Eczema - home health advice

Definition

Eczema (or dermatitis) refers to a group of chronic skin disorders that primarily involve the epidermis and include atopic, contact, stasis, seborrheic, nummular, dyshidrotic, generalized, or localized scratch dermatitis. Type depends on cause and location on body, but treatment is generally the same. Family history of allergic rhinitis, asthma, or atopic dermatitis often exists. Neurodermatitis is used to describe eczematoid rashes that seem to have a major stress-related component.
Etiology

Eczema can be caused by allergies, allergies secondary to digestive disorders (hydrochloric acid deficiency, for example), drugs, environmental exposures, or be secondary to immune diseases, genetic metabolic disorders, or nutritional deficiencies.
Risk Factors

Inflammation exacerbated by:

* Stress or anxiety
* Allergies to ingestants (foods), inhalants, and contactants
* Lack of sleep
* Heredity
* Excessive consumption of fruit, especially citrus and sour types
* Underlying emotional problems, especially compulsive behaviors

Signs and Symptoms

* Itching
* Erythema
* Lesions usually appear on face, neck, trunk, and genital areas. May be characterized as: papules, oozing and crusting vesicles (infants); induration, scaling (adults, children)

Differential Diagnosis

Various types of eczema (dermatitis):

* Contact eczema: localized rash where offending agent touched skin; caused by irritants, allergens, light, chemicals, perfumes, metals
* Atopic eczema: patient often has a history of vitamin B12 problems, asthma, allergic respiratory problems (hay fever), allergies
* Seborrheic eczema: on face, chest, scalp
* Nummular eczema: chronic round red spots that crust and scale; accompanies dry skin in winter; often associated with emotional stress; usually found in people over the age of 35
* Stasis eczema: over lower legs; associated with poor venous return; skin turns brown
* Dyshidrotic eczema (pompholyx, vesicular dermatitis): 1 to 2 mm "tapioca"-like vesicles found on soles, palms, and sides of fingers that may merge to form multiloculated blisters; scaling and fissuring after blisters dry; itching, usually occurs after age 30 and will recur
* Localized scratch eczema: patches with whitish areas surrounded by increased pigmentation; more frequent in women age 20 to 50; allergic components, exacerbated by scratching.

Other noneczematous disorders:

* Inflammatory tinea pedis
* Vesicular tinea
* Herpes simplex virus infection
* Dermatophytosis
* Psoriasis

Diagnosis
Physical Examination

Skin inflammation with blisters that itch, ooze, and crust over. Patient may have a family history of asthma or food or environmental allergies.
Laboratory Tests

If HSV infection suspected, a Tzanck smear is done.
Other Diagnostic Procedures

Obvious physical appearance is generally basis for diagnosis. Food allergy tests may be necessary if food allergy is suspected cause.
Treatment Options
Treatment Strategy

Lubricate skin with oil, moisturizers
Drug Therapies

* Topical and systemic corticosteroids apply according to package directions for skin lesions; high-potency topical steroid applied early may stop the itching and the attack. One percent topical hydrocortisone for children; may use higher concentration in adults
* Disulfiram recommended for nickel allergy or dyshidrotic eczema
* Oral cromolyn sodium recommended for nickel allergy or dyshidrotic eczema
* Zinc oxide apply locally for severe itching
* Topical psoralen with special UVA light sources to treat hands and feet; response slow

Complementary and Alternative Therapies

Eliminating allergenic foods is key in treating eczema. Following nutritional guidelines and using herbal support as needed may be effective in reducing inflammation and hypersensitivity reactions.

Hypersensitivity reactions may be associated with stress and anxiety. Mind-body techniques such as meditation, tai chi, yoga, and stress management may help reduce reactivity.
Nutrition

Note: Lower doses are for children.

* Eliminate all food allergens from the diet. The most common allergenic foods are dairy, soy, citrus, peanuts, wheat, fish, eggs, corn, and tomatoes. An elimination/challenge trial may be helpful in uncovering sensitivities. Remove suspected allergens from the diet for two weeks. Reintroduce foods at the rate of one food every three days. Watch for reactions that may include gastrointestinal upset, mood changes, flushing, and exacerbation of eczema.
* A rotation diet, in which the same food is not eaten more than once every four days, may be helpful in chronic eczema.
* Reduce inflammatory foods in the diet including saturated fats (meats, especially poultry, and dairy), refined foods, and sugar. Patients with antibiotic sensitivity should eat only organic meats to avoid antibiotic residues. Avoid caffeine and alcohol.
* Increase intake of fresh vegetables, whole grains, and essential fatty acids (cold-water fish, nuts, and seeds).
* Flaxseed (3,000 mg bid), borage (1,500 mg bid), or evening primrose oil (1,500 mg bid) are anti-inflammatory. Children should be supplemented with 500 mg doses of these oils bid, or with cod liver oil (1/2 to 1 tsp. daily).
* Beta-carotene (25,000 to 100,000 IU/day), zinc (10 to 30 mg/day), and vitamin E (100 to 400 IU/day) support immune function and dermal healing.
* Zinc spray can heal the tissue in a subset of patients.
* Vitamin C (250 to 1,000 mg bid to qid) inhibits histamine release. Vitamin C from rose hips is citrus-free and hypoallergenic.
* Selenium (50 to 200 mcg/day) helps to regulate fatty acid metabolism and is a cofactor in liver detoxification.
* Bromelain (250 mg bid to qid taken between meals) is a proteolytic enzyme that reduces inflammation.
* For eczema that is resistant to treatment consider oral supplementation with hydrochloric acid.
* If after six weeks there is no improvement, switch oils to omega-6/vegetable oils one to two times/day.

Flavonoids, a constituent found in dark berries and some plants, have anti-inflammatory properties, strengthen connective tissue, and help reduce hypersensitivity reactions. The following are flavonoids that may be taken in dried extract form as noted.

* Catechin (25 to 150 mg bid to tid), quercetin (100 to 250 mg bid to tid), hesperidin (100 to 250 mg bid to tid), and rutin (100 to 250 mg bid to tid).
* Rose hips (Rosa canina) are also high in flavonoids and may be used as a tea. Drink 3 to 4 cups/day.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, it is important to ascertain a diagnosis before pursuing treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. of herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as noted.

Herbs that support dermal healing and lymphatic drainage are useful for relieving eczema. Use the following herbs in combination as a tincture (15 to 30 drops tid) or tea (2 to 4 cups/day). Burdock root (Arctium lappa), yellowdock (Rumex crispus), red clover (Trifolium pratense), cleavers (Galium aparine), yarrow (Achillea millefolium), peppermint (Mentha piperita), and nettles (Urtica dioica). To prepare a tea, steep the root elements for 10 minutes, then add the rest of the herbs and steep an additional 5 to 10 minutes.

Topical applications of creams and salves containing one or more of the following herbs may help relieve itching, burning, and promote healing. Chickweed (Stellaria media), marigold (Calendula officinalis), comfrey (Symphytum officinale), and chamomile (Matricaria recutita).

Marshmallow root tea (Althea officinalis) may soothe and promote healing of gastrointestinal inflammation that is often found with this condition. Soak 1 heaping tbsp. of marshmallow root in 1 quart of cold water overnight. Strain and drink throughout the day.
Homeopathy

An experienced homeopath should assess individual constitutional types and severity of disease to select the correct remedy and potency. The use of acute remedies may exacerbate eczema.
Physical Medicine

Starch, oatmeal, and other baths may temporarily relieve the symptoms.
Acupuncture

Acupuncture may help restore normal immune function and reduce the hypersensitivity response.
Patient Monitoring

* This chronic, recurring disorder can flare up with stress or exposure to offending agents. Lesions of the hands and feet can become severe and need prompt attention.
* With underlying psychopathologies, short- or long-term psychotherapy, hypnosis, behavioral therapy, or biofeedback techniques may help.

Other Considerations
Prevention

Conservative introduction of solid foods as child is weaning may help prevent hypersensitivity conditions. If there is a strong family history of allergies or atopic conditions and/or if the child's immunity has been compromised in infancy, delay the introduction of highly allergenic foods (especially dairy and grains) until 1 year or older.

Infants exclusively breast-fed have a lower risk of atopic eczema development, and develop symptoms at a later age. This may reflect later contact with cow's milk, a common sensitizer.
Complications/Sequelae

Continuing recurrences may accompany stress and increase levels of anxiety or depression. Overuse of topical cortiosteroids may atrophy skin.
Prognosis

Even moderate to severe cases of eczema are usually just an annoyance. Meticulous care will control most flare-ups. Eczema is a chronic disease that tends to lessen in severity or resolve with advancing age. Most children see resolution by puberty.
Pregnancy

Nutritional support and topical applications may safely relieve symptoms during pregnancy.
References

The Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Tiburon, Calif: Future Medicine Publishing Inc; 1997.

Morse PF, et al. Meta-analysis of placebo-controlled studies of the efficacy of Epogam in the treatment of atopic eczema: relationship between plasma essential fatty acid changes and clinical response. Br J Dermatol. 1989;121:75-90.

Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin, Calif: Prima Publishing; 1998:296-300.

Noble J, ed. Textbook of Primary Care Medicine. 2nd ed. St Louis, Mo: Mosby-Year Book; 1996:345-365, 368-375, 1064-1084.

Tierney LM Jr, McPhee SJ, Papadakis MA, eds. Current Medical Diagnosis and Treatment. Norwalk, Conn: Appleton & Lange; 1994.

Werbach, M. Nutritional Influences on Illness. New Canaan, Conn: Keats Publishing; 1988:186-188.