Eczema

Eczema

More Than Just an Itch

If it's mild, eczema can be just a minor inconvenience--a small, rough, red patch that appears on your elbow and makes you feel self-conscious about wearing a short-sleeved shirt.

But if it's severe, there's a lot more to it. Women with extremely bad cases of eczema say that it affects their social life: Sometimes their skin itches so badly and looks so awful that they're too uncomfortable and embarrassed to be around other people at all.

It affects their relationships in many ways. For example, they might not be able to visit people with pets or be around anyone wearing wool because contact with these things might make their skin break out.

And sometimes they have to stop in the middle of lovemaking and towel down because too much sweat irritates their skin. Even being held in someone's arms can be uncomfortable, because the heat and contact make their skin itch.

It affects their work: Some days they can't go to work because they feel so depressed that all they can do is sleep.

Doctors refer to eczema as "the itch that rashes," says Karen K. Deasey, M.D., attending dermatologist at Bryn Mawr Hospital in Pennsylvania. That's because it generally begins as itching that's so severe that not scratching becomes practically impossible. The scratching in turn provokes a rash that can range from red and blistering skin to a thick, discolored patch of skin. It can appear in one spot or cover the entire body.

Most people who develop eczema first get it in childhood: Up to 90 percent of patients have it by the time they are five years old. But it can also appear in adulthood, says Elizabeth Whitmore, M.D., clinical director of dermatology at Johns Hopkins University in Baltimore. With adult onset, the person generally has hay fever or other allergies and then develops eczema, she says. Overall, some 15 million Americans suffer from it.

How do you get eczema? "It runs in families," says Dr. Deasey. So if your parents or someone else in the family has it, it's no surprise that you do, too, she says. If family members have asthma, hay fever or allergies, that can also be related to your susceptibility to eczema. A personal or family history of allergic disease has been noted in 75 to 80 percent of patients with eczema, studies show. And the worse your own hay fever or allergies, the worse your eczema may be, says Dr. Deasey.

The Effect of Hormones and Pregnancy

Many women with eczema notice variations in their skin condition during different phases of the menstrual cycle. And physicians say they often notice changes in eczema during pregnancy.

According to one study from Edinburgh, Scotland, women with premenstrual syndrome experienced worsening of their eczema before menstruation. And while the study also showed that in 52 percent of cases, eczema worsened with pregnancy, 24 percent of women experienced an improvement in their eczema during pregnancy.

One study alone, though, isn't sufficient to represent what's happening for most women, says Sharon Hymes, M.D., clinical associate professor of dermatology at the University of Texas Medical School in Houston. So for the time being, all you can do is take note of the intensity of your eczema at various phases of your cycle and see if you notice any pattern.

There are no definite answers, either, on whether breastfeeding will ultimately prevent a child from developing eczema. "Whether or not nursing the child will delay or prevent the onset of eczema is not clear," says Dr. Hymes. "I recommend that women should nurse if they can, for all the reasons that it's good to nurse."

Eczema and Stress

If you've noticed a relationship between stress and your eczema flare-ups, it's not your imagination. There is a link, Dr. Deasey says. "Whether the eczema makes people more stressed or they are just more prone to stress is hard to say," she says.

Stress triggers the nerves to produce substances that, through a series of events, make the inside of the blood vessels sticky, says George Murphy, M.D., professor of dermatology and pathology at the University of Pennsylvania in Philadelphia. These sticky vessels then act like flypaper for white blood cells. When the cells stick, cross through the vessel wall and enter into the tissue, they cause the inflammation of eczema, hives, psoriasis or other skin disorders.

So do your best to keep your stress levels low. It may help keep eczema at bay.

How to Get Control

Managing stress isn't all you can do to cope with eczema. Here are some more strategies.

Stay lubricated. The mainstay of therapy for eczema is keeping the skin hydrated, says Kristin M. Leiferman, M.D., associate professor of dermatology at the Mayo Clinic and the Mayo Clinic Foundation in Rochester, Minnesota. Use mild soaps and bath oils, and apply your moisturizer within minutes of toweling off, she says. "The key is keeping the skin from drying out. Use body lotion day in and day out, whether or not you're itching," Dr. Deasey says. For tough eczema cases, try petroleum jelly and moisturizing lotions such as Nivea, Eucerin, Neutrogena Emulsion or Aquaphor Natural Healing Ointment, experts say.

Surround yourself with moisture. One trick to remind you to keep laying on the lotion between baths or showers is to place several bottles of moisturizer around the house and in your office or briefcase. This will remind you to use it and make it easy to find, says Marianne O'Donoghue, M.D., associate professor of dermatology at Rush Presbyterian-St. Luke's Medical Center in Chicago.

Think humid. Use a humidifier in your home to keep the air from getting too dry. This will keep your skin from getting too dry as well, says Dr. Deasey.

Use shower savvy. Another way to keep your skin from drying out is to keep your showers on the cool side, says Dr. O'Donoghue. And decrease bathing in the winter, when skin is drier, she says.

Avoid scratchy materials. Rough materials that can irritate the skin can aggravate eczema. "You need to stay away from itchy things like polyester and wool," says Dr. Deasey. "Don't get hot and itchy. And stay with natural fibers like cotton or lightweight, soft-fiber wools like cashmere."

Go topical. Topical steroid creams are a central part of treatment, says Dr. Leiferman. One percent hydrocortisone cream is a good place to start, experts say, and if that doesn't work, see your doctor about a stronger medication. Doctors generally use low- to midpotency steroids and reserve the ultrahigh-potency medications only for severe cases or severe flare-ups, she says.

Shine a light. Natural sunlight or ultraviolet rays can help eczema. Ask your doctor about ultraviolet B light therapy or an ultraviolet light treatment called PUVA. But don't try to do it yourself in the tanning salon, says Dr. Leiferman. The wrong dosage can be painful and permanently damage your skin.

Stop the itch. One way to stop the itching of eczema is to take over-the-counter antihistamines such as Benadryl or Chlor-Trimeton, says Dr. O'Donoghue.

Get support. Find someone else who's dealing with eczema, says Shelley Diamond of San Francisco, who has it. "They're the only ones who can really understand what you're going through," she says.

Laugh if you can. Although eczema can be painful and very frustrating, humor is a good way to deal with it, says Corky Stewart, executive director of the Eczema Association for Science and Education in Portland, Oregon. "We call the letters section of our newsletter 'The Scratch Pad.' And we tell our members that if they don't donate each year, they'll get 'scratched' from the list," she says.

Keep a journal. "A lot of people with eczema develop a habit of scratching and they are not aware of it," says Stewart. "Some find if they keep a journal, they become more aware. Then they can be more mindful and try not to do it."