprietary liposome formulation. Efficacy and safety was assessed using EASI (Eczema Area and Severity Index), an established index used for evaluating the severity of the signs of atopic dermatitis and a Subject Reported Evaluation of Treatment. Study results showed significant improvements in Erythema, Infiltration, Excoriation and Lichenification scores. In addition, subjects responding to a post treatment evaluation questionnaire indicated a substantial benefit when rating effectiveness, itching and appearance.
This study indicates that Relieva® is useful in adult patients with atopic dermatitis.
Apollo Pharmaceuticals continuous research in dermatology offers another option for the treatment of adult patients with Atopic Dermatitis (eczema).

2007-11-23T01:10:00.000-08:00

Eczema Study Points to Skin's Protective Layer as Key Factor
Shielding Lotion a Superior Skin Care Option Says Dermatologist

BEVERLY HILLS, CA--(Marketwire - November 20, 2007) - 21st Century Formulations, manufacturers of Skin MD Natural, applauded the Australian Eczema Society's research that suggests a defective skin barrier is the primary cause of this skin disease that plagues millions the world over. Previously it has been thought that the immune system was responsible for eczema outbreaks.
This research shows that a key factor in developing eczema is the structure of the skin barrier and the integrity of the cells' lipids and binders. These findings support Skin MD's research into how the skin heals and paves the way for better skin care treatment and management of the debilitating disorder.
Dr. Peter Helton, medical director of the Helton Skin and Laser Institute in Newport Beach, California, says shielding lotion is superior to conventional moisturizers for treating dry skin and eczema. "With a shielding lotion we get faster results and the patient has to use less medication," says Dr. Helton.
Airline pilot Rod Wilkinson has suffered from severe eczema for the past eight years. Like many other eczema sufferers, Wilkinson has invested time and money in seeing doctors and specialists, not to mention the lotions and potions that promised a 'cure.' He has been prescribed, and/or recommended, a long list of skin care products and treatments ranging from steroids to warm olive oil and orally taken oregano drops.
"I even tried a remedy off the Internet that consisted of a root extract to take orally and a cream," says Wilkinson. "The tincture tasted as bad as the oregano drops I had used earlier. I couldn't follow through with it, it just tasted too bad. I did finish using the cream, but it didn't do any good."
His is not an unusual story -- many eczema sufferers try one remedy after the other with little or no result. "If it's out there, I've tried it," says Wilkinson. "Nothing worked until I used this shielding lotion."
Wilkinson began using Skin MD Natural on his eczema in January and noticed a difference within three weeks. He began a strict routine of applications morning and evening. At first he saw improvement only at the edges; the spreading had stopped. Then the bright colors started to fade and the scabbing went away. Most impressive was that the persistent itching was gone. "That was a big relief!" says Wilkinson. "After approximately a month it was obvious that the eczema crud was on the retreat."
Wilkinson continued this treatment for almost a year and documented the improvement month to month. He is still applying Skin MD Natural every other day as insurance against a return of the eczema. "It doesn't happen overnight," says Wilkinson. "Just keep using the shielding lotion and don't give up."
Skin MD Natural is available in thousands of pharmacies and some CVS stores across the country. For a limited time this effective skin care product can be purchased in these stores at a considerable saving.

SOURCE: 21st Century Formulations

Eczema video

2007-11-23T01:00:00.001-08:00

Apples, fish benefits for unborn babies

2007-11-22T10:10:00.000-08:00

Consumption of apples and fish by mothers during pregnancy could be extremely beneficial for babies, latest research suggests.

Apples are already linked to better lung health when taken by adults, perhaps due to their antioxidant properties, and oily fish in particular contain Omega-3 oils, which, scientists suggest offer several health benefits.

Scientist Graham Devereux and other researchers at the University of Aberdeen quizzed 2,000 pregnant women on their eating habits, and then observed their children's health over a period of five years.

They found that those women who ate four or more apples a week were half as likely to have an asthmatic child compared with those who ate one or fewer.

The researchers also discovered a link between eating more fish during pregnancy and a lower chance of children developing the allergic skin condition eczema, the online edition of BBC News reported.

Women who ate one or more portions of any type of fish during pregnancy had almost half the chance of having a child diagnosed with eczema within the first five years, the researchers said.

The study presented at the recently held American Thoracic Society conference suggests that a simple modification that can be made to a pregnant mother's diet may help protect her child from developing asthma.

Source:

Hindustan Times

2007-11-15T00:38:00.000-08:00

Kids with sensitive skin may be allergic to oats

NEW YORK (Reuters Health) - Children with skin allergies may be allergic to oat proteins commonly found in skin products, study findings suggest.
Of 302 children seen at a pediatric dermatology unit in Bordeaux, France, nearly one third had a positive skin reaction to oats, report Dr. Franck Boralevi, at the Hopital Pelligrin-Enfants, and colleagues.
The researchers used skin patch tests and skin prick tests to determine the sensitivity to oat proteins among children, ages 4 months to 15 years old, with eczema. Also referred to as atopic dermatitis, eczema is a chronic skin disorder that causes scaly and itchy rashes.
Overall, 32.5 percent of the children were sensitive to oats, study investigators report in the medical journal Allergy. Skin patch tests showed oat sensitivity among 14.6 percent, while skin prick tests identified oat sensitivity among 19.2 percent of those tested.
Hospital-based oral food challenges, completed by 32 of the 98 children who tested positive for oat sensitivity, further identified 16 percent with sensitivity to oat meal.
None of the parents of these children suspected an oat allergy in their child. Previous history taking and clinical examinations also had not identified these allergies, the researchers note.
Of the children who were tested with oat protein allergy by repeatedly applying oat cream to a skin area previously unaffected by atopic dermatitis, 28 percent developed eczema or other skin eruptions.
Three quarters of all of the children had been previously treated with oat-containing emollients. Thirty-two percent of these children who used skin produces containing oat previously tested positive on the skin patch tests.
The investigators suspect the repeated application of oat-containing skin products appears to be associated with oat sensitization in this study population, the investigators report.
Boralevi and colleagues also found that the percentage of children with positive skin patch reactions decreased with age, a finding that is in accordance with previous studies, they note.
The researchers suggest that oat-containing skin products be avoided in children younger than two years old.
SOURCE: Allergy, November 2007.

2007-11-14T00:41:00.000-08:00

Ceragenix Epiceram product phase 4 results positive

Analysis of: Ceragenix Announces Results from Phase IV Study of EpiCeram(TM) Meet All Primary and Secondary Endpoints www.irconnect.com

Implications: The recent Epiceram phase 4 data comparing it to Cutivate are positive, and bode well for the product. The concept of barrier repair makes sense in light of the recent findings in regards to the genetic basis of atopic dermatitis. Repairing the barrier with Epiceram will reduce inflammation, and the results show that this reduction approaches that with a steroid. The biggest potential is using Epiceram as the base for many other compounds/conditions where the barrier is impaired like psoriasis, etc.Analysis: This study will increase the market significantly, because there is a non steroid option which has good efficacy, and repairs the barrier. Epiceram can be used as the base into which other compounds can be mixed, so that you can treat the primary condition, and repair the barrier. Dermatologists and other physicians, as well as patients are looking for a new treatment modality for atopic dermatitis, especially one that will have minimal or no side effects.

2007-11-12T22:14:00.000-08:00

Skin Scare: A Natural Disaster
Omaha, NE--The demand for organic isn't just growing, it's booming. And now the trend is leaping from food to skincare. In fact, industry analysts say people spend more than six billion dollars on natural products for face and body. That number is expected to reach 10+ billion by 2012.
Part of the appeal or organics is just what it implies--all natural ingredients, grown without pesticides. Most people assume that since organic food is so good for you, the same can be said for other products.
Shopper Danielle Kohlander agrees. "It seems like you're not hurting your skin or what you're putting in your body. It seems like it would be better."
Dermatologists say there are some pluses with going all natural. Eliminating artificial fragrances and preservatives do help some people with allergies and skin sensitivities to those ingredients. But it can also lead to rashes and itchy, red skin in others.
"I certainly see a lot of patients with atopic dermatitis or eczema or very sensitive skin that actually get irritated by a natural product," says Methodist dermatologist, Dr. Jill Nelson.
Dr. Nelson says the longer the list of ingredients in a product, the bigger your chance of having an allergy or sensitivity to something inside. She says two biggies that affect a lot of people, fruit acids and nut oils.
She says the assumption that organic and all natural is better isn't always true. "One could assume poison ivy could be grown organically without any pesticides but that would not be a good thing to use on your skin."
The lack of preservatives in many organic products also means the shelf life is much shorter than your regular goods and they can contaminate easier. Dermatologists recommend organic foundations, cleansers, and lip products get tossed every six months.
That news, plus, the higher price of going pure have some shoppers hesitant about jumping on the bandwagon.
"I'm not sure they're really doing what they say they're going to do especially at the kind of price they're sold at," says Jackie Hansel.
Doctors say there is a way to make sure you and the product have no problems.
"Test them in an unaffected area like the crease of the arm to see if they're developing irritation there," says Dr. Nelson. She also suggests reading labels so you know what's inside.
And if you think something is irritating your skin, Dr. Nelson says you can check by simplifying your routine and using bland products for a while--even water in some cases will work. Then eventually add your normal products--one at a time--to see what's causing problems. If this doesn't clear up the irritation, you may need to see a dermatologist.
Reported by Carol Wang,
Source:
www.action3news.com

2007-11-12T00:23:00.000-08:00

Children With Atopic Dermatitis Show Hypersensory Profile

Responses to a sensory profile questionnaire indicate that children with atopic dermatitis (AD) have hypersensory sensitivity, according to Israeli researchers.Senior investigator Dr. Ayelet Shani-Adir told Reuters Health that this was the first time such a study has been conducted. "We believe," she added, "that understanding the sensory and behavioral characteristics of AD patients can promote a multidisciplinary intervention program for children with AD and improve their quality of life."
As reported in the October issue of the Journal of the American Academy of Dermatology, Dr. Shani-Adir of Haemeq Medical Center, Afula and colleagues used the Short Sensory Profile, which covers a range of sensory modalities including tactile sensitivity and taste and smell, to study 53 patients with atopic dermatitis and 61 healthy controls aged 3 to 10 years.Assessment included behaviors such as avoidance of being barefoot in sand or grass, fear of falling, and reacting emotionally to touch.The AD children "had significantly higher sensory sensitivity than the control group (p = 0.013) ... in all sensory modalities except vestibular sensation," the investigators found. The highest difference was in the tactile subscale.The researchers therefore call for larger and more detailed studies of the sensory modulation dysfunction in this population in order "to promote development of effective intervention processes."
J Am Acad Dermatol 2007

2007-11-09T01:40:00.000-08:00

Gene mutation discovery might help improve eczema treatment

LONDON - A gene called 'filaggrin' undergoes different mutations in people from differing ethnic backgrounds and leads to dry skin, eczema and skin ailments, researchers from the Dundee University have found. The discovery has the potential to accelerate treatments for eczema of the skin.Lead researcher Professor Irwin McLean and colleagues had already found that defects in filaggrin were the cause of eczema. Now they have discovered that mutations in this gene are not uniform in people from all ethnic backgrounds. Some 15 different mutations have so far been identified in the gene.The findings are described in detail in the journal NatureMcLean's team has worked in conjunction with Dr Alan Irvine in Dublin in identifying the gene and its different mutations. Any person with only one mutation has a 60 percent risk of developing eczema, the team reported. However people with two mutations almost certainly develop eczema, the team added."Once we cracked this exceptionally difficult gene, we were surprised to learn how many different defects in filaggrin were waiting to be discovered, not only in European people, but other populations worldwide," McLean said.Eczema is a disease that affects one in five UK children. With the knowledge of these mutations doctors can start treatment protocols early.

2007-11-09T01:34:00.000-08:00

Eczema Care - Food Additives

The vast majority of foods we consume today contain additives. Additives can be natural or synthetically made and their are about 300 additives listed for UK use. There are 6 main groups:
Preservatives
Chemical preservatives are used to increase the shelf life of products by delaying the growth of bacteria and fungi.
Colourings
Colourings are used to make our food look attractive to eat. Many processed and pre-packed foods would not look at all appetising with the absence of colour.
Flavour Enhancers
These make our foods taste stronger and are often used in savoury products. For example monosodium glutamate to which some people are sensitive.
Antioxidants
Antioxidants prevent fatty foods from becoming rancid.
Stabilisers and Emulsifiers
Emulsifiers help to mix oil and water together whilst stabilisers help keep them together.
Sweeteners
These are mainly used in low calorie products, eg fizzy drinks, sugar substitutes.
There has been a great deal of interest in food additives over the past 20 years, mainly due to the changes in food labelling in the 1980's. Rather than just using generic terms on packing, each additive needs to be listed. Approved additives usually have the number 'E' and these have been approved by the EC (European Community).
It is extremely difficult to pinpoint the foods that may be affecting an individual's eczema. But, the general rule of thumb is to eat a diet based on fresh, home cooked food. When using processed or pre-prepared foods, check the labels for any particular additives you wish to avoid.
There are 11 azo colourings and 10 benzoate preservatives and these are the two groups of food additives believed to irritate eczema. The most commonly used additives are tartrazine E102, sunset yellow E110, armaranth E123 and ponceau E124.

2007-11-08T01:45:00.001-08:00

Recommended Eczema Goods

I have been riddled with eczema from a young age right through to my adulthood, and throughout that time I have tried many different products to help my skin condition. Some of the products are only available via prescription, but it is well worth a simple trip to your local doctor!
Here is a list of my favourite products.
• Mosituriser - Diprobase - This stuff is brilliant. It is really thick and will keep your skin moist for longer than any other moisuriser.
• Steroid - Betnovate - When you eczema becomes really bad, the doctor may prescribe you with a mild steroid cream. Betnovate works wonders and has really helped clear my skin.
• Soap - "Simple Soap" - You wash every day, so why not wash without irritating your skin. Simple Soap or any un-fragranced soap will not irritate your skin.
• Washing Powder - "NON-Biological" - any washing powder with those words on it will not irritate your skin!
• Deodorant - "Sensitive" - as long as the product has "Sensitive" written on it, then it shouldn't worsen your eczema.
• Dairy - Soya or goat's milk - I personally continue with regular milk, however Soya or goats milk is recommended by doctor's.
Most products are by trial and error. None will completely stop your condition but they won't worsen it. It may take some time before you have things right, but the effort is well worth it.
Sponsored links

2007-11-08T01:24:00.000-08:00

Latin Names?
This can cause a problem when common ingredients are not recognised. An example of this is arachis oil', which is the International Nomenclature of Cosmetic Ingredients (INCI) name for peanut oil. The only answer is for you to have a list with the Latin names of the ingredients that you must avoid and refer to this whenever buying products.
Ingredient (INCI Name)
Avocado (Persea gratissima)
Bitter Almond (Prunus amara)
Brazil Nut (Bertholletia excelsa)
Coconut (Cocos nucifera)
Cod Liver Oil (Gadi iecur)
Egg (Ovum)
Hazel Nut (Corylus rostrata/americana/avellana)
Macadamia Nut (Macademia ternifolia)
Melo (Cucumis melo)
Milk (Lac)
Mixed Fish Oil (Piscum iecur)
Pea (Pisum sativum)
Peanut Oil (Arachis oil)
Sesame (Sesamum indicum)
Soya (Glycine soja)
Sweet Almond/Almond Oil (Prunus dulcis)
Walnut (Juglans regia/nigra)

2007-11-08T01:19:00.001-08:00

What Do Steroids Do?
Steroids are essentially hormones and there are many different types with quite different actions. The human body makes it own steroids in the adrenal gland and these are vital for the body's normal function. Different types of synthetic steroids have been developed for use in medicine. There is a group called anabolic steroids, which some athletes take (illegally!) to help build up muscle mass, and these should not be confused with the steroids used in eczema. The other group is called catabolic steroids or glucocorticoids e.g. prednisolone); they are used as an oral medicine for a variety of different diseases because of their anti-inflammatory and immunosuppressive properties. This means that they act by damping down the activity of various immune cells that cause inflammation. Catabolic steroids have proved a very useful medicine, even lifesaving, in some medical conditions such as severe asthma or rheumatoid arthritis. The down side of this group of steroids is that if they are used at a high dose for a prolonged period they have many side-effects such as weight gain, bone thinning, decreased growth in children, high blood pressure and loss of muscle mass. Because of this, doctors try to use these at the lowest possible dose for short periods. This type of steroid is occasionally used in the treatment of a very severe flare-up of eczema. However, for the reasons already mentioned, they would normally be used for only a few weeks, starting at a high dose and then slowly decreasing. This method should prevent or minimise any serious side-effects. Fortunately, these anti-inflammatory steroids can also be made into creams for topical application - directly onto the skin. They act in a way like that of their oral counterpart, as they have been developed to try to produce the same anti-inflammatory properties without all the general ('systemic') side-effccts on the rest of the body, even after long-term use. This approach has been very successful and the topical steroids provide one of the main components in eczema treatment

2007-11-08T00:56:00.000-08:00

Hints & Tips

New emollient
If you are trying a new product, leave it on a patch of eczema-free skin for 24 hours, to check that your skin does not react to it.
Repeat Prescriptions
As most fellow suffers will know, repeat perscriptions for creams, dressings and antibiotics soon add up. Ask your pharmacist about a pre-paid perscription were £32.40 (2002 price) pays for every perscription you'll need for 4 months.
Handy emollient
Spoon the emollient into small pots to carry around with you. Baby food jars can be ideal for this.
Keeping a spare supply of your emollient at your workplace or in the car will help you to moisturise your skin when it is beginning to become dry and itchy, rather than by risking more problems by waiting until you get home.
Cool emollient
No, not a trendy emollient but rather if your skin is particularly hot and itchy, you may find it helpful to cool your emollients in the fridge before putting them on your skin. See also 'handy emollient'.
Body hair
Apply moisturising creams (emollients) downwards so that the hair on the arms and legs is combed. This will stop the hair from being itchy.
After bath
Apply creams as soon as possible after a bath, when the skin is well hydrated. This will help lock in the moisture. Adding an emollient to the bath water will also help lock in moisture - Remember bathing alone [ i.e. and not applying any creams afterwards ] will dry the skin out. Leave one hour between the application of applying emollients and topical corticosteroids.
Hand Held Games
Portable hand held games e.g. game boys are great ways for young kids to keep them amused when their eczema is bothering them. Because it helps to keep them distracted and keeps both their hands occupied so they don't scratch - it gives them something fun to do, and helps alleviate some anxiety during those times when they just want to tear themselves to bits. Save their use for those times and then the child can learn to use it as a positive self help strategy.
Face
If you apply emollients with your ringfinger ( second smallest ) you are less likely to put too much pressure on delicate areas such as your face.
Dab the lotion across the face and gently stroke it into the skin, using your ringfingers to stroke it out from the nose.
Soothing Sprays
In the warmer months keep a bottle of lavender water or rose water in the fridge. A quick spray every so often is wonderfully soothing and helps to prevent heat-related skin problems from gaining a foothold!
Shower Gel? Instead of Soap
Some people seem to find that they don't react to shower gels in the same way that they react to soaps. So you could try a shower gel instead.
Make-Up
Be careful - irritants, irritants, irritants....but not just make-up for the skin but also nail polish!
Sleep
In order to sleep I use to take a sleeping pill because the itching would keep me up for hours, now I put five to six drops of strong lavender on my pillow and read for a while. Usually I fall asleep much quicker and dont feel grumpy in the morning from the sleeping pills.
Housework
If you are about to wash dishes or do anything you know that will trigger your eczema, apply your emollients before and after the job. Some people find it helpful to use lotions underneath gloves, particularly if they are placing their hands in hot water.
Food
If you want to tackle the diet as a cause it is essential that you keep detailed records and seek the help of a dietician. Not all people with eczema find food makes their eczema worse.
Rubber seals
Emollients on clothing can cause problems with washing machines, as the rubber seals may be broken down. Washing emollient-smeared clothing inside old pillow cases can minimise the damage. Occasionally you should do a hot wash without clothes to help clean away the emollient deposits from previous washes. See also Boil Clothes hint below.
Dust Mites and Beds
An effective way to reducing dust mites is to hoover the matress of the bed on each side.
T-shirt Bath
Bath your baby in a long sleeve t-shirt to prevent scratching.
Nappy Changing
Undo the legs of the babygrow and pop each of them over the hands of your baby so that he/she cannot scratch their bare legs and tummys whilst your hands are occupied. It's also good fun!
Boil Clothes
I've been struggling with laundering my sons very greasy sleep suits for a couple of years, experiencing the common problem of trashed washing machine seals etc. But, I've found a solution, I boil them in washing-up liquid, rinse out all the soap suds and then wash them as usual in the washing machine with an extra rinse. The washing-up liquid dissolves the grease, saving a lot of time and effort. I hope this helps someone struggling with the same problem.
Toy warning
Be careful of itchy toys. Also tell your friends and relatives so that they do not waste their money on presents you can¹t use. Also tell them to buy cotton clothing.
Toy care
You can freeze soft toys overnight to kill dust mites.
Mix in Milk
If using sedatives then it is better to mix in with the milk. They can be strong tasting and could cause the baby to be sick which is the last thing you want. Mixing with the milk is a good way of getting it down without upsetting the baby.
File baby's nails at night time
Do the toe- nails as well. It is easier to file than it is to cut. If you have to cut the nails then it means they are too long and it will have already caused some bleeding.
Cover Hands
This is a tip to help those who have babies through to young children in helping them to cover one of the hardest parts of the body - the hands. I have found that using a pair of cotton socks over the hands then placing a piece of tubigrip - with a hole cut out along the side for the thumb to go through it - over the top of the sock is an easy, quick and cheap way of covering the hands. The tubigrip which holds the sock directly against the skin and prevents the sock from being removed -yet still allows kids to have the flexibilty to move their fingers around (even though covered). We came up with this idea when our daughter was in hospital - and all involved found it to be quite effective.
Torch to Distract
No! Don't set the baby alight! A great tip for distraction while dressing or changing a young child. A torch!! Show the child how to shine it on the roof/wall then let them go for it. Added tip.. keep the torch to change time so it doesnt lose its appeal so fast.

2007-11-07T00:14:00.000-08:00

Emollients
Emollients have been used for over 5,000 years and they form an essential part of the therapy for all dry skin conditions, including atopic and contact eczema.
Emollients are safe and effective and, in the majority of cases, mild to moderate eczema can be successfully treated by using emollient therapy alone.
Unfortunately, emollients are under used, as people often perceive them to be inactive moisturisers and do not understand why they are so important in controlling eczema. When used correctly as a daily skin care regime, emollients become effective ‘active treatments’. Emollient therapy is not just about products but understanding how and when to use them.
.
Why are emollients so effective?
Dry skin is one of the main symptoms of eczema. Changes in skin moisture levels cause a reduction in the barrier function, which in turn increases water loss, thus allowing the penetration of irritants and allergens which trigger eczema.
Itching is another major and most distressing symptom of eczema and produces an itch-scratch-itch cycle. Scratching leads to the release of histamine, a chemical in the body, which makes the itching worse and leads to skin damage. This also allows entry for irritants, allergens and bacteria which trigger eczema.
Emollients soothe and relieve the itch, producing an oily layer over the skin surface which traps water beneath it. The resulting restoration of the skin’s barrier function by emollients prevents penetration of irritants, allergens and bacteria thereby reducing or preventing the development of eczema. A good skin care routine using emollients can soothe, moisturise, and protect the skin, thus helping to reduce the need for steroid preparations. In mild to moderate eczema, topical steroids and calcineurin inhibitors (e.g. Elidel and Protopic) should only be necessary intermitently for flare-ups of eczema.
What are emollients?
Emollient is simply the medical word for moisturiser. However, emollients are different from cosmetic moisturisers in that they tend to be unperfumed and do not have anti-ageing ingredients. Applying emollients can be very time consuming and tedious, but it helps to know what they do for your skin. Emollients help skin to feel more comfortable and less itchy. They keep the skin moist and flexible, helping to prevent cracks. There are many types of emollients and they can be classified according to how they are applied.
Lotions, creams and ointments: applied directly to the skin.
Bath and shower oils: added to the bath water or directly to the skin in the shower.
Soap substitutes: used instead of soap to cleanse the skin.
Lotions
Lotions contain more water and less fat than creams. They spread easily and are cooling, but are not very effective at moisturising very dry skin. They are useful for hairy areas or for quick absorbtion if time is short.
Creams
Creams contain a mixture of fat and water and feel light and cool on the skin. They are easier to spread over sore skin and are not greasy. All creams contain preservatives and people can become sensitised to them, although this is rare. Creams need to be used liberally and frequently so that the skin is not allowed to dry out.
Ointments
Most ointments do not contain water; therefore they do not need a preservative. This makes them ideal for people who react to preservatives. Ointments are often stiff and greasy and some people may find them cosmetically unacceptable. However, because they are very effective at holding water in the skin, they are useful for very dry and thickened skin, under wet wraps or if a heavier cream is required at night. Ointments should not be used on weeping eczema – use a cream or lotion instead. The absence of preservatives in ointments makes them vulnerable to contamination by bacteria transferred from your skin. It is very important not to put your fingers into the pots of ointment. Instead decant some of the ointment into another clean container before applying to your skin.
Bath oils
Bubble baths are extremely drying and potentially irritating to people with eczema. However, daily baths remove dirt and skin debris which could cause infection. Bath oils and warm water clean and hydrate the skin coating it with a film of oil to trap water in the skin.
Some bath oils are fully-dispersing while others are semi-dispersing, leaving more or less oil on the skin. As with emollients it can be a case of trial and error. Experiment to see which suits your or your child’s skin best. Some doctors prescribe emulsifying ointment for bathing. This needs to be dissolved with boiling water first and whisked with a fork. Some people find this helpful, while others find it messy and time-consuming. Discuss with your doctor to find an emollient regime
that works best for you.
Bath oils can be used in the shower, either on a sponge, or applied all over before showering off.
It is also possible to obtain emollients specially designed for the shower. If you find that entering the water stings the skin, apply a soap substitute or emollient all over before entering the water. Be careful not to slip – always use a bath/shower mat. Grab rails are also helpful. Placing a towel in the bath may also be helpful especially when bathing an active baby. Bath oils do make a mess of the bath. Wipe around the bath with paper towels or tissues – this will absorb excess oil and shine the bath. Warn other bath users that the bath or shower may still be slippery. The bath may be cleaned with a bath cleaner but be careful to rinse it thoroughly before use.
Soap substitutes
Soap is alkaline and very drying to skin with eczema. The hands are particularly at risk, as they are washed more frequently. Each wash degreases the skin. Detergent base soap-substitutes (liquid soaps/cleansers) and perfumed products should also be avoided as they tend to irritate eczematous skin.
Emollient soap-substitutes do not foam and may take a little while to get used to. It is not essential to have bubbles to clean the skin and emollient washing creams are very effective at cleaning the skin. Soap-substitutes can either be applied before bathing, showering or washing or scoop up a handful of cream and apply over the skin while in the water.
Choosing the right emollient
The best emollient is one which the patient prefers because then you, or your child, will use it more frequently. Dermatology nurses sometimes give out emollients for people to try. Always try new emollients on a small area of unaffected skin first to test for a reaction.
Once you have chosen your emollients they will need to be used frequently to have maximum benefit. Ideally this would be every few hours but it should be at least 3 to 4 times a day – getting through a 500g tub per week is not unusual.
It is important to use emollient products for the purpose for which they were designed. Aqueous cream was designed as an emollient soap substitute and for this purpose it is acceptable.
However if aqueous cream is used as a leave on emollient cream it can irritate the skin of children with eczema and make it worse rather than better. In an audit of children attending a paediatric dermatology clinic using aqueous cream caused irritant reactions in more than fifty percent of the children (Cork et al 2003).¹
When and how to apply emollients
When the skin is very dry, using a combination of the three types of emollients helps to give the best hydration and restore the skin’s barrier function to normal. Emollients can be used in combination with other treatments which your doctor may prescribe, such as topical steroids and topical calcineurin inhibitors.
There are no standard rules regarding whether to apply a topical steroid preparation after or before using an emollient. Some people are happiest using an emollient first to prepare the skin, followed by the steroid. However, whichever order of care you choose it is important that you leave as long a period as practical, approximately 1/2 to 1 hour, between the two treatments to avoid diluting the strength of the topical steroid preparation, and to prevent the spread of topical steroids and calcineurin inhibitors to areas not affected by eczema.
Emollient cream or ointment

Use liberally and frequently – every hour if the skin is very dry, but at
least 3 times a day.

Apply gently in the direction of hair growth. Never rub up and down vigorously as this could trigger itching, block hair follicles or create more heat in the skin.
Apply emollients after bathing, while water is still trapped in the skin, for extra hydration.
Avoid putting hands into large tubs of emollient cream. Use a spatula to take out the correct amount each time and replace the lid immediately.
Alternatively, ask your doctor or pharmacist about pump dispensers for emollients.
Continue to use the emollient, even when the eczema has improved, this will help prevent flare-ups.
Apply the emollients to all of your skin
Storage depends on whether you prefer your emollient warm or cold – try either the airing cupboard or fridge.

Bath oil

Adding oil to warm, not hot, bath water cleanses and hydrates the skin., Pat (do not rub) the skin dry. Apply emollient.

Emollient soap substitutes
Use whenever you would use soap, but particularly on the hands and
while bathing or showering.

¹ An audit of adverse drug reactions to aqueous cream in children with atopic eczema: M.J Cork
et al Pharmaceutical Journal, Vol 271 29 November 2003,
The National Eczema Society is grateful to Dr. Michael Cork, Head of Academic Dermatology, University of Sheffield Medical School and Honorary Consultant dermatologist at Sheffield Childrens and Royal Hallamshire Hospitals for his
help in the preparation and review of this sheet.
Disclaimer
These details are only as a general guide. Individual circumstances differ and the National Eczema Society does not prescribe, give medical advice or endorse products or treatments. We hope you will find the information useful, but it does not replace and should not replace the essential guidance given by your general practitioner, dermatologist and dermatology nurse..
Updated and revised 04/06
©National Eczema Society 2006

2007-11-06T01:59:00.000-08:00

SUN SCREENS AND INGREDIENTS
WHAT TO LOOK FOR
Some people find that sunscreens can make their eczema worse. When you chose a sunscreen you will need to think about the same things as you would when choosing an emollient. You should always be careful and make sure that you test any new sunscreen before applying it to the whole of your body. Apply a small amount to the inside of the arm and wait 24 hours before using all over the body. If the skin becomes red and/or itchy do not use the sunscreen, but ask your pharmacist, nurse or doctor for further advice.
Sunscreens are made up of chemical absorbers, physical reflectors or a
mixture of both.
Chemical absorbers penetrate the skin and allow some UVA light to get to the skin but are a potential irritant.
Physical blockers such as titanium dioxide reflect the UVA, UVB and infra-red rays. They do not penetrate the skin and are therefore less Irritating. However, one drawback of titanium dioxide is that it tends to leave a white sheen on the skin, which may not be cosmetically acceptable.
Preservatives
Most sunscreens contain preservatives but one chemical in particular may cause an allergic reaction.
Methyldibromoglutaronitrile

This is a chemical found in a number of sunscreens which has caused an increase in allergic reactions in recent years. Typical reactions to the chemical are swelling, itching and acute dermatitis, which could be very painful. Products that are free from this chemical include:
Bergaderm Sunscreen mousse 12/20/30 UVA UVB
E45 Sun Lotions
Sunsense range of sun protection
Vichy Capital Soleil SPF60
Sunscreens on prescription are usually only prescribed for patients diagnosed with photo dermatosis/polymorphic light eruption (sun sensitivity). Prescribing sunscreens for eczema will usually be at the nurses/GP’s discretion.

On parts of the skin that are not covered remember to apply a high factor sunscreen, atleast factor 15, and reapply every two hours.
Whilst every effort has been made to provide accurate information in the following list, manufacturers may change their ingredients and you are advised to check the product contents on the packaging before use, or speak to your pharmacist regarding the contents.
Disclaimer
These details are provided only as a general guide. Individual circumstances differ and the National Eczema Society does not prescribe, give medical advice or endorse products or treatments. We hope you will find the notes helpful but they do not replace and should not replace the essential guidance, which can be given by your doctor.
©National Eczema Society 2007

2007-11-06T01:44:00.000-08:00

ECZEMA AND THE SUN
Many people find that their eczema improves with exposure to sunlight (this is particularly true of the contact and discoid types) while others experience a worsening of their condition. Whatever your own experience, the skin will still need protection from the sun’s harmful rays, both during the British Summer-time and when you are away on holiday in a warm climate. In this factsheet, we offer ways of protecting the skin from exposure to the sun.
The damaging effects of the sun
The fairer your skin, the greater the chance of burning. In the short-term, severe sunburn can result in blisters, sickness, shivering and fever but it is also important to consider the long-term effects of over-exposure to the sun.
These include premature ageing of the skin and even skin cancers. The B rays are responsible for burning, while the A rays can damage fibres in the lower levels of the skin, causing wrinkles and ageing.
General advice
Even on an overcast or cloudy day, the sun's rays will still reach you. Wearing loose long-sleeved cotton tops and trousers will protect arms and legs from the sun and a wide-brimmed hat will shield the head and face. Cotton and linen are the best materials for keeping cool. Creams and lotions should be applied to protect exposed skin.
In addition to sunscreens, it is vital to be sensible about the amount of sun exposure, particularly when on holiday. Wherever you are, the sun is always strongest between 11.00am and 2.00pm. Babies under 6 months should not be exposed to direct sunlight, so keep them in the shade at all times.
Protecting your skin
All sunscreens give protection against B rays; some also protect against A rays. The sun protection factor (SPF) tells you the extent to which the sunscreen filters out the B rays. The higher the SPF, the greater the degree of protection. SPF’s range from 2 up to 50, but someone with very fair skin or who has eczema that worsens in sunlight should use a cream with a factor of 15 or above.

The star rating on products indicates their protective effects against UVA rays. The more stars the higher the protection. Sunscreen should be pplied about every two hours.
Water-resistant creams may be better when swimming, but should still be re-applied afterwards.
Sunscreens can be very expensive, especially if you need to use them every day. In some cases, it may be possible to get certain brands on prescription. Alternatively, sunscreens can be bought over the counter. Ask your doctor or local pharmacist for their advice. Own brand products sold by chain stores are increasingly available and can be just as effective as the more expensive ones made by cosmetic companies.
Sunscreens
Sunscreens can irritate eczema in some people. When choosing a sunscreen to use you will need to consider the same factors as you would when choosing an emollient.
Ingredient labelled products will help you to avoid substances to which you have a known sensitivity, but you should always be careful and make sure that you test any new sunscreen before applying it to the whole body. Try not to rub too hard when applying cream as this will set off itching.
Another factor that you may wish to consider is whether to use a sunscreen based on
chemicals, which can irritate eczema, one containing a non-chemical mineral as its base (usually titanium dioxide), or a product that is a combination of both chemicals and minerals. Chemical sunscreens are absorbed into the skin whilst those containing titanium dioxide sit on the skin and act as a barrier. Therefore some people with eczema prefer to use mineral based or combination products rather than chemical sunscreens. Titanium dioxide can leave a white sheen on the skin and this can be off putting, particularly for those with darker skins. However, as with all products used on the skin, what works for one person with eczema will not necessarily suit another, so a process of trial and error
will probably be needed.
Remember that sunscreens are not designed to allow you to spend unlimited time in the sun but to provide protection when you are exposed to sunlight.
Moisturising and avoiding irritation
Sun exposure is drying to the skin. If you can, apply your emollient about half an hour before applying a sunscreen. This will stop the sunscreen from becoming diluted by the emollient and will make sure that the sunscreen keeps its protective properties. If you are using a moisturiser that is greasy or oily, be careful not to overdo the application of the moisturiser as this can cause a ‘frying’ effect. A better solution may be the purchasing of a UV sun suit to minimise the need for sun creams.
Salt water and sand may be irritating for some people with eczema, particularly if the skin is broken or cracked. Particles of sand or salt can lodge in the skin cracks and sting.
Chlorine can also be irritating for some people. It may help to apply a thick layer of emollient before swimming. A tepid shower or a soak in a bath, with oils suitable for eczema, will remove all particles of salt and sand and help to soothe the skin after a trip to the beach or the pool.

Light-sensitive eczema
Some types of eczema are directly caused or made worse by exposure to the sun, although this is rare. The term for this kind of eczema is photosensitive.
Certain drugs and chemicals such as antihistamines and antibiotics can also cause the skin to become sensitive to sunlight. Therefore if you are taking these for your eczema and are planning to spend time in the sunshine, check with your doctor.
Temperature control
Many people find that heat is a key factor in triggering their eczema. Covering up in light trousers and tops will not only protect against sun exposure (see above) but will help to keep you cool. Natural fibres for clothing, such as cotton or linen, are preferable to synthetic fabrics, which can make you feel hot and sweaty.
List of Companies supplying UV clothing for adults and children
Disclaimer
These details are provided only as a general guide. Individual circumstances differ and the National Eczema Society does not prescribe, give medical advice or endorse any products or treatments. We hope you find this information useful but they do not replace, and should not replace, the essential guidance which can be given your doctor or nurse.
National Eczema Society 2007
All rights reserved

2007-11-05T00:53:00.000-08:00

Moisturizers For Eczema Skin
Moisturizers have been found to help restore the skin barrier providing a protective layer on surface of the skin to trap water and prevent the penetration of irritants and allergens. As the diagram shows, an emollient cream is superior in trapping the moisture within the skin.

There are five randomized controlled trials showing benefit to emollient use in atopic eczema. Kantor showed a global improvement from the use of moisturizers. (Today Ther Trends 1993;11:157-66). Whilmer and Andersson showed the advantage of urea containing moisturizers.

CHOICE PRODUCTS:

Sticky: Vaseline, 25% water in Hydrophilic Petrolatum, unscented cold cream, aqueous cream.

Less sticky: Uremol, Dermalac, Lachydrin
Moisturizers Should:
Be perfume free and cosmetically acceptable to the patient
Protect – offer a layer of protection on the surface of the skin
Rehydrate - trap and hold water to return moisture to the skin
Restore - assist with restoring the barrier by filling in the holes and gaps in the skin barrier
As much as 400-500 grams of moisturizer (one to two entire bottles) a week is reasonable in children and proportionately more in adults. Several studies have shown that with increased moisturization the skin barrier can be restored, resulting in a significant reduction in the amount of topical medication used to manage eczema, especially in mild to moderate eczema. (Pediatri Dermatol 1997; 14:321-4) To have a maximal effect complete emollient therapy is needed to produce maximal rehydration, restoration of the barrier and prevention of penetration of potential irritants and allergens.
Complete Emollient Therapy Consists Of:
A mild soap-free cleanser
An emollient/therapeutic bath oil-not as effective as direct skin moisturizing
An emollient/moisturizing cream/lotion/ointment
When choosing a moisturizer look for the following ingredients: Petrolatum, mineral oil, silicone (protect), glycerin, panthenol, hyaluronic acid, propylene glycol, butylene glycol (rehydrate), stearyl alcohol, cetyl alcohol, tocopheryl acetate, prolipids (restore).

2007-11-05T00:41:00.001-08:00

Eczema Treatment Selection Chart

If There Is Improvement:
Maintain through moisturizing and intermittent anti-inflammatory
If Persistent Or Severe:
Moisturize
Increase strength of steroid
Continue immunomodulators
Consider oral or steroids
UV light
Oral immune supressants

2007-11-05T00:11:00.001-08:00

Asthma risk in young children with atopic eczema: A systematic review
October 31, 2007
A systematic review of published prospective follow-up studies concerning the relationship of early life atopic eczema (AE) to asthma in later childhood was conducted. Thirteen prospective cohort studies were included from 1960-2005; 4 birth cohort studies and 9 eczema cohort studies.
The pooled odds ratio (OR) for the risk of asthma after eczema (compared to children without eczema) was 2.14. The prevalence of asthma at age 6 years was 35.8% in inpatients with eczema cohort studies and 29.5% for a combined group of in and outpatients. The risk of developing asthma after eczema in early childhood was approximately one in every 3 children, a lower risk than previously reported (van der Hulst, A.E. et al. J Allergy Clin Immunol 2007, 120 (5): 565-569).

Prebiotics hinders development of skin allergy in babies at high risk

2007-11-04T00:19:00.000-07:00

Prebiotics can cut the chances of developing atopic dermatitis in babies at high risk of the disorder, suggests a study published ahead of print in the Archives of Disease in Childhood.
Human breast milk contains natural prebiotics (oligosaccharides), which promote the growth of bacteria, such as lactobacilli and bifidobacteria that boost the development of a healthy immune system.This can help prevent allergies in a very young child.
Researchers developed an infant formula based on the prebiotic content of human breast milk and tested it out on a group of babies one of other of whose parents had atopic eczema, or allergic rhinitis, or asthma.
All the mothers were advised to breastfeed their babies, all of whom were born after a normal length pregancy. But for those unable to start or continue, their babies were divided into two groups, with 102 given a prebiotic formula feed and 104 given a normal formula.
The babies were seen on a monthly basis up to the age of 6 months, and their parents kept a symptom diary.
Over the six months, only 10 babies fed the prebiotic formula developed atopic dermatitis, compared with 24 fed the normal formula. An assessment of stool samples from 98 of the babies showed a significant increase in bifidobacteria in those fed the prebiotic feed.
This strongly suggests that formula feed supplemented with prebiotics can modify the bowel bacteria and so reduce the chance of developing atopic dermatitis among children at high risk of the disorder.

http://adc.bmjjournals.com/

Knowing Your Child's Eczema

2007-11-01T04:36:00.000-07:00

What is eczema?

Eczema is a common skin condition affecting ten to twenty per cent of children. The exact cause of eczema is not known. However if there is a history of eczema, asthma or hay fever in the family, your child is more likely to develop one of these conditions. Unfortunately there is no cure for eczema, although there are many ways to keep it under control. Approximately fifty per cent of children will no longer be troubled by eczema by two years of age and eighty five per cent by five years of age.

Eczema is a red, hot, dry and itchy rash that can affect one or many areas on the face and body and it can be mild, moderate or severe. There are often scratch marks on the skin because of the itch. These areas may become infected with bacteria and this can worsen the eczema. If there is an infection, your child may need a course of oral antibiotics.

When the rash begins in the first few months of life it normally affects the face. The cheeks and chin become red, dry, hot and itchy. This is made worse by dribbling, hands touching the face and mouth and saliva irritating the skin. The scalp and facial blood vessels are dilated quickly if baby is overheated. At this age eczema may also affect the trunk and limbs, but the changes in these areas are not usually as severe. As the child becomes a toddler the eczema is less likely to affect the face and more likely to be present on the limbs and trunk. The napkin area is not usually affected. When the child becomes school aged the eczema tends to affect the hot areas of the body, such as the flexures of the neck, elbows, knees and buttocks for similar reasons.

What aggravates eczema?

HEAT, DRYNESS and PRICKLE aggravate eczema. It is important you are aware of these three factors and remove them from your child’s environment. You should keep your child COOL, well MOISTURISED and in LOOSE, LIGHT COTTON CLOTHING and BLANKETS.

Heat and Clothing

The skin of a child with eczema is very hot, and heat increases the itch. There are many things that can make your child hot. Clothing can aggravate eczema. It is best to dress your child in a couple of thin layers rather than a thick layer, as it is easier and more effective to remove the top layer of clothing to suit the environment and stop your child becoming hot and itchy than it is to change the environmental temperature.If your child is participating in physical activities, take a layer of clothing off before doing so to avoid over heating. Educate your child and his/her teachers about this too.

Heat and Bath time

A hot bath can heat your child and cause him/her to become itchy. Bath your child once a day in tepid water adding one capful of bath oil to the bath and use this as a soap substitute. Soaps and some pinetar preparations can be drying to the skin. Your child should be bathed at least two hours before bedtime. The bath should be a pleasurable experience; toys in the
bath are a good idea.

Heat and Car Trips

Travelling in the car can be an unpleasant experience when your child has eczema. The heat generated in the car can cause the child to become hot and itchy. Sunlight shades are beneficial in reducing the heat of the car. Heaters should be used minimally or switched off. It is important to try and predict the occurrence of overheating and also avoid clothing that may be applying pressure or trapping heat. Avoid long car trips if possible and dress your child for the car ride not for the destination. After the trip, assess the heat and itch of your child and institute the appropriate treatments, such as, removing clothing and if needed applying a wet dressing. If a long journey is unavoidable, ensure you take many breaks, use air-conditioning and apply wet dressings and cool compressing often. If your child scratches in the car, canvas armbands may need to be used.

Heat and Bedtime

Children often itch more at night because they get hot under the bed-covers, the skin has more contact with clothing and seams and many children are in a habit of waking. If the eczema is not in good control, children may have difficulty sleeping and may wake a few times each night. Children with eczema should ideally sleep in their own beds, so as not to overheat. Soft cotton or silk sheets and at most one thin cotton blanket are appropriate bed linen. Woollen underlies or blankets, plastic mattress protectors, or doona covers should not be used.

Frequent waking and scratching at night and blood on the sheets in the morning are signs that your child will need a wet dressing just before bed. Wet dressings improve the sleep pattern of children with eczema, by keeping them cool and reducing the itch. Your doctor may prescribe a sedative at night until the eczema and sleeping pattern improves. Antihistamines should NOT be used routinely, or for children under two years of age.

Heat and School

Your child should wear one to two thin cotton layers to school. Woollen jumpers will make them hot and itchy. It is important to educate your child’s teacher about factors that worsen eczema. Ask them not to sit your child next to the heaters. If your child is itchy at school they should apply moisturiser and a cool towel to the itchy area. The teacher should not make a fuss in front of the class. However, they should be aware to remind your child to apply treatment in a private place. On hot days, your child may wet his/her clothes to reduce the heat and itch of the skin.

Heat and Home

The home should be kept cool. Air blowing heaters are the most drying to the skin. It is best if your child’s bedroom is not heated. Remember, your child feels hotter and is more affected by heat than you. It is better to apply another layer of clothing rather than it is to turn up the heater. Do not be concerned about your child catching a “cold” from being under dressed as this is an old wives’ tale.

Dryness and the Skin

The skin should be moisturised many times a day to help with this dryness. There are many things that can dry the skin like water, air-blowing heaters, cleaning agents, soap, swimming and the environment, such as Victoria’s dry winds in summer and winter. Your child’s skin will be dryer in the winter as the humidity is lower and heaters are used more. You may notice the eczema will improve on a tropical holiday.

What moisturisers should I use and how often should I use them?

Children with eczema usually have very dry skin, which worsens the itchiness. Moisturisers are used to prevent the skin from drying and they should be used frequently, and are very important in the management of eczema. Moisturisers can be used alone and can also be applied over the steroid and tar creams and under wet dressings. They are applied as often as required to prevent the skin from becoming dry, which may be three to five times a day every day. And are applied all over the face and body and not just to the areas of eczema. They should be applied on a regular basis and continued until your child’s eczema has resolved. Your child should be encouraged to participate in and recognize the need for the application of moisturisers. If any creams irritate the skin, stop its use, apply a bland moisturiser, preferably in an ointment form and contact your local doctor or dermatologist if it continues. Some of the greasier moisturisers may cause blocked pores. The blocked pores look like small pimples. If this occurs, change the moisturiser to a cream or lotion base.

What clothes detergent should I use?

Detergents aggravate eczema skin and dry it by removing oil. Try to use Lux or Velvet soap in your washing machine and ensure a good rinse. Crepe bandages used for wet dressings may be washed in the washing machine. Disposable towels used for wet dressings should not be washed with detergents or soaps. Dry garments in a tumble dryer if possible, as clothes tend to dry softer than if hung on the line. Try to avoid baby wipes, as they tend to dry and irritate the skin.

Can my child go swimming?

Yes, your child is able to swim, however if they are having a flare of their eczema your doctor or nurse may suggest your child may need to stop swimming until the eczema improves. Prior to swimming apply moisturiser to the skin. After swimming remove the chorine/salt water in a cool fresh water shower with bath oil, and then apply a moisturiser before dressing.

Do dummies aggravate eczema?

Dummies may aggravate eczema around the mouth, chin and chest areas. This is because saliva wells up under the dummy and irritates the skin. Food products may also aggravate the skin around the mouth. This is not necessarily an allergy and the area is best protected with a thick ointment moisturiser. Eczema often gets worse during teething.

Prickle and the Skin

Clothing can worsen eczema especially when it has a “prickly” feeling. Large fibres, especially seams, wool, stitching, tags, frills and lace edges will make your child feel itchier. Small cotton or silk fibres are the fabrics of choice for clothing or bed linen. You need to be aware if your child is becoming itchy from a garment. If the seams are harsh turn the garment inside out and unpick the tags, or line areas with a piece of silk. Undergarments made of silk such as boxer shorts are popular with children with eczema for day and night time use. If you are unsure about a piece of clothing feel it. If it feels slightly rough or prickly to you it will be very irritating to your child.

My doctor has prescribed a cortisone cream. Is this safe?

Your doctor may prescribe a cortisone cream or ointment for areas of eczema on the face and body. These ointments help to settle inflammation and redness of eczema. Cortisone is a natural body hormone and if used as prescribed carefully by your doctor, is completely safe. Avoid strong cortisone ointments on the face and flexures, hydrocortisone is preferred for these areas. Ointments are preferred, as they are more moisturising than creams.

How do I apply cortisone ointments?

When using cortisone ointments apply a layer of the cortisone to the red areas. Cortisone ointments are best used once or twice a day only when the skin is red. Reduce its usage as the eczema settles. Cortisone ointments come in different strengths and your doctor should discuss with you what strength is appropriate for your child.

Is my child allergic to some foods?

Foods are not the single cause or cure of eczema. Only about ten per cent of children with eczema have proven allergies to diet. However if most of these children with food allergies stopped eating the foods they are allergic to they would still have some eczema and require the same topical treatments as other children with eczema. Children who have allergies to foods may be extremely itchy without a lot of redness. Other children with allergies to foods may develop a hive like reaction to foods immediately or within two or more hours after food. These reactions tend to start in the early months of life and are seen less often as children grow out of them. If you are concerned your child may have food allergies, keep a food diary and the reactions to these foods to show to your doctor. Some foods that may cause allergies are; egg, dairy, seafood and nuts, beef, chicken, wheat, citrus fruit and junk food. When starting a new food give only a small amount of each new food, do not give large amounts too quickly. Breast-feeding is the best form of milk for the baby with eczema. Do not restrict your child’s diet without consulting a doctor.

Dust mite and eczema

It would appear that the house dust mite can flare eczema. However, the degree of importance of the irritation of the house dust mite is controversial. Many people without eczema are allergic to house dust mite and many eczema sufferers do not improve greatly when they use anti-dust mite measures. From our experience, we think that house dust mite probably plays a minor role in most children’s eczema, but occasionally can be more important. Please discuss this issue further with your doctor if you are concerned.

Can I use splints/armbands on my child’s arms to stop him/her from scratching?

Armbands/splints may be required at times to stop your child from scratching. Armbands are better than mittens and allow the skin time to heal and improve. They are useful at night and in the car, or when you cannot supervise your child and when the itch is worse. Armbands should not be used all day long. During the day if you can, distract your child with activities to reduce scratching.

Can I immunise my child?

Your child should continue to have all immunisations unless told otherwise by your doctor. If your child is allergic to eggs there are no contra-indications for your child being immunised for measles, mumps or rubella. Although, if the reaction is severe, it is best to have the immunisation performed by your local doctor or immunisation clinic, and your child should not have the flu or yellow fever immunisation.

Wet Dressings for Eczema

Wet dressings are important for the effective treatment of eczema. Wet dressings are essential when your child is itchy and hot and if they are waking from the itch. Your child may need a wet dressing if they itch and scratch during the night, if there is blood in the sheets in the morning, and if the eczema is still present despite treatment with cortisone ointments, moisturisers and bath oils. You will need to apply wet dressings at night for a few nights to get it under control. Initially they may be required during the daytime but should be changed as soon as they are dry. Early use of wet dressings will reduce the amount of cortisone creams needed to control the eczema substantially. Parents who have used wet dressings, generally express great satisfaction with the technique.

Why do wet dressings help eczema?

COOL wet dressings help to reduce the itch.
The itch is worse when the skin is hot.
DAMP wet dressings help with the treatment of infection.
They help to clean the skin’s surface.
The skin is REHYDRATED with the moisturiser under the wet dressing.
Wet dressings PROTECT the skin from trauma.

What items do I need for a wet dressing?

Moisturiser (50% soft and 50% liquid paraffin or sorbolene cream)
Cortisone or tar cream if prescribed
Tepid water
Bowl
Disposable towels
Crepe bandages

How to apply a wet dressing

Wet disposable towels in a bowl of tepid water and one capful of bath oil.
Apply cortisone or tar creams, if they are due to be applied.
Apply moisturiser to the body and face.
Wrap the wet towels around the affected areas gently,using a few layers.
Wrap crepe bandages around the wet towels, firmly but not tightly. Avoid direct contact with the skin.

Wet dressings may be applied as often as required to any area of the body with eczema, for example, the elbow or the knee. The wet dressings will dry, please try not to leave the dressings on dry as dry dressings can irritate the skin by causing it to become hot, dry and itchy. Please note the water used in the wet dressing does not have to be cold. Wet dressings cool the skin by the water evaporating just like sweat.

Can I apply a wet dressing to my child’s head, neck or trunk?

No. It is not advised to wet dress the head, neck or trunk.

What can I use if my child’s face, neck, trunk and scalp are itchy?

Instead of using a wet dressing use cool compressing to areas on the face, head or other areas on the body for immediate relief. Wet cool compresses can be applied to the neck as a scarf (only knot once), and a wet bandana can be applied to the head. The scarf and bandana should be applied only under supervision. For the trunk, it is advised for you to apply a wet T-shirt or singlet over a layer of moisturiser if the trunk is red or itchy. A dry T-shirt can be applied over this.

To Cool Compress

Fill a bowl with COOL water
Add a capful of bath oil to the water
Add disposable towels to the water, and soak until wet
Apply moisturiser to the areas, i.e. soft and liquid paraffin to the face or scalp
Hold the wet disposable towel to the red, hot or itchy areas for five to ten minutes, repeat every half to one hour until the redness, heat or itch has subsided
Reapply moisturiser to the skin once the towel has been removed from the area

Wet dressings and cool compressing should not be used as a last resort treatment, when your child’s eczema is at its worse. Use these helpful techniques as soon as the eczema flares rather than leaving it until the eczema becomes severe and infected. Think of the wet dressing and cool compressing techniques as first line treatments when the eczema flares or becomes itchy.

If your child initially refuses to allow you to apply wet dressings or cool compressing, persist slowly with these techniques to keep your child’s eczema under control. Teach your child the value of wet dressings and encourage them to participate with the application or encourage your child to apply wet dressings to their doll. Rewards are important in encouraging the application and continuation of wet dressings and eventually your child will understand the benefits.

How will I know if my child’s eczema is infected and what should I do if it is?

When eczema is infected it is often crusted, the crusts are normally yellow in colour, there may also be areas of weeping, and this is often a sudden change in the normal eczema. Your child may also be itchier than usual and the skin may be painful to touch, when severe your child may find it difficult to extend their elbows or knees. Children with eczema may often get secondary infections if the eczema is not under control. The eczema becomes infected because children scratch and the skin is then broken. One small area of infection can flare the other areas of eczema.

The cold sore virus can also infect eczema.A sudden onset of clusters of blisters will result from this infection, which requires special treatment. Your child should avoid close contact with people with cold sores and school sores. If you think the eczema is infected you should go to your family doctor and have the infected areas swabbed. If your doctor thinks the eczema is infected he/she will start your child on a course of antibiotics. If there are areas of crusts it is very important to remove them, as if you do not remove the crusts you are not treating the infection properly as antibiotics cannot get to the crusts to treat the infection.

To remove the crusts

Fill a bowl with tepid water
Soak disposable towels in the water
Apply the wet towels to the crusted areas for five to ten minutes, while also trying to gently wipe the crusts away
Do this half to one hourly until the crusts have been removed. This usually takes between one to five hours and this may also
be done at bath time.
When the crusts are removed you can start the moisturisers and cortisone creams and wet dressings and cool compressing. If there are areas of weeping simply hold a wet disposable towel to the area for five to ten minutes every half to one hour until the weeping stops, if crusts persist you may need to continue to cool compress more frequently. Do not apply creams over weeping areas. Remember, if the skin is dry, moisturise it, and if it is wet, dry it out with wet towels.

My doctor has prescribed an antiseptic wash for my child, how does this help the eczema?

Antiseptic washes are important in the maintenance and treatment of eczema infections. They help to reduce the bacteria on the skin. When your child scratches and breaks the skin’s barrier the skin may become easily infected. By using an antiseptic wash the numbers of bacteria are reduced this helps to reduce the amount of skin infections. When the skin is infected it can be more difficult to keep under control. On the other hand some antiseptics can irritate the skin so it is important to use these only if directed by your doctor.

My daughter with eczema has behaviour that is to sometimes difficult to control, she often scratches to get my attention or to get what she wants, what should I do to help this situation?

Some children with eczema have learnt that if they scratch they will get what they want or attention from their parents. It is encouraged that parents do not give in to their child’s scratching behaviour. Scratching behaviour is often worse when the child is crying, stressed, upset or having a tantrum to get their own way. Treat the tantrum first and later deal with the eczema. When scratching gets attention the behaviour is more likely to be repeated. Avoid always telling your child to stop scratching or giving in; rather use distraction activities, especially ones using your child’s hands. Distraction is always a good way to stop children scratching by taking their mind off the skin and itch. Positive language should be given as often as possible, never use words such as ”bad skin”. It is common for childrens’ behaviour to deteriorate with the eczema. When the eczema is under control the behaviour usually improves. This can be due to many factors such as itchy, hot skin, and lack of sleep. Seek help and talk to your treating doctor or nurse if your child’s behaviour is worsening.

My child is eight months old and has had eczema since five months of age. He is waking four to six times a night, and has not gained weight for the past six weeks. He is eating and drinking well and has not had any vomiting or diarrhoea, why is this and how can I help?

When eczema is not well controlled, children may wake many times a night. This vicious circle can lead to the eczema and sleep pattern deteriorating more, the eczema becoming secondarily infected, and minimal or no weight gain. Poor weight gain can be attributed to poor sleep and feeding. Short and broken feeds can be associated with itch, this can produce broken feeding patterns. A child needs to sleep and feed well to help them gain weight and grow. To help your child sleep well it is important to keep them cool and apply wet dressings just before bedtime. You will need to apply wet dressings at bedtime until the eczema is under control and your child is sleeping well, the weight will also increase with this improvement. If the eczema is under control and the weight has not increased it is important to visit you family doctor for consultation on this matter.

As you can appreciate, eczema is influenced by many factors. Just as the skin is improving it may become worse again for no clear reason. Unfortunately this tends to happen with eczema. Remember to treat the flare as soon as possible with wet dressings, cool compressing and cortisone creams and maintain it with moisturisers and bath oils. Eczema takes a lot of time and attention to keep it under control, however it is easier to keep it under control than to manage it when it is infected or severe.

Written by Emma King, Dr George Varigos, Dr David Orchard and Dr John Su.
We would like to thank the children and their parents for their participation and time spent in helping
with the production of this booklet, and acknowledge the wonderful care given by the nurses and doctors
to the eczema patients admitted to the Royal Children’s Hospital.
This booklet was made possible by the generous support of Dermatec Laboratories,
manufacturers of Dermaveen Colloidal Oatmeal for eczema.
Illustrations by Jocelyn Bell
Designed by the Educational Resource Centre,
Women’s & Children’s Health Care Network, October 1999, 996082

A.T.S. Pharmaceuticals, A Division of Auriga Laboratories, Launches Zytopic(TM) Cream for the Treatment of Atopic Dermatitis

2007-11-01T03:27:00.000-07:00

LOS ANGELES, Oct 31, 2007 (BUSINESS WIRE) - Auriga Laboratories, Inc. (OTCBB:ARGA), a specialty pharmaceutical company building the first nationwide, commission-only pharmaceutical sales force, announced today the launch of Zytopic(TM) Cream convenience kit that contains Zytopic(TM) Cream (triamcinolone, USP 0.1%), as well as Clere(TM), a soap free cleanser, and Emolene(TM), a hypoallergenic moisturizer. The introduction of this brand adds to the current ATS portfolio which also includes Akurza(TM) Cream & Lotion (Salicylic Acid 6%), and the brand Xyralid(TM) (lidocaine HCl /hydrocortisone acetate) brand.

Zytopic(TM) Cream is indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses, such as atopic dermatitis. Clere(TM) is a hypoallergenic (no perfumes or dyes) cleanser to help manage pruritic conditions. Many cleansers contain detergents, perfumes, dyes and other allergens that further irritate sensitive skin commonly seen in atopic patients. Emolene(TM) is a hypoallergenic cleansing moisturizer also included in the Zytopic(TM) Cream Convenience Kit. Zytopic(TM) Cream will be promoted to dermatologists and primary care practitioners by the ATS Pharmaceutical division of Auriga.

The atopic dermatitis market, and the triamcinolone 0.1% segment, offers ATS the greatest sales opportunity to date. Over five million triamcinolone prescriptions are written on an annual basis according to Wolter Kluwers Health Data, generating estimated sales of over $36 million in the U.S. annually. "In addition, US treatment guidelines recommend the use of hypoallergenic emollients and soap-free cleansers as part of atopic dermatitis treatment regimens. The bundling of these three products into a convenience kit may assist patients to better comply with their physician's directions," said Philip S. Pesin, CEO of Auriga.

Zytopic(TM) Cream is contraindicated in patients with a history of hypersensitivity to any of the components of the lotion. Systemic absorption of topical corticosteroids has produced reversible hypothalamic-pituitary-adrenal (HPA) axis suppression, manifestations of Cushing's syndrome, hyperglycemia, and glucosuria in some patients. The following local adverse reactions are reported infrequently with topical corticosteroids, but may occur more frequently with the use of occlusive dressings. These reactions are listed in an approximate decreasing order of occurrence: burning, itching, irritation, dryness, folliculitis, hypertrichosis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis, maceration of the skin, secondary infection, skin atrophy, striae, miliaria.

SOURCE: Auriga Laboratories, Inc.

2007-10-31T01:46:00.000-07:00

A new study of atopic disease in families has come to the conclusion that fathers’ genes play an equal part in the spread of eczema.

Doctors have known for many years that eczema - also known as atopic dermatitis - runs in families. In the past, it was thought that if a baby suffered from eczema, it was more likely to have come from the mother’s side.

The latest study overturns that theory - suggesting that fathers’ genes are equally responsible.

The results come from information provided by 8,500 families taking part in the Children of the 90s study based at the University of Bristol. The project has already reported a dramatic rise in eczema and asthma over the last 20 years.

Researchers asked parents to report on their history of atopic disease (asthma, hayfever and eczema) and compared it with their children’s record of eczema upto the age of 3½.

Among the parents - 47 per cent of mothers and 41 per cent of fathers reported some atopic disease themselves with hayfever the most common.

In families where there was no history of eczema in either parent - 28 per cent of children showed signs of eczema as infants.

Where either the mother or father had eczema - 40 per cent of their children had eczema. If both parents had eczema - it went up to 52 per cent in their children.

The report’s author Dr Nellie Wadonda-Kabondo says: “While doctors have tended to group the atopic diseases together - our findings support the idea that there are several different genes involved.

“The child’s risk of developing eczema was much higher if parents had a history of eczema, but if parents had hay fever or asthma the risk of the child developing eczema was substantial only if both parents had one or both of these diseases.

“It is important to establish the patterns of how children inherit eczema so that we can search for the genes that cause this disease.”

Wadonda-Kabondo N, Sterne J, Golding J, Kennedy CTC. Archer C, Dunnill MG, Association of parental eczema, hayfever and asthma with atopic dermatitis in infancy: birth cohort study. Archives of Disease in Childhood.

http://www.bris.ac.uk

Books

2007-10-30T05:45:00.000-07:00

Books about atopic dermatitis.
Free download!

Children's books:

Penny's World Book
Download: http://www.mediafire.com/?6ij0in22umm

Under My Skin: A Kid's Guide to Atopic Dermatitis
Download: http://www.mediafire.com/?cyrczq927tl

Book:
Eczema: It's Time To Take Control
Download: http:// www.mediafire.com/?0tzyzj4qch1

2007-10-29T02:16:00.000-07:00

Factors That Make Atopic Dermatitis Worse

Many factors or conditions can make symptoms of atopic dermatitis worse, further triggering the already overactive immune system, aggravating the itch-scratch cycle, and increasing damage to the skin. These factors can be broken down into two main categories: irritants and allergens. Emotional factors and some infections and illnesses can also influence atopic dermatitis.

Irritants are substances that directly affect the skin and, when present in high enough concentrations with long enough contact, cause the skin to become red and itchy or to burn. Specific irritants affect people with atopic dermatitis to different degrees. Over time, many patients and their family members learn to identify the irritants causing the most trouble. For example, frequent wetting and drying of the skin may affect the skin barrier function. Also, wool or synthetic fibers and rough or poorly fitting clothing can rub the skin, trigger inflammation, and cause the itch-scratch cycle to begin. Soaps and detergents may have a drying effect and worsen itching, and some perfumes and cosmetics may irritate the skin. Exposure to certain substances, such as solvents, dust, or sand, may also make the condition worse. Cigarette smoke may irritate the eyelids. Because the effects of irritants vary from one person to another, each person can best determine what substances or circumstances cause the disease to flare.

Allergens are substances from foods, plants, animals, or the air that inflame the skin because the immune system overreacts to the substance. Inflammation occurs even when the person is exposed to small amounts of the substance for a limited time. Although it is known that allergens in the air, such as dust mites, pollens, molds, and dander from animal hair or skin, may worsen the symptoms of atopic dermatitis in some people, scientists aren't certain whether inhaling these allergens or their actual penetration of the skin causes the problems. When people with atopic dermatitis come into contact with an irritant or allergen they are sensitive to, inflammation-producing cells become active. These cells release chemicals that cause itching and redness. As the person responds by scratching and rubbing the skin, further damage occurs.

Common Irritants

Wool or synthetic fibers
Soaps and detergents
Some perfumes and cosmetics
Substances such as chlorine, mineral oil, or solvents
Dust or sand
Cigarette smoke

A number of studies have shown that foods may trigger or worsen atopic dermatitis in some people, particularly infants and children. In general, the worse the atopic dermatitis and the younger the child, the more likely food allergy is present. An allergic reaction to food can cause skin inflammation (generally an itchy red rash), gastrointestinal symptoms (abdominal pain, vomiting, diarrhea), and/or upper respiratory tract symptoms (congestion, sneezing, and wheezing). The most common allergenic (allergy-causing) foods are eggs, milk, peanuts, wheat, soy, and fish. A recent analysis of a large number of studies on allergies and breastfeeding indicated that breastfeeding an infant for at least 4 months may protect the child from developing allergies. However, some studies suggest that mothers with a family history of atopic diseases should avoid eating common allergenic foods during late pregnancy and breastfeeding.

In addition to irritants and allergens, emotional factors, skin infections, and temperature and climate play a role in atopic dermatitis. Although the disease itself is not caused by emotional factors, it can be made worse by stress, anger, and frustration. Interpersonal problems or major life changes, such as divorce, job changes, or the death of a loved one, can also make the disease worse.

Bathing without proper moisturizing afterward is a common factor that triggers a flare of atopic dermatitis. The low humidity of winter or the dry year-round climate of some geographic areas can make the disease worse, as can overheated indoor areas and long or hot baths and showers. Alternately sweating and chilling can trigger a flare in some people. Bacterial infections can also trigger or increase the severity of atopic dermatitis. If a patient experiences a sudden flare of illness, the doctor may check for infection.

2007-10-29T02:14:00.000-07:00

Natural Remedies for Eczema

1) Probiotics

Probiotics, or "good" bacteria, are live microbial organisms naturally found in the digestive tract. They are thought to suppress the growth of potentially harmful bacteria, influence immune function, and strengthen the digestive tract's protective barrier.

Studies suggest that babies at high risk for allergic disorders such as eczema have different types and numbers of bacteria in their digestive tracts than other babies, and that probiotic supplements taken by pregnant women and children may reduce the occurrence eczema in children.

A large, long-term study examined whether the use of a probiotic supplement or a placebo could influence the incidence of eczema in infants. Researchers randomized 1223 pregnant women carrying high-risk babies to use a probiotic supplement or a placebo for 2 to 4 weeks before deliver.

Starting from birth, infants received the same probiotics as their mothers had plus galacto-oligosaccharides (called a "prebiotic" because it has been shown to help multiple strains of beneficial bacteria flourish) for 6 months. After 2 years, the probiotics were significantly more effective than placebo at preventing eczema.

In addition to the use of probiotics to prevent eczema, probiotics have also been explored as a treatment for infants and children who already have eczema. Some studies have found that probiotics alleviate symptoms of eczema only in infants and children who are sensitized to food allergens.

Researchers are testing different strains of bacteria to see if one particular strain is more effective for eczema. One of the most commonly used probiotic strains used in eczema studies is Lactobacillus GG. Other strains used include Lactobacillus fermentum VRI-033 PCC, Lactobacillus rhamnosus, Lactobacillus reuteri, and Bifidobacteria lactis. The prebiotic galacto-oligosaccharides has also been used.

Consult a qualified health professional before using probiotics. Children with immune deficiencies should not take probiotics unless under a practitioner's supervision. For more information about probiotics, read Acidophilus and Other Probiotics.

2) Topical Herbal Creams and Gels

Gels and creams made from herbal extracts of chamomile, licorice, and witch hazel have been explored to reduce symptoms of eczema. The following are results of some of the preliminary studies.

A double-blind study compared a 1% and 2% licorice gel compared to a placebo gel for eczema. After two weeks, both the 1% and 2% licorice gels were more effective than the placebo gel, and the 2% gel was more effective at reducing redness, swelling, and itching than the 1% gel.
A study compared chamomile cream to 0.5% hydrocortisone cream or placebo. After two weeks, the chamomile cream was more effective than the hydrocortisone cream, but was not significantly more effective than the placebo cream. This study was not double-blind, so it cannot be used as proof that chamomile cream is effective for eczema.
In a German double-blind study, 72 people with moderately severe eczema used either a placebo cream containing witch hazel extract, 0.5% hydrocortisone cream, or the cream alone for 14 days. The hydrocortisone was more effective than witch hazel. Witch hazel was not significantly more effective than the placebo cream.

Consult a qualified practitioner before using any topical herbal applications. Some herbs, such as chamomile, are known to cause allergic contact dermatitis.

3) Gamma-linolenic Acid

Gamma-linolenic acids (GLA), such as evening primrose oil and borage oil, are a type of essential fatty acid. GLA has been shown to correct deficiencies in skin lipids that can trigger inflammation, which is why it is thought to help with eczema. However, recent, well-designed clinical studies with GLA have generally found that it does not help with eczema.

For example, one double-blind study examined the use of borage oil (500 mg a day) or placebo in 160 adults with moderate eczema. After 24 weeks, the overall effectiveness was not significantly better with borage oil compared with the placebo.

Atopic Dermatitis Pictures

2007-10-29T02:06:00.001-07:00

Atopic dermatitis is quite often seen on the cheeks of infants. It consists of red (erythematous), scaling plaques that are diffusely scattered over the infant's body and face.

This person has inherited allergic skin inflammation (atopic dermatitis) on the arms. Red (erythematous), scaly plaques can be seen on the inside of the elbows (antecubital fossa). In adults, atopic dermatitis usually involves the body creases, or flexural areas (antecubital fossa and popliteal fossa).

These red (erythematous), scaly plaques on the legs are caused by an inherited allergic condition called atopic dermatitis. Many of these areas have been scratched until they are raw and infected, with the infection triggering and perpetuating the problem. In adults, atopic dermatitis frequently involves the body creases (inside elbows, behind knees).

2007-10-29T02:00:00.001-07:00

Atopic Dermatitis (Atopic Eczema)

Atopic Dermatitis (or Atopic Eczema) is a chronic relapsing inflammatory skin disorder in infancy and childhood associated with increased serum IgE levels, allergen sensitisation and a family history of allergic diseases.

Symptoms for severe cases of atopic dermatitis are:

persistent skin lesions;
regular use of topical steroids;
co-existent allergic morbidities (diarrhea, vomiting, rhinitis, wheeze);

Originally controversial, the association of food allergy with atopic dermatitis has now been clearly demonstrated, especially in severe disease of infancy.

The association between food allergy and atopic dermatitis has been demonstrated through various studies and clinical observations: 37% of children with atopic eczema have food allergy.

There is an increasing prevalence with increasing severity. Many children out-grow their allergies. Transient allergies include those to milk, eggs, soy and wheat, whereas allergies to peanut, tree nuts, fish and shellfish appear to be more persistent.

The management of infantile atopic dermatitis should therefore incorporate appropriate strategies to diagnose and manage underlying food allergies. Food elimination has been shown to resolve symptoms of atopic dermatitis.
In cases where appropriate dietary elimination must accompany measures taken to reduce inflammation in the skin, treatment goals are twofold the control of cutaneous symptoms and the promotion of optimal growth.

by AAA Editorial Board
Date of publication: 01/02/2006

Dust mite

2007-10-29T00:49:00.001-07:00

Dust mite

The house dust mite may be an important year-round cause of atopic dermatitis (eczema) and asthma.

Dermatophagoides pteronyssinus, the house dust mite, can only be seen with a microscope but it is nevertheless a common and significant cause of allergy. It may make the nose run or cause sneezing and wheezing. In some patients it also contributes to exacerbations of atopic dermatitis.

The dust mite hides in the dust that can be found in even the cleanest bedroom – deep in carpets and curtains and in the seams of mattresses, where even the most house-proud individual can't find it. It thrives in poorly ventilated and humid homes.

Bedding

The dust mite's favourite haunt is bedding, particularly mattresses. If sleeping in a bunk, an allergy-prone child is best on the top mattress.
The dust mite may be found in high concentrations in bedding made from wool, cotton and artificial fibres. Wash and dry the sheets every week.
Obtain special mite resistant covers for pillow, mattress and duvets.
Wash the bedding in hot water (at least 54 Celcius) regularly or use a dust mite control laundry additive.

Measures to reduce the numbers of house dust mite.

Use a vacuum cleaner that has a HEPA filter. Vacuum all carpets each week, especially in the bedrooms and under the beds. If you can, choose vinyl flooring rather than carpet as it tends to hoard less dust. Vacuum upholstery and curtains, and don't forget the mattress and blankets.
Use a damp duster to do the cleaning as it is much better at collecting dust than a dry one.
Wash curtains regularly. There is less dust when curtains are made of lightweight materials. They also need to be vacuumed often, and wash them regularly too (perhaps six-weekly).
Hang clothes up in wardrobes, and that includes the dressing gowns! Make sure the wardrobe is well ventilated, or consider a chemical moisture remover such as anhydrous calcium chloride flakes.
Dehumidifiers can reduce numbers of house dust mites, as they prefer a moist environment.
Put soft toys in the freezer for a few hours.

Can Soaps & Detergents Cause A Rash?

2007-10-29T00:46:00.001-07:00

Source: http://www.medicinenet.com

Can Soaps & Detergents Cause A Rash?

Medical Author: Alan Rockoff, MD
Medical Editor: Frederick Hecht, MD, F.A.A.P.

For years, patients have been coming to my office with eczema, complaining that they had changed their soaps and detergents but their rashes had not gone away.

The first thing I always tell them is: "Contrary to what you've heard, eczema is rarely, if ever, caused by soaps and detergents."

I say this because it fits with my experience. People get rashes when they haven't used anything different, and they don't become consistently better if they keep shifting products in a futile effort to locate the culprit in the laundry.

And now -- at last! -- there is published scientific evidence to back up my experience.

In the Journal of the American Academy of Dermatology, Donald V. Belsito from the University of Kansas and his colleagues in the North American Contact Dermatitis Group published an article entitled "Allergic contact dermatitis to detergents: A multicenter study to assess prevalence." Their conclusion reads, in part: "Laundry detergents appear to be a rare cause of ACD [allergic contact dermatitis]." They found that fewer than 1% of patients, in whose cases a laundry product was suspected, reacted to allergy testing with detergent. The authors added that the true prevalence of allergy may have been even less than this small number since several patients who did react may simply have had an irritation rather than a true allergy.

No single study, however carefully done, ever settles a complicated issue once and for all. Still, it's gratifying to see science confirm clinical experience. Many cases of eczema reflect heredity or sensitivity rather than allergy. These rashes come and go as they please. Despite their unexplained onset and fluctuations, treatment can control them with little effort or risk.

So, before you chuck all your expensive soap, detergent, fabric softener, shampoo, or makeup, put conventional wisdom on hold and check with a physician to see whether what you're doing is helpful or just a waste of time and money.

Reference: Belsito, D. Journal of the American Academy of Dermatology; ""Allergic contact dermatitis to detergents: A multicenter study to assess prevalence." February 2002

A Breakthrough Treatment for Eczema

2007-10-29T00:36:00.000-07:00

Source: http://www.medicinenet.com

A Breakthrough Treatment for Eczema

Medical Author: Alan Rockoff, MD
Medical Editor: Leslie J. Schoenfield, MD, PhD

The word "breakthrough" is overused. If every hot item reporters gush about on the evening health news were the real thing, we would have "broken through" a long time ago. Instead, the word is often applied to soon-forgotten advances that aren't and cures that don't.

Every once in a while, however, something new comes along that represents a genuine breakthrough. In 2001, the FDA approved tacrolimus (brand-name: Protopic) for treating eczema, also known as atopic dermatitis. Protopic is the first effective nonsteroid treatment for this common, chronic, itchy condition. A related drug, pimecrolimus (brand-name: Elidel), is now on the market.

These new drugs are referred to as "immune modulators." They were first used internally to help patients with kidney and liver transplants avoid rejecting the organs they received. They work by suppressing the immune system. When these drugs are used externally to treat the skin, however, they do not weaken or change the body's immune system. Also, unlike topical steroids (cortisone creams), these new medications don't cause thinning of the skin and breaking of superficial blood vessels (atrophy).

The major side effect of these new topical medications is a sensation of burning of the skin. Some patients complain that their skin stings or burns for a period after they apply the cream. This feeling tends to lessen as the skin heals. At this point neither Protopic nor Elidil is approved for use in children under the age of 2. However, when further studies are complete, doctors will most likely be able to treat infants and very young children too.

The good news is that these immune modulators work. Many patients who respond poorly or not at all to topical steroids do very well when they use this new class of medication. This doesn't mean that steroid creams won't be used anymore. Properly prescribed, these old standbys are safe and effective for many situations, even for children, or in sensitive areas like the face or groin.

It is also important to remember that no drugs, including the new ones, cure eczema altogether. This condition represents an inherited sensitivity that tends to recur throughout life. Still, many patients with atopic dermatitis will now be able to achieve comfortable and better-looking skin by using tacrolimus, pimecrolimus, and the related medications that are sure to follow.

What is atopic dermatitis?

2007-10-29T00:28:00.000-07:00

Atopic dermatitis is a chronic (long-lasting) disease that affects the skin. The word "dermatitis" means inflammation of the skin. "Atopic" refers to diseases that are hereditary, tend to run in families, and often occur together. These diseases include asthma, hay fever, and atopic dermatitis. In atopic dermatitis, the skin becomes extremely itchy and inflamed, causing redness, swelling, cracking, weeping, crusting, and scaling.

Atopic dermatitis most often affects infants and young children, but it can continue into adulthood or first show up later in life. In most cases, there are periods of time when the disease is worse, called exacerbations or flares, which are followed by periods when the skin improves or clears up entirely, called remissions. Many children with atopic dermatitis enter into a permanent remission of the disease when they get older, although their skin often remains dry and easily irritated. Environmental factors can activate symptoms of atopic dermatitis at any time in the lives of individuals who have inherited the atopic disease trait.

What is the difference between atopic dermatitis and eczema?

Eczema is a general term for many types of skin inflammation (dermatitis). Atopic dermatitis is the most common of the many types of eczema. Several other forms have very similar symptoms. The diverse types of eczema are listed and briefly described below.

Types of Eczema

Atopic dermatitis: a chronic skin disease characterized by itchy, inflamed skin
Contact eczema: a localized reaction that includes redness, itching, and burning where the skin has come into contact with an allergen (an allergy-causing substance) or with an irritant such as an acid, a cleaning agent, or other chemical
Allergic contact eczema: a red, itchy, weepy reaction where the skin has come into contact with a substance that the immune system recognizes as foreign, such as poison ivy or certain preservatives in creams and lotions
Seborrheic eczema: a form of skin inflammation of unknown cause that presents as yellowish, oily, scaly patches of skin on the scalp, face, and occasionally other parts of the body
Nummular eczema: coin-shaped patches of irritated skin-most commonly on the arms, back, buttocks, and lower legs-that may be crusted, scaling, and extremely itchy
Neurodermatitis: scaly patches of skin on the head, lower legs, wrists, or forearms caused by a localized itch (such as an insect bite) that becomes intensely irritated when scratched
Stasis dermatitis: a skin irritation on the lower legs, generally related to circulatory problems
Dyshidrotic eczema: irritation of the skin on the palms of hands and soles of the feet characterized by clear, deep blisters that itch and burn

How common is atopic dermatitis?

Atopic dermatitis is very common. It affects males and females equally and accounts for 10 to 20 % of all referrals to dermatologists (doctors who specialize in the care and treatment of skin diseases). Atopic dermatitis occurs most often in infants and children and its onset decreases substantially with age. Scientists estimate that 65 percent of patients develop symptoms in the first year of life, and 90 percent develop symptoms before the age of 5. Onset after age 30 is less common and often occurs after exposure of the skin to harsh conditions. People who live in urban areas and in climates with low humidity seem to be at an increased risk for developing atopic dermatitis.

About 10% of all infants and young children experience symptoms of the disease. Roughly 60 percent of these infants continue to have one or more symptoms of atopic dermatitis even after they reach adulthood. This means that more than 15 million people in the United States have symptoms of the disease.

What causes atopic dermatitis?

The cause of atopic dermatitis is not known, but the disease seems to result from a combination of genetic (hereditary) and environmental factors. Evidence suggests that the disease is associated with other so-called atopic disorders such as hay fever and asthma, which many people with atopic dermatitis also have. In addition, many children who outgrow the symptoms of atopic dermatitis go on to develop hay fever or asthma. Although one disorder does not cause another, they may be related, thereby giving researchers clues to understanding atopic dermatitis.

In the past, it was thought that atopic dermatitis was caused by an emotional disorder. We now know that emotional factors such as stress can exacerbate, but do not cause the condition.

Is atopic dermatitis contagious?

No. Atopic dermatitis is definitely not contagious; it cannot be passed from one person to another. There is no cause for concern in being around someone with even an active case of atopic dermatitis.

What are the symptoms of atopic dermatitis?

Symptoms vary from person to person. The most common symptoms are dry, itchy skin, cracks behind the ears, and rashes on the cheeks, arms, and legs. The itchy feeling is an important factor in atopic dermatitis, because scratching and rubbing in response to itching worsen the skin inflammation that is characteristic of this disease. People with atopic dermatitis seem to be more sensitive to itching and feel the need to scratch longer in response. They develop what is referred to as the "itch-scratch" cycle. The extreme itchiness of the skin causes the person to scratch, which in turn worsens the itch, and so on. Itching is particularly a problem during sleep, when conscious control of scratching decreases and the absence of other outside stimuli makes the itchiness more noticeable.

How atopic dermatitis affects the skin can be changed by patterns of scratching and resulting skin infections. Some people with the disease develop red, scaling skin where the immune system in the skin becomes very activated. Others develop thick and leathery skin as a result of constant scratching and rubbing. This condition is called lichenification. Still others develop papules, or small raised bumps, on their skin. When the papules are scratched, they may open (excoriations) and become crusty and infected. The box below lists common skin features of the disease. These conditions can also be found in people without atopic dermatitis or with other types of skin disorders.

Can atopic dermatitis affect the face?

Yes. Atopic dermatitis may affect the skin around the eyes, the eyelids, and the eyebrows and lashes. Scratching and rubbing the eye area can cause the skin to change in appearance. Some people with atopic dermatitis develop an extra fold of skin under their eyes, called an atopic pleat or Dennie-Morgan fold. Other people may have hyperpigmented eyelids, meaning that the skin on their eyelids darkens from the inflammation or hay fever (allergic shiners). Patchy eyebrows and eyelashes may also result from scratching or rubbing.

Is the sufferer's skin type important?

Yes. Differences in the skin of people with atopic dermatitis may contribute to the symptoms of the disease. The epidermis, which is the outermost layer of skin, is divided into two parts: the inner part, which contains moist, living cells; and the outer part, which consists of dry, flattened, dead cells. Under normal conditions, the outer layer of skin acts as a barrier, keeping the rest of the skin from drying out and protecting other layers of skin from damage caused by irritants and infections. When this barrier is damaged or is naturally thin, irritants act more intensely on the skin.

The skin of a person with atopic dermatitis loses too much moisture from the epidermal layer. This allows the skin to become very dry, which reduces its protective abilities. In addition, the skin is very susceptible to recurring disorders, such as staphylococcal and streptococcal bacterial skin infections, warts, herpes simplex, and molluscum contagiosum (which is caused by a virus).

Skin Features of Atopic Dermatitis

Lichenification: thick, leathery skin resulting from constant scratching and rubbing
Papules: small raised bumps that may open when scratched, becoming crusty and infected
Ichthyosis: dry, rectangular scales on the skin
Keratosis pilaris: small, rough bumps, generally on the face, upper arms, and thighs
Hyperlinear palms: increased number of skin creases on the palms
Urticaria: hives (red, raised bumps), often after exposure to an allergen, at the beginning of flares, or after exercise or a hot bath
Cheilitis: inflammation of the skin on and around the lips
Atopic pleat (Dennie-Morgan fold): an extra fold of skin that develops under the eye
Hyperpigmented eyelids: eyelids that have become darker in color from inflammation or hay fever

What are the stages of atopic dermatitis?

Atopic dermatitis affects each child differently, both in terms of onset and severity of symptoms. In infants, atopic dermatitis typically begins around 6 to 12 weeks of age. It may first appear around the cheeks and chin as a patchy facial rash, which can progress to red, scaling, oozing skin. The skin may become infected. Once the infant becomes more mobile and begins crawling, exposed areas such as the knees and elbows may also be affected. An infant with atopic dermatitis may be restless and irritable because of the itching and discomfort. Many infants improve by 18 months of age, although they remain at greater than normal risk for dry skin or hand eczema later in life.

In childhood, the rash tends to occur behind the knees and inside the elbows, on the sides of the neck, and on the wrists, ankles, and hands. Often, the rash begins with papules that become hard and scaly when scratched. The skin around the lips may be inflamed, and constant licking of the area may lead to small, painful cracks. Severe cases of atopic dermatitis may affect growth, and the child may be shorter than average.

The disease may go into remission. The length of a remission varies, and it may last months or even years. In some children, the disease gets better for a long time only to come back at the onset of puberty when hormones, stress, and the use of irritating skin care products or cosmetics may cause the condition to flare.

Although a number of people who developed atopic dermatitis as children also experience symptoms as adults, it is unusual (but possible) for the disease to show up first in adulthood. The pattern in adults is similar to that seen in children; that is, the disease may be widespread or limited. In some adults, only the hands or feet may be affected and become dry, itchy, red, and cracked. Sleep patterns and work performance may be affected, and long-term use of medications to treat the condition may cause complications. Adults with atopic dermatitis also have a predisposition toward irritant contact dermatitis, especially if they are in occupations involving frequent hand wetting, hand washing, or exposure to chemicals. Some people develop a rash around their nipples. These localized symptoms are difficult to treat, and people often do not tell their doctor because of modesty or embarrassment. Adults may also develop cataracts that are difficult to detect because they cause no symptoms. Therefore, the doctor may recommend regular eye exams.

How is atopic dermatitis diagnosed?

Currently, there is no single test that says unequivocally "this is atopic dermatitis" and there is no single symptom or feature that can be used to identify the disease. Each patient experiences a unique combination of symptoms, and the symptoms and severity of the disease may vary over time. The doctor bases the diagnosis on the individual's symptoms and may need to see the patient several times to make an accurate diagnosis. It is important for the doctor to rule out other diseases and conditions that might cause skin irritation. In some cases, the family doctor or pediatrician may refer the patient to a dermatologist or allergist (allergy specialist) for further evaluation.

A valuable diagnostic tool is a thorough medical history, which provides important clues as to the possible causes of the patient's ailment. The doctor may ask about all of the following: a family history of allergic disease; whether the patient also has diseases such as hay fever or asthma; exposure to irritants; sleep disturbances; any foods that seem to be related to skin flares; previous treatments for skin-related symptoms; use of steroids; and the effects of symptoms on schoolwork, career, or social life. Sometimes, it is necessary to do a biopsy of the skin or patch testing to determine if the skin's immune system overreacts to certain chemicals or preservatives in skin creams. A preliminary diagnosis of atopic dermatitis can be made if the patient has three or more characteristics from each of two categories: major features and minor features. Some of these characteristics are listed in the box below.

Skin scratch/prick tests (which involve scratching or pricking the skin with a needle that contains a small amount of a suspected allergen) and blood tests for airborne allergens generally are not as useful in diagnosing atopic dermatitis as a medical history and careful observation of symptoms. However, they may occasionally help the doctor rule out or confirm a specific allergen that might be considered important in the diagnosis. Negative results on skin tests are reliable and may help rule out the possibility that certain substances are causing skin inflammation in the patient. However, positive skin scratch/prick test results are difficult to interpret in people with atopic dermatitis and are often inaccurate. In some cases, where the type of dermatitis is unclear, blood tests to check the level of eosinophils (a type of white blood cell) or IgE (an antibody whose levels are often high in atopic dermatitis) are helpful.

Major and Minor Features of Atopic Dermatitis

Major Features

Intense itching
Characteristic rash in locations typical of the disease
Chronic or repeatedly occurring symptoms
Personal or family history of atopic disorders (eczema, hay fever, asthma)

Some Minor Features

Early age of onset
Dry, rough skin
High levels of immunoglobulin E (IgE), an antibody, in the blood
Ichthyosis
Hyperlinear palms
Keratosis pilaris
Hand or foot dermatitis
Cheilitis
Nipple eczema
Susceptibility to skin infection
Positive allergy skin tests

What factors can aggravate atopic dermatitis?

Many factors or conditions can intensify the symptoms of atopic dermatitis, which can trigger the following cycle: further stimulating the already overactive immune system in the skin; aggravating the itch-scratch cycle; and increasing damage to the skin. These exacerbating elements can be broken down into two main categories; irritants and allergens. Emotional factors and some infections can also influence atopic dermatitis.

What are skin irritants in patients with atopic dermatitis?

Irritants are substances that directly affect the skin, and when used in high enough concentrations with long enough contact, cause the skin to become red and itchy or to burn. Specific irritants affect people with atopic dermatitis to different degrees. Over time, many patients and their families learn to identify the irritants that are most troublesome to them. For example, wool or synthetic fibers may affect some patients. Rough or poorly fitting clothing can rub the skin, trigger inflammation, and prompt the beginning of the itch- scratch cycle. Soaps and detergents may have a drying effect and worsen itching, and some perfumes and cosmetics may irritate the skin. Exposure to certain elements, such as chlorine, mineral oil, or solvents, or to irritants, such as dust or sand, may also aggravate the condition. Cigarette smoke may irritate the eyelids. Because irritants vary from one person to another, each person has to determine for himself or herself what substances or circumstances cause the disease to flare.

Common Irritants

Wool or synthetic fibers
Soaps and detergents
Some perfumes and cosmetics
Substances such as chlorine, mineral oil, or solvents
Dust or sand
Cigarette smoke

What are allergens?

Allergens are substances from foods, plants, or animals that provoke an overreaction of the immune system and cause inflammation (in this case, the skin). Inflammation can occur even when the person is exposed to small amounts of the allergen for a limited time. Some examples of allergens are pollen and dog or cat dander (tiny particles from the animal's skin or hair). When people with atopic dermatitis come into contact with an irritant or allergen to which they are sensitive, inflammation- producing cells permeate the skin from elsewhere in the body. These cells release chemicals that cause itching and redness. As the person scratches and rubs the skin in response, further damage occurs.

Certain foods act as allergens and may trigger atopic dermatitis or exacerbate it (cause it to become worse). Food allergens clearly play a role in a number of cases of atopic dermatitis, primarily in infants and children. An allergic reaction to food can cause skin inflammation (generally hives), gastrointestinal symptoms (vomiting, diarrhea), upper respiratory tract symptoms (congestion, sneezing), and wheezing. The most common allergy-causing (allergenic) foods are eggs, peanuts, milk, fish, soy products, and wheat. Although the data remain inconclusive, some studies suggest that mothers of children with a family history of atopic diseases should avoid eating commonly allergenic foods themselves during late pregnancy and (if breast feeding) while they are breast feeding the baby. Although not all researchers agree, most experts think that breast feeding the infant for at least 4 months may have a protective effect for the child.

If a food allergy is suspected, it may be helpful to keep a careful diary of everything the patient eats, noting any reactions. Identifying the food allergen may be difficult if the patient is also being exposed to other allergens, and may require supervision by an allergist. One helpful way to explore the possibility of a food allergy is to eliminate the suspected food and then, if improvement is noticed, reintroduce it into the diet under carefully controlled conditions. A two week trial is usually sufficient for each food. If the food being tested causes no symptoms after two weeks, a different food can be tested in like manner afterwards. Likewise, if the elimination of a food does not result in improvement after 2 weeks, other foods may be eliminated in turn.

Changing the diet of a person who has atopic dermatitis may not always relieve symptoms. A change may be helpful, however, when a patient's medical history and specific symptoms strongly suggest a food allergy. It is up to the patient and his or her family and physician to judge whether the dietary restrictions outweigh the impact of the disease itself. Restricted diets often are emotionally and financially difficult for patients and their families to follow. Unless properly monitored, diets with many restrictions can also contribute to nutritional problems in children.

What are aeroallergens?

Some allergens are called aeroallergens because they are present in the air. They may also play a role in atopic dermatitis. Common aeroallergens are dust mites, pollens, molds, and dander from animal hair or skin. These aeroallergens, particularly the house dust mite, may worsen the symptoms of atopic dermatitis in some people. Although some researchers think that aeroallergens are an important contributing factor to atopic dermatitis, others believe that they are insignificant. Scientists also don't understand the way in which aeroallergens affect the skin; whether the aeroallergen affects the person internally after being inhaled, or whether the aeroallergen actually penetrates the patient's skin.

No reliable test is available that determines whether a specific aeroallergen is an exacerbating factor in any given individual. If the doctor suspects that an aeroallergen is contributing to a patient's symptoms, the doctor may recommend ways to reduce exposure to the offending agents. For example, the presence of the house dust mite can be limited by encasing mattresses and pillows in special dust-proof covers, frequently washing bedding in hot water, and removing carpeting. However, there is no way to completely rid the environment of aeroallergens.

What other factors may play a role in atopic dermatitis?

In addition to irritants and allergens, other factors, such as emotional issues, temperature and climate, and skin infections can affect atopic dermatitis. Although the disease itself is not caused by emotional factors or personality, it can be exacerbated by stress, anger, and frustration. Interpersonal problems or major life changes, such as divorce, job changes, or the death of a loved one, can also make the disease worse. Often, emotional stress seems to prompt a flare of the disease.

Bathing without proper moisturizing afterward is a common factor that triggers a flare of atopic dermatitis. The low humidity of winter or the dry year-round climate of some geographic areas can intensify the disease, as can overheated indoor areas and long or hot baths and showers. Alternately sweating and chilling can induce an attack in some people. Bacterial infections can also prompt or increase the severity of atopic dermatitis. If a patient experiences a sudden onset of illness, the doctor may check for a viral infection (such as herpes simplex) or fungal infection (such as ringworm or athlete's foot).

How is atopic dermatitis treated?

Treatment involves a partnership between the doctor and the patient and his or her family members. The doctor will suggest a treatment plan based on the patient's age, symptoms, and general health. The patient and family members play a large role in the success of the treatment plan by carefully following the doctor's instructions. Some of the primary components of treatment programs are described below. Most patients can be successfully managed with proper skin care and lifestyle changes and do not require the more intensive treatments discussed.

The doctor has three main goals in treating atopic dermatitis: healing the skin and keeping it healthy; preventing flares; and treating symptoms when they do occur. Much of caring for the skin involves developing skin care routines, identifying exacerbating factors, and avoiding circumstances that stimulate the skin's immune system and the itch-scratch cycle. It is important for the patient and family members to note any changes in skin condition in response to treatment, and to be persistent in identifying the most effective treatment strategy.

Skin Care: Healing the skin and keeping it healthy are of primary importance both in preventing further damage and enhancing the patient's quality of life. Developing and following a daily skin care routine is critical to preventing recurrent episodes of symptoms. Key factors are proper bathing and the application of lubricants, such as creams or ointments, within 3 minutes of bathing. People with atopic dermatitis should avoid hot or long (more than 10 to 15 minutes) baths and showers. A lukewarm bath helps to cleanse and moisturize the skin without drying it excessively. The doctor may recommend limited use of a mild bar soap or non-soap cleanser because soaps can be drying to the skin. Bath oils are not usually helpful.

Once the bath is finished, the patient should air-dry the skin, or pat it dry gently (avoiding rubbing or brisk drying), and apply a lubricant immediately. Lubrication restores the skin's moisture, increases the rate of healing, and establishes a barrier against further drying and irritation. Several kinds of lubricants can be used. Lotions generally are not the best choice because they have a high water or alcohol content and evaporate quickly. Creams and ointments work better at healing the skin. Tar preparations can be very helpful in healing very dry, lichenified areas. Whatever preparation is chosen, it should be as free of fragrances and chemicals as possible.

Another key to protecting and restoring the skin is taking steps to avoid repeated skin infections. Although it may not be possible to avoid infections altogether, the effects of an infection may be minimized if they are identified and treated early. Patients and their families should learn to recognize the signs of skin infections, including tiny pustules (pus-filled bumps) on the arms and legs, appearance of oozing areas, or crusty yellow blisters. If symptoms of a skin infection develop, the doctor should be consulted to begin treatment as soon as possible.

Treating Atopic Dermatitis in Infants and Children

Give brief, lukewarm baths.
Apply lubricant immediately following the bath.
Keep child's fingernails filed short.
Select soft cotton fabrics when choosing clothing.
Consider using antihistamines to reduce scratching at night.
Keep the child cool; avoid situations where overheating occurs.
Learn to recognize skin infections and seek treatment promptly.
Attempt to distract the child with activities to keep him or her from scratching.

Medications and Phototherapy: If a recurrence of atopic dermatitis occurs, several methods can be used to treat the symptoms. With proper treatment, most symptoms can be brought under control within 3 weeks. If symptoms fail to respond, this may be due to a flare that is stronger than the medication can handle, a treatment program that is not fully effective for a particular individual, or the presence of trigger factors that were not addressed in the initial treatment program. These factors can include a reaction to a medication, infection, or emotional stress. Continued symptoms may also occur because the patient is not following the treatment program instructions.

Corticosteroid creams and ointments are the most frequently used treatment. Sometimes, over-the-counter preparations are used, but in many cases, the doctor will prescribe a stronger corticosteroid cream or ointment. Occasionally, the base used in certain brands of corticosteroid creams and ointments is irritating for a particular patient and a different brand is required. Side effects of repeated or long-term use of topical corticosteroids can include thinning of the skin, infections, growth suppression (in children), and stretch marks on the skin.

Tacrolimus (Protopic) and pimecrolimus (Elidel) ointments are powerful topical medicated creams (drugs that are applied to the skin) that is used for the treatment of atopic dermatitis. These new drugs are referred to as "immune modulators." They were first used internally to help patients with kidney and liver transplants avoid rejecting the organs they received. They work by suppressing the immune system. When these drugs are used externally to treat the skin, however, they do not weaken or change the body's immune system. Also, unlike topical steroids (cortisone creams), these new medications don't cause thinning of the skin and breaking of superficial blood vessels (atrophy).

Some treatments reduce specific symptoms of the disease. Antibiotics to treat skin infections may be applied directly to the skin in an ointment, but are usually more effective when taken by mouth in pill form. Certain antihistamines that cause drowsiness can reduce nighttime scratching and allow more restful sleep when taken at bedtime. This effect can be particularly helpful for patients whose nighttime scratching aggravates the disease. If viral or fungal infections are present, the doctor may also prescribe medications to treat those infections.

Phototherapy is treatment with light that uses ultraviolet A or B light waves, or a combination of both. This treatment can be an effective treatment for mild to moderate dermatitis in older children (over 12 years old) and adults. Photochemotherapy, a combination of ultraviolet light therapy and a drug called psoralen, can also be used in cases that are resistant to phototherapy alone. Possible long-term side effects of this treatment include premature skin aging and skin cancer. If the doctor thinks that phototherapy may be useful in treating the symptoms of atopic dermatitis, he or she will use the minimum exposure necessary and monitor the skin carefully.

When other treatments are not effective, the doctor may prescribe systemic corticosteroids; drugs that are taken by mouth or injected into muscle instead of being applied directly to the skin. An example of a commonly prescribed corticosteroid is prednisone. Typically, these medications are used only in resistant cases and are only given for short periods of time. The side effects of systemic corticosteroids can include skin damage, thinned or weakened bones, high blood pressure, high blood sugar, infections, and cataracts. It can be dangerous to suddenly stop taking corticosteroids, so it is very important that the doctor and patient work together in changing the corticosteroid dose.

In adults, immunosuppressive drugs, such as cyclosporine, are also used to treat severe cases of atopic dermatitis that have failed to respond to any other forms of therapy. Immunosuppressive drugs restrain the overactive immune system by blocking the production of some immune cells and curbing the action of others. The side effects of cyclosporine can include high blood pressure, nausea, vomiting, kidney problems, headaches, tingling or numbness, and a possible increased risk of cancer and infections. There is also a risk of relapse after the drug is discontinued. Because of their toxic side effects, systemic corticosteroids and immunosuppressive drugs are used only in severe cases and then for as short a period of time as possible. Patients requiring systemic corticosteroids or immunosuppressive drugs should be referred to a dermatologist or an allergist specializing in the care of atopic dermatitis to help identify trigger factors and alternative therapies.

In rare cases, when no other treatments have been successful, the patient may have to be hospitalized. A 5 to 7 day hospital stay allows intensive skin care treatment and reduces the patient's exposure to irritants, allergens, and the stresses of day-to- day life. Under these conditions, the symptoms usually clear quickly if environmental factors play a role or if the patient is not able to carry out an adequate skin care program at home.

Tips for Working With Your Doctor

Provide complete, accurate medical information about yourself or your child.
Make a list of your questions and concerns in advance.
Be honest and share your point of view with the doctor.
Ask for clarification or further explanation if you need it.
Talk to other members of the health care team, such as nurses, therapists, or pharmacists.
Don't hesitate to discuss sensitive subjects with your doctor.
Discuss changes to any medical treatment or medications with your doctor before making them.

Atopic Dermatitis and Quality of Life

Despite the symptoms caused by atopic dermatitis, it is possible for people with the disorder to maintain a high quality of life. The keys to an improved quality of life are education, awareness, and developing a partnership among the patient, family, and doctor. Good communication is essential for all involved. It is important that the doctor provides understandable information about the disease and its symptoms to the patient and family and demonstrate any treatment measures recommended to ensure that they will be properly carried out.

When a child has atopic dermatitis, the entire family situation may be affected. It is important that families have additional support to help them cope with the stress and frustration associated with the disease. The child may be fussy and difficult, and often is unable to keep from scratching and rubbing the skin. Distracting the child and providing as many activities that keep the hands busy is key, but requires much effort and work on the part of the parents or caregivers. Another issue families face is the social and emotional stress associated with disfigurement caused by atopic dermatitis. The child may face difficulty in school or other social relationships and may need additional support and encouragement from family members.

Adults with atopic dermatitis can enhance their quality of life by caring regularly for their skin and being mindful of other effects of the disease and how to treat them. Adults should develop a skin care regimen as part of their daily routine, which can be adapted as circumstances and skin conditions change. Stress management and relaxation techniques may help decrease the likelihood of flares due to emotional stress. Developing a network of support that includes family, friends, health professionals, and support groups or organizations can be beneficial. Chronic anxiety and depression may be relieved by short-term psychological therapy.

Recognizing the situations when scratching is most likely to occur may also help. For example, many patients find that they scratch more when they are idle. Structured activity that keeps their hands occupied may prevent further damage to the skin. Occupational counseling also may be helpful to identify or change career goals if a job involves contact with irritants or involves frequent hand washing, such as kitchen work or auto mechanics.

Controlling Atopic Dermatitis

Prevent scratching or rubbing whenever possible.
Protect skin from excessive moisture, irritants, and rough clothing.
Maintain a cool, stable temperature and consistent humidity levels.
Limit exposure to dust, cigarette smoke, pollens, and animal dander.
Recognize and limit emotional stress.

What is the hope for long term management of atopic dermatitis?

Although symptoms of atopic dermatitis can be very difficult and uncomfortable, the disease can be successfully managed. People with atopic dermatitis, as well as their families, can lead healthy, normal lives.

Atopic Dermatitis At A Glance

Atopic dermatitis is the most common and significant type of eczema.
The skin sensitivity of this disease is inherited.
The patient's skin is "super sensitive" to many irritants.
Dry scaly patches develop in a characteristic distribution.
Itching is intense and scratching hard to resist.
Scratching can cause skin thickening and darkening and lead to bacterial infection.
Extremely dry skin can break down and ooze or weep.
If the itch can be controlled, the rash (which is aggravated by vigorous scratching) can be contained.
Treatment of atopic dermatitis is centered around rehydrating the skin with moisturizers and cautious use of topical steroids to reduce inflammation and itching.
Oral antihistamines are often necessary to break the "itch-scratch" cycle.
Since secondary infections can aggravate the rash, topical or oral antibiotics may also be occasionally indicated.