Allergy Conditions
Skin – Treating Eczema
Written by Dr Adrian Morris
| Atopic Eczema, otherwise known as Atopic Dermatitis or Infantile
Eczema, is a chronic relapsing itchy disease of the skin. |
It may commence after the 3rd month of life as a weepy rash on the face and
outer surfaces of arms and legs and then progress in later childhood as a dry
scaly itchy rash commonly of the inner creases of the elbows and knees. Some
children may not outgrow eczema and the condition often continues into adulthood
“It’s not the eruption that itches, but the itch that erupts.”
PREVENTION
Institute general allergy prevention measures in high allergy risk
newborns. These include avoidance of parental smoking during pregnancy
and after birth and breast feeding until at least 6 months of age.
Common allergy-provoking foods such as milk, eggs, fish, peanuts, wheat
and soya should be avoided in the breast feeding mother’s daily diet.
Avoidance of solid foods in babies up to 6 months of age, followed by
the careful introduction of the potential allergy-provoking foods such
as cows’ milk, wheat and peanut extract at 12 months, and eggs and fish
only being introduced after 18 months.
AAbout 10% of infantile eczema is food allergy related and food
colourants and additives can also aggravate eczema in older children. In
addition adverse reactions to citrus fruit, tomatoes, pineapples and
Marmite, are common in patients with eczema.
Clothing:
CChildren should avoid hot humid and cold dry weather, excessive
sweating, woollen or synthetic clothing close to the skin and perfumed
soaps. Cotton underwear, clothing and bed-linen are recommended.
Detergents:
NNon-biological washing powders such as Sunlight and Skip should be used
instead of enzyme enriched Punch, Biotex, Surf or Omo. Bubble baths,
household antiseptics and medicated soaps are best avoided. Swimming
pool chlorine may also irritate and dry out the skin. Local household
skin irritants include wool, mohair, nylon and feathers. House dust
mites as well as dog and cat skin flakes may aggravate eczema.
Bath:
BBath water should be lukewarm and moisturing emollients must be applied
to the skin within 3 minutes of patting the skin dry (never rub the skin
dry). If the non-perfumed soaps such as Pears, Dove or Neutragena
irritate the skin then the use of aqueous cream, Aquabar or Cetaphil
lotion are recommended.
In Bed:
AAs much skin as possible should be covered with non-allergenic light
weight cotton clothing, taking care not to overdress or overheat the
child. Cotton nigh gloves as well as neatly clipped finger nails will
reduce scratching. Sometimes elbow splints need to be applied to stop
intractable scratching at night.
Immunisations:
RRoutine childhood immunisations should be given. Consult your doctor if
you have any concerns about these immunisations.
Future Career:
YYoung adults should decide on a career that is less likely to expose
them to irritant chemicals and should probably avoid nursing,
hairdressing, catering, motor mechanics or the building industry.
Protective gloves with cotton inner-linings will help prevent irritant
contact dermatitis that is so very common in eczema sufferers.
TREATMENT:
Emollients:
These moisturings creams and oitments, the mainstay of eczema treatment,
are completely safe and should be applied liberally at least twice daily
to hydrate and protect the skin. Some people may find that certain of
these preparations irritate their skin, if this occurs another product
should be tried.
DDifferent emollients include Emulsifying ointment (HEB), Aqueous
cream (UEA), Cetomacrogol, Ultrabase and Oilatum cream. Sometimes
coal-tar is applied to treat thickend skin.
Cortisone Creams:
These produce rapid relief and are used for short periods to settle
eczema flare-ups. They may also be used for longer periods when diluted
in an emollient in which case treatment should be tapered off slowly.
HHowever, their long term use may lead to thinning of the skin, but
some of the newer preparations seem to be much safer. Cortisone tablets
or injections are very rarely, if ever, used in eczema.
Antibiotics:
EEczema sufferers are more prone to skin infections (bacterial, fungal
and viral, including the common wart!). Antibiotic creams and
occasionally oral antibiotics are prescribed to treat infected eczema
which may present as sudden development of crusting, oozing and redness
of the skin.
Antihistamines:
TThe older sedating type antihistamine tablets or syrups such as Aterax
will reduce itching especially at night. Antihistamine creams may
sensitise the skin and should be avoided.
Other
Therapies:
Evening primrose oil (or gamolenic acid) has been tried with some
success and at present extracts of chinese herbal tear are being
evaluated.
Copyright: Allergy Society of South Africa 1993br>Written by
Dr Adrian Morris This information sheet is freely available from:
| ALLSA P.O. Box 88 Observatory, 7935 Cape Town, R.S.A. |
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