Dermatitis and Eczema
Dermatitis and Eczema
23 Clear-Skin Remedies
Maybe the first question you asked yourself after the doctor diagnosed your condition was, "Why me? Why am I stuck with the itching and dryness of eczema? Why do I have to suffer the redness and irritation of dermatitis?"
Your doctor is perhaps best qualified to answer that question, difficult as it can be, but it may help to know that you're not alone. The latest government statistics show that close to nine million Americans suffer from some form of dermatitis every year. That's a lot of scratching.
The following tips are designed to help those with physician-diagnosed conditions of eczema or dermatitis control the itching and dryness that typically accompany those afflictions.
The experts tell us that, in general, the best way to treat the itching of eczema and dermatitis at home is to keep dry, patchy skin moist and well lubricated. For that reason, many of the remedies offered in Dry Skin and Winter Itch, beginning on page 224, may help with this problem as well.
Got a Nickel Rash? "Nickel dermatitis is probably the most common contact dermatitis going," says Howard Donsky, M.D. "But people often don't suspect that that's the problem—they think they've got a problem with gold." Nickel dermatitis occurs ten times more often in women than men, and is often triggered by ear piercing. Strangely enough, having the ears pierced can cause rashes to occur in other areas of the body whenever the person comes in contact with nickel-containing metal. Suddenly, bracelets, necklaces, and other jewelry the person has worn for years can bring on a contact rash. If this sounds like what's happening to you, the following tips might help. Buy posts of stainless steel. Newly pierced ears should be studded only with steel posts until the earlobes heal (about three weeks). Stay cool. Since perspiration plays a big role in nickel dermatitis—it leaches out the nickel in nickel-plated jewelry—stay out of the heat if you're wearing this type of jewelry. Or don't wear it if you're going out in the heat. Go for the gold. Buy only quality gold jewelry, says Dr. Donsky. "If it's less than 24-karat gold, there's some nickel in there," he says, "and the lower the karat the higher the nickel." Don't go nickel nuts. Some European dermatologists are advising nickel-sensitive patients to watch what they eat. Having observed that nickel dermatitis can occur without any apparent contact with the metal, these doctors are telling folks to avoid apricots, chocolate, coffee, beer, tea, nuts, and other foods high in nickel. While intriguing, the "nickel-nut" theory hasn't garnered a great following on this side of the Atlantic. "The jury's still out on foods high in nickel causing a reaction," Dr. Donsky confirms. "But if you're highly sensitive to nickel, there might be some validity to it." |
|
Beware of dry air. Dermatitis is aggravated by dehumidified air, especially during winter months when forced-air heat circulates in the home.
"Forced-air heat is a bit more drying than other types of heat," says Howard Donsky, M.D., staff dermatologist at Toronto General Hospital in Toronto. Since dry air tends to aggravate the itching of eczema or dermatitis, keeping indoor air moist should be a primary concern of sufferers and their families. "If you can counter dry air with a good humidifier, then forced-air heat's not as much of a problem," Dr. Donsky notes.
But, the experts caution, don't expect a single room humidifier to do it all. "People think that if they put a humidifier in their place, that'll take care of it," says Hillard H. Pearlstein, M.D., a private practitioner and assistant clinical professor of dermatology at Mount Sinai School of Medicine of the City University of New York. "But humidifiers are like air conditioners—you really need a big unit to do anything. If you sleep next to it, however, that's okay. Put it next to your bed."
Like it lukewarm. The long-held belief that people with dermatitis should avoid bathing is coming under increased scrutiny. While some physicians feel excessive bathing can aggravate the condition, others feel that regular bathing reduces the chances of infection and helps soften the skin.
Our experts generally fall into the second category. "Bathe, but bathe in lukewarm water," says Dr. Donsky. "Avoid water that's either too hot or too cold."
Go for the grease. Regular soap need not be avoided in your bath as long as a moisturizer is applied after its use to keep the skin from drying out. "You can't bathe too frequently unless you grease up afterward," says Dr. Pearlstein. "The grease is what holds the water in, and dry skin is a function of water loss, not of oil loss."
Some favorite after-bath emollients (or greases, as dermatologists typically call them) include Complex-15, Eucerin, Keri, Lubriderm Lotion, or Moisturel Lotion. If your skin still seems dry after using one of those products, move up to creams such as Lubriderm Cream, Purpose, or Moisturel Cream, or ointments such as Aquaphor, Eucerin, Nivea, or Petrolatum White.
Take an oatmeal bath. For an additional soothing treat, Dr. Donsky recommends adding colloidal oatmeal like Aveeno to the bath, and even using oatmeal as a soap substitute. For the bath, pour 2 cups of colloidal oatmeal (available at pharmacies) into a tub of lukewarm water. The term colloidal simply means the oatmeal has been ground to fine powder that will remain suspended in water. For use as a soap substitute, wrap colloidal oatmeal in a handkerchief, place a rubber band around the top, dunk it in water, wring it out, and use as you would a normal washcloth.
Avoid antiperspirants. Metallic salts such as aluminum chloride, aluminum sulfate, and zirconium chlorohydrate are the active ingredients in many antiperspirants, and these have been known to cause irritation in people with sensitive skin. "Usually it's the antiperspirant, as opposed to the deodorant, that's irritating," Dr. Donsky says. "I recommend that people use a product called Aqueous Zephiran, an over-the-counter product available in drugstores." Or, if you plan to continue using commercially produced antiperspirants, look for those that contain such anti-irritants as allantoinate, zinc oxide, magnesium oxide, aluminum hydroxide, or triethanolamine.
Try this OTC. Topical creams, ointments, and lotions containing cortisone are often used to alleviate the itching and inflammation of dermatitis or eczema. Hydrocortisone is the mildest member of the cortisone family of steroid hormones, and it is available as a nonirritating emollient at drugstores.
"Half-percent hydrocortisone cream is available without a prescription," says Dr. Pearlstein, "and that can help. You've got to start somewhere, and going to the drugstore and getting 0.05 percent hydrocortisone cream won't hurt you." Stronger cortisone creams can have serious side effects, however, and should not be used without a doctor's direct supervision.
Take comfort in cotton. "Cotton clothing worn next to the skin is much better than either wool or polyester, especially wool," says dermatologist John F. Romano, M.D., a clinical instructor at New York Hospital-Cornell University Medical Center. The bottom line: Avoid synthetics or itchy fabrics, as well as tight- or ill-fitting clothes. In addition to looking tacky, such clothing can trigger itching.
MEDICAL ALERT
A Wolf in Sheep's Clothing There once was a time when wolves roamed freely across the face of Europe and the vast continent of Asia. Occasionally, humans were attacked. Those who survived sometimes bore upon their faces the red marks of the wolf—the mark of the lupus. Other people bore similar marks but had been ravaged by no animal. These people were known to have the disease of lupus, the attack of the wolf. Today, we know that lupus is actually an attack of the body upon itself. It can take two forms, sometimes affecting only the skin, other times attacking both the skin and many vital organs throughout the body. It can be brought on by exposure to sunlight, certain drugs, or emotional crisis. Lupus always leaves its mark; a patchy, red skin rash, roughly resembling a butterfly, that appears typically on the cheeks or the bridge of the nose. As one patch heals, a new one forms. These lesions itch and form scales. The person may suffer from severe arthritic joint pain, fever, and lung inflammation. If you recognize these symptoms, contact your physician immediately. This wolf cannot be tamed at home. |
|
Stay away from fake nails. Recent research at the Cleveland Clinic Foundation has shown that acrylic manicure products can cause "frequent and obvious cases of dermatitis." Such acrylics may be present in artificial fingernails, fingernail extenders, or sculptured nails, and can cause eye, nose, and respiratory irritation in addition to allergic contact dermatitis.
Such products were once limited to salons, but they have become available for application at home. Even so, "Probably most people don't have a problem with artificial nails," says Dr. Donsky. "The problem was that the first fixatives had formaldehyde in them, and some of them still do. You can have a contact problem with that, as well as with the other polymers in artificial nails."
If you suspect an allergic reaction from such products, avoiding contact with them may be the only cure.
Compress to soothe. Cold, wet dressings can help soothe and relieve the itching associated with contact dermatitis. "I tell people to try cold milk instead of water," says Dr. Romano. "It seems to be a lot more soothing."
His recommendation: Put milk into a glass with ice cubes and let it sit for a few minutes. Then pour the milk onto a gauze pad or thin piece of cotton and apply it to the irritated skin for 2 or 3 minutes. Resoak the cloth and reapply, continuing the process for about 10 minutes.
Though Dr. Romano doesn't recommend this treatment for cases of generalized eczema or dermatitis, eczema can sometimes get so bad that it begins to ooze. This condition is known as weeping eczema, and some doctors believe it responds well to cold compresses applied several times a day. If the condition does not respond, however, consult your physician as soon as possible.
Cool with calamine. "Calamine lotion is good for many types of rashes that ooze and may need to be dried out," Dr. Romano says. "Also, calamine lotion with menthol or phenol added to it can be purchased over-the-counter at drugstores, and that seems to help itching better than calamine lotion alone."
Put your diet to the test. "Food allergies can play a big role in atopic dermatitis during childhood," says Dr. Pearlstein. "They are intimately related before age 6, and you can manipulate an infant's diet and do well in helping his skin."
Traditionally, eggs, orange juice, and milk have been implicated as eczema aggravators in children. But, says Dr. Pearlstein, "I certainly wouldn't incriminate those foods wholesale." That means parents will need to consult their physicians about trying elimination diets, just to be sure. Such diets seem to work best in infants less than 2 years old, Dr. Pearlstein says. "After age 6, we've found that food plays a minimal role in most people."
For adults, Dr. Pearlstein says he leaves diet manipulation largely in the hands of his patients. If you think there's any food you eat that has an adverse effect on your skin, avoid it and see what happens, he says. If your problem clears up, you may have a food allergy.
Avoid quick changes in air temperature. "If you have eczema," says Dr. Donsky, "then rapid temperature changes can be a problem." Going from a warm room out into cold winter air, or even from an air-conditioned room to a hot shower, can trigger itching. Wearing layers of clothing—cotton clothing—is the best way to protect yourself in the first instance, says Dr. Donsky. And, of course, persons with eczema should always avoid hot baths or showers. A little forethought can help cut down on this type of itch trigger.
Use white to wipe. For controlling the itch of contact dermatitis, "white toilet paper's best," Dr. Donsky says. "It's the dyes that irritate."
Beware of baby lotions. "Sometimes baby lotions aren't the best thing for childhood eczema," Dr. Romano says. "They have a high water content, and that can further dry and irritate the skin as evaporation takes place. "Some of the fragrances and active ingredients in baby lotions (lanolin and mineral oil) are common causes of skin allergy.
"What you want instead are creams or ointments," he says. "Something like Eucerin Cream, Aquaphor, or Vaseline Dermatology Formula."
The Alternate Route
The Primrose Path The early research looked promising. A study published in the British medical Journal Lancet showed a significant improvement in eczema when patients took high doses of evening primrose oil (EPO) in capsule form. Other studies, however, were unable to confirm those results and the battle over EPO is still raging. "Evening primrose oil has gotten a lot of press," says Hillard H. Pearlstein, M.D., "but we don't think there's anything to it. There's no scientific evidence that it does anything." John F. Romano, M.D., is likewise skeptical. "There have been some reports that EPO can help in cases of atopic dermatitis, but I don't know that I'm convinced." Those who are still tempted to try EPO should be advised that it takes a rather large number of these expensive capsules to produce results and it can take at least six months to see any results. Also, cases of "imposter EPO" have been discovered, so beware of discount prices and "no-name" brands. You can find EPO in health food stores. |
|
Rub some urea on me. "Emollients that contain urea are pretty good for relieving the itch of eczema or dermatitis," says Dr. Pearlstein. "Urea is a sloughing agent, and it's a good product. We usually use it when the skin is a little thick from rubbing and scratching."
A couple of urea-containing products to try include Carmol 10 or 20, or Ultra Mide 25. Emollients that contain lactic acid (LactiCare 1 percent or 2 percent, Aqua Lacten, or Lac-Hydrin) are also recommended.
Use antihistamines for atopics. Antihistamines block the release of histamine from mast cells, thereby reducing such classic allergy symptoms as headaches, runny nose, and itching. For that reason, "over-the-counter antihistamines such as Benadryl are good for eczema," says Dr. Romano.
Antihistamines reduce itching by preventing histamine from reaching and swelling sensitive skin cells. A note of caution, however, antihistamines must sometimes be taken in large doses to bring relief. Drowsiness can result, leading to possible problems with driving or handling dangerous machinery.
Wash once, rinse twice. When it comes to doing laundry for people with eczema or dermatitis, "it's not the detergent so much as the rinse," says Dr. Romano.
"You've got to make sure the detergent is washed out thoroughly," he says. "Don't overdetergent your clothes when washing, and always use a second rinse cycle to get all the soap out."
Get to know your eye doctor. In a 20-year study of 492 people at the Mayo Clinic in Rochester, Minnesota, 13 percent of those with atopic dermatitis developed cataracts. "There is a higher incidence of cataracts in people with atopic dermatitis," Dr. Pearlstein confirms. "Atopics should be seen by an ophthalmologist more frequently than other people."
PANEL OF ADVISERS
Howard Donsky, M.D., is an associate professor of medicine at the University of Toronto and staff dermatologist at Toronto General Hospital. He is author of Beauty is Skin Deep.
Hillard H. Pearlstein, M.D., is a private practitioner and assistant clinical professor of dermatology at the Mount Sinai School of Medicine of the City University of New York in New York City.
John F. Romano, M.D., is a dermatologist and an attending physician at St. Vincent's Hospital and Medical Center of New York. He is also clinical instructor in medicine at New York Hospital-Cornell University Medical Center in New York City.
