Eczema, also known as atopic dermatitis

• Eczema, also known as atopic dermatitis is a skin problem that causes dry, itchy, scaly, red skin
• The cause of eczema is not completely understood, although it does tend to run in families
• In many people, eczema is caused by a genetic dysfunction in the outer layer of the skin
• The role of the outer layer of skin is to keep environmental irritants, allergens (proteins that cause allergy) and microbes from entering the body
• Eczema is a chronic condition, it typically improves and then flares (worsens) periodically
• Despite popular belief, mild to moderate eczema is rarely related to food allergy
• In 30% children under age 5 years old with moderate to severe eczema, foods such as cow’s milk, egg, wheat and soy may flare in the eczema. If a food allergy is suspected, the patient should be evaluated by a trained allergist 
  
  
• There is no specific test to diagnose eczema
• The diagnosis is based on the medical history and physical exam performed by your doctor
• Often people with eczema have a personal or family history of allergic conditions such as food allergies, asthma and allergic rhinitis (runny nose, congestion, sneezing when around things such as pollen and animals)
  
  TREATMENT OPTIONS
• Eczema is not curable, although symptoms can be controlled
• Your doctor will advise you of treatment options that are best for you
• Eliminate factors the worsen eczema such as heat and excessive sweating, dry environments, exposure to harsh chemicals or cleaning solutions, house dust mites and wool or synthetic clothing
• Wear 100% cotton clothing as much as possible
• Consider double rinsing all laundry and do not use fabric softeners or dryer sheets
• Keep nails short and clean
• Daily bath with lukewarm water for 5 - 10 minutes. Avoid perfumed or colored soaps and bathoils. Emilys Soap is recommended. Pat the skin dry following the bath, then moisturize.
• Keep the skin well hydrated with a moisturizer (Emilys skin products, Eucerin, Cetaphil) used several times per day and always after a bath
• Topical steroid ointments are used to decrease the inflammation and skin damage. Once the skin is healed these medications can be stopped. You may have to start and stop these medication several times
• The goal is to use the lowest amount and lowest dose of topical steroids to prevent side effects such as skin discoloration and thinning of the skin. These side effects happen with large amounts of high doses of the medications
• Newer skin treatments for eczema include tacrolimus (Protopic) and pimecrolimus (Elidel)
• In some cases your doctor may recommend a dilute bleach bath to help reduce the number of bacteria on the skin which can cause infections or worsen symptoms. To prepare a bleach bath, add ¼ to ½ cup of bleach to a full bathtub (40 gallons of water). Bleach baths are usually taken for 5 - 10 minutes twice a week. Always rinse off after a bleach bath
• Wet wraps are another option to control eczema. This involves dampened cotton wraps that are worn over the affected area usually in the night
• Your doctor will discuss other treatment options such as Exposure to  altered UV rays, called narrow band UVB rays, which may shut down the immune system cells in the skin that have caused the inflammation. Phototherapy may relieve symptoms of eczema and dermatitis without the need for medicated skin creams or medications taken by mouth.
•  The link between skin disorders and changes in barrier lipid composition, especially in ceramides, is difficult to prove because of the many variables involved. However, most skin disorders that have a diminished barrier function present a decrease in total ceramide content with some differences in the ceramide pattern. Formulations containing lipids identical to those in skin and, in particular, some ceramide supplementation could improve disturbed skin conditions.