General Dermatology

Eczema & Hand Eczema

Eczema is a term used to describle a group of inflamed skin conditions that result in chronic, relapsing and very itchy rashes. About 15 million people in the United States suffer from some form of eczema, including 10 to 20 percent of all infants. There is no known cause for the condition, but it appears to involve an overactive immune system in the presence of certain materials and often occurs in people susceptible to allergies. Symptoms vary from person to person but often include dry, red, itchy patches on the skin which, when scratched, tend to break out in rashes. Sometimes rashes "bubble up" and ooze; other times they may be more scaly. A common result of excessive scratching is lichenification, the leathery texture caused by skin thickening.

Objects and conditions that trigger itchy eczema outbreaks may include rough or coarse materials touching the skin, excessive heat or sweating, soaps, detergents, disinfectants, fruit and meat juices, dust mites, animal saliva and danders, upper respiratory infections and stress. Avoidance of those triggers is the simplest way to minimize flare-ups.

The first and most critical step in preventing eczema is to restrain yourself from scratching. Moisturizing lotions or creams, cold compresses and nonprescription anti-inflammatory corticosteroid creams and ointments are often helpful. Beyond this, physicians may prescribe corticosteroid medication, antibiotics to combat infection or sedative antihistamines. Phototherapy is a common procedure to reduce rashes, as are tar treatments (though messy). For severe cases, drugs such as cyclosporine A may be recommended. The FDA is currently studying a new class of drugs called topical immunomodulators (TIMs) for the modulation of immune response to reduce eczema flare-ups.

Children and infants often inadvertently worsen their eczema because they cannot control scratching. You can help by applying moisturizer regularly, avoiding sudden temperature changes, keeping rooms free of dust mites, using mild soaps on skin and clothing, and dressing the child in breathable clothing.

Hand Eczema is generally a chronic condition which can be controlled when properly treated, but tends to reoccur when your hands come in contact with certain irritating substances. The following suggestions may help.

  • Avoid contact with soapy water, detergents, ammonia, cleanser, bleach, furniture polish, and other household cleaning agents. Avoid solvents such as paint thinner, turpentine, alcohol, gasoline, acetone, fingernail polish remover. These strong agents were made for removing dirt and grease from floors, walls, dishes, not your skin. The less exposure to water the better.
  • When cooking, take special care to avoid contact with fruit juices (especially citrus fruits), raw meat, and raw vegetables (particularly tomatoes, potatoes, onions, and garlic).
  • To protect your hands while cleaning and cooking by wearing cotton cosmetic gloves (available at cosmetic counters) with separate rubber type gloves over them. Neoprene gloves (Bluettes) or vinyl gloves are often less irritating than real rubber. Use the largest size gloves you can find so that air can circulate freely. It is important that the rubber not contact your skin directly. Try not to wear the rubber gloves for longer than 30 minutes at a time since heat and perspiration inside the gloves can be as irritating as soap and water. Use long-handled brushes whenever possible to keep glove wearing time to a minimum.
  • For washing your hands and body, use special non-irritating soap-free cleansers such as Cetaphil or Aquanil. These soap substitutes are also excellent for bathing babies and young children.
  • When doing dry, dusty, or dirty work, wear cotton gloves to prevent your hands from excessive soiling. Use heavy cotton or leather gloves for gardening.
  • Rings, particularly those with hollow backs, tend to collect soap particles. Try to rinse them clear after each hand washing, and once a week remove hollow-backed rings and clean the inside with a toothbrush and vinegar. If the skin on your hands is severely inflamed, do not wear rings.
  • Your doctor will give you a prescription cream specifically designed to reduce the inflammation and irritation of your skin. Use it sparingly on the inflamed skin only. Once your skin is healed, discontinue the prescription cream. Moisturizing creams such as Cetaphil cream, Moisturel, DML Forte, Eucerin, Nivea, and Aquaphor are helpful. You can apply them nightly to improve healing and maintain skin integrity.

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