Eczema is a chronic skin condition categorized by recurrent rashes that leave the skin dry, inflamed, itchy, swollen, flakey and sometimes blistered. People who suffer from eczema need to make an extra effort to take care of their skin. Eczema should be kept moisturized, soothed and protected from allergens. Failing to take care of eczema can cause the condition to worsen or trigger an irritating flare up.

Currently, there are two medicated eczema creams that have been approved by the FDA: pimecrolimus and tacrolimus. Both of these creams contain powerful immunosuppressant drugs called calcineurin inhibitors. Because these drugs have been found to cause cancer in rare cases, the FDA warned patients against their long term use in 2006. To lessen the risk of side effects, calcineurin inhibitors are usually only used to control severe flare ups in patients over two years old.

While a prescription eczema cream can be used to treat severe flare ups, most patients will need a gentler cream for everyday use. When dealing with eczema, one of the most important things is to keep the skin moisturized. To find a moisturizing lotion, look for those that contain rich oils, humectants and natural extracts. Avoid lotions that are primarily composed of water as these lotions can be overly drying.

It is also important to choose lotions that are free of certain irritants like fragrances and harsh preservatives. Instead of these irritating ingredients, look for an eczema cream that contains soothing ingredients like aloe, chamomile, vitamins and antioxidants. Some popular choices for eczema include Nutraderm, Eucerin, Lubriderm and Nivea. However, there are hundreds of creams that can be used by eczema patients.

To control bouts of severe rash, over-the-counter corticosteroid creams can also be used to control inflammation, itching and irritation. More serious cases of eczema can also be treated with prescription corticosteroid creams. Still, while steroid creams can be beneficial, regularly hydrating the skin with a gentle moisturizer is the best way to control eczema on a day-to-day basis.

Eczema is a chronic skin disorder that involves scaly and itchy rashes. as well as blistering, weeping, or peeling of the skin. Atopic eczema is the most common type.

See also:

• Contact dermatitis
• Dyshidrotic eczema
• Nummular eczema
• Seborrheic dermatitis

Infantile eczema; Atopic dermatitis; Dermatitis - atopic; Eczema - atopic

Atopic eczema is due to a hypersensitivity reaction(similar to an allergy) in the skin, which leads to long-term inflammation.

Eczema is most common in infants. Many people outgrow it by early adulthood. The condition tends to run in families.

People with eczema often have a family history of allergic conditions such as asthma, hay fever, or eczema.

The following can make eczema symptoms worse:

• Allergies to pollen, mold, dust mites, or animals
• Colds or the flu
• Contact with rough materials
• Dry skin
• Exposure to environmental irritants
• Exposure to water
• Feeling too hot or too cold
• Fragrances or dyes added to skin lotions or soaps
• Stress

Typical skin changes may include:

• Blisters with oozing and crusting
• Ear discharge or bleeding
• Raw areas of the skin from scratching
• Skin coloring changes -- more or less coloring than the normal skin tone (See: Skin abnormally dark or light)
• Skin redness or inflammation around the blisters
• Thickened or leather-like areas, called lichenification, which can occur after long-term irritation and scratching

Both the type of rash and where the rash appears can depend on the age of the patient:

• In children younger than age 2, skin lesions begin on the face, scalp, hands, and feet. It is often a crusting, bubbling, or oozing rash.
• In older children and adults, the rash is more commonly seen on the inside of the knees and elbows, as well as the neck, hands, and feet.
• During a severe outbreak, rashes may occur anywhere on the body.

Itching, which is sometimes intense, almost always occurs. Itching may start even before the rash appears.

Diagnosis is primarily based on:

• Appearance of the skin
• Personal and family history

The health care provider should examine the lesions to rule out other possible causes. A skin lesion biopsy may be performed, but is not always needed to make the diagnosis.

Allergy skin testing may be helpful for people with:

• Difficult-to-treat eczema
• Other allergy symptoms

CARE AT HOME

Taking care of your skin at home may reduce the need for medications.

Avoid scratching the rash or skin if you can:

• Relieve the itch by using a cold compress and taking antihistamines to reduce severe itching.
• Keep your child's fingernails cut short. Consider light gloves if nighttime scratching is a problem.

Keep the skin moist (called lubricating or moisturizing the skin). Use ointments (such as petroleum jelly), creams, or lotions 2 - 3 times a day. Moisturizers should be free of alcohol, scents, dyes, fragrances, or other chemicals.

Avoid anything that makes your symptoms worse. This may include:

• Foods such as dairy, peanuts, eggs, or wheat (always discuss with your doctor first)
• Irritants such as wool and lanolin
• Strong soaps or detergents, as well as chemicals and solvents
• Sudden changes in body temperature and stress, which may cuase sweating and worsen the condition
• Triggers that cause allergy symptoms

When washing or bathing:

• Keep water contact as brief as possible and use less soap than usual. Short, cooler baths are better then long, hot baths.
• Do not scrub or dry the skin too hard or for too long.
• After bathing, it is important to apply lubricating creams, lotions, or ointment on the skin while it is damp. This will help trap moisture in the skin.

MEDICATIONS

Antihistamines taken by mouth may help with itching or if you have allergies. Often you can buy them without a prescription.

• Some antihistamines can cause sleepiness, but may help with scratching while sleeping.
• Newer antihistamines cause little or no sleepiness. Some are available over the counter. These medications include fexofenadine (Allegra), loratadine (Claritin, Alavert), and cetirizine (Zyrtec).

Most causes of atopic eczema are treated with medications that are placed directly on the skin or scalp (called topical medicines):

• At first, you will probably be prescribed a mild cortisone (or steroid) cream or ointment. If this doesn't work, you may need a stronger steroid medicine. You may need different strengths of steroids for different areas of skin.
• Medicines called topical immunomodulators (TIMs) may be prescribed for anyone over 2 years old. TIMs include tacrolimus (protopic) and pimecrolimus (Elidel). Ask your doctor about concerns over a possible cancer risk associated with the use of these medicines.
• Creams or ointments that contain coal tar or anthralin may be used for thickened areas.

Other medicines that may be used include:

• Oral or injected corticosteroids when the eczema is severe
• Antibiotic creams or pills if the skin is infected
• Allergy shots (immunotherapy)

Eczema is a chronic condition, but you can control it with treatment, by avoiding irritants, and by keeping the skin well-moisturized.

In children, it often clears beginning around age 5 - 6, but flareups will often occur. In adults, it is generally a long-term or recurring condition.

People with eczema tend to have dry skin that flares up more in the winter, when the air is cold and dry.

• Infections of the skin caused by bacteria, fungi, or viruses
• Permanent scars

Call for an appointment with your health care provider if:

• Eczema does not respond to moisturizers or avoiding allergens
• Symptoms worsen or treatment is ineffective
• You have signs of infection (such as fever, redness, pain)

Studies have shown that children who are breast-fed are less likely to get eczema. This is also true when the nursing mother has avoided cow's milk in her diet. Other dietary restrictions may include eggs, fish, peanuts, and soy.

Eczema tends to run in families. Controlling stress, nervousness, anxiety, and depression can help in some cases. Keeping the skin well-moisturized and avoiding irritants is important.

Excema and Hand Dermatitis. In: Habif TP, ed. Clinical Dermatology. 4th ed. St. Louis, Mo: Mosby; 2004:chap 3.

Lewis-Jones S, Mugglestone MA; Guideline Development Group. Management of atopic eczema in children aged up to 12 years: summary of NICE guidance. BMJ. 2007;335:1263-1264.

Ascroft DM, Chen LC, Garside R, Stein K, Williams HC. Topical pimecrolimus for eczema. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005500.

Vitiligo is a skin condition in which there is loss of pigment (color) from areas of skin, resulting in irregular white patches that feel like normal skin.

Vitiligo appears to be an acquired condition and may appear at any age. There is an increased rate of the condition in some families.

The cause of vitiligo is unknown, but autoimmunity may be a factor. Vitiligo is associated with three systemic diseases:

• Pernicious anemia
• Hyperthyroidism
• Addison's disease

The condition affects about 1% of the United States population.

Vitiligo is more noticeable in darker skinned people because of the contrast of white patches against dark skin.

There is a sudden or gradual appearance of flat areas of normal-feeling skin with complete pigment loss. Lesions appear as flat areas with no pigment and with a darker border. The edges are sharply defined but irregular.

Frequently affected areas are the face, elbows and knees, hands and feet, and genitalia.

Examination is usually sufficient to confirm the diagnosis. In some cases, a skin biopsy may be needed to rule out other causes of pigment loss. Your doctor may also perform blood tests to check the levels of thyroid or other hormones, and vitamin B12 levels.

Vitiligo is difficult to treat. Early treatment options include the following:

• Light therapy (exposure to controlled intense ultraviolet light in a doctor's office or hospital)
• Medicines taken by mouth such as trimethylpsoralen (Trisoralen)
• Medicines applied to the skin such as:
  • Corticosteroid creams
  • Immunosuppressants such as pimecrolimus (Elidel) and tacrolimus (Protopic)
  • Repigmenting agents such as methoxsalen (Oxsoralen)

Skin may be grafted or removed from normal areas and placed onto areas of pigment loss.

Several manufacturers produce cover-up makeup or skin dyes to mask vitiligo. Ask your health care provider for the names of these companies.

In extreme cases when most of the body is affected, the remaining pigmented skin may be depigmented. This is a permanent change and is a last resort.

It is important to remember that skin without pigment is extremely susceptible to the sun's damaging effects. Be sure to apply a high-SPF sunblock and use appropriate safeguards against sun exposure.

• American Vitiligo Research Foundation -- www.avrf.org
• National Vitiligo Foundation -- www.nvfi.org
• VitiligoSupport.com -- www.vitiligosupport.org

The course of vitiligo varies. Some areas may regain pigmentation (coloring), but other new areas may appear. Loss of pigment may be progressive.

Depigmented areas are more likely to sunburn or develop certain skin cancers.

Call for an appointment with your health care provider if you develop areas of skin that lose their coloring.