Human skin is an amazing and resilient part of the body, functioning as an immune helper, a waste disposer, and a sensory receptor. The largest organ in the body, its two square yards protect our internal parts, but with such a complex system of follicles, glands, and layers of epithelial cells, there are many chances for things to go wrong.
Many people think that a lifetime of itchy, irritated skin is normal, and that the only “real” skin disorders are conditions like psoriasis, keratosis, and acne. It might be surprising to think of an itchy rash as being part of a skin disorder, but many people can suffer from skin problems without even knowing it. In fact, if you’re prone to any kind of recurring, itchy rash, it might not be a simple case of sensitive skin. You might be suffering from a dermatological disorder called eczema.
The Eczema Spectrum
Eczema isn’t just one specific skin condition; it refers to a whole host of common, non-contagious rashes which range from the mildly irritating to the painfully severe. As a catch-all term, eczema is the most common skin condition in the United States. According to the National Institutes Of Health, up to fifteen million people in the U.S. suffer from some form of eczema, often called “the itch that rashes” because of the way severe itching often precedes the appearance of the skin response. By far, the most common form of eczema is simple atopic dermatitis, characterized by dry, itchy, reddish patches of irritated skin that can appear anywhere on the body. Some other kinds of eczema are mild and fleeting, such as the contact dermatitis caused by allergic reactions to things like poison ivy or soap, or the neurodermatitis that results from an insect bite. Some other forms of eczema are more severe and chronic, such as dyshidrotic eczema, which causes burning, itching blisters to develop on the palms of the hands and soles of the feet. Even dandruff, whose proper name is seborrheic dermatitis, is sometimes considered an eczema rash.
Besides generally itchy and irritated skin, eczema can cause any number of symptoms including swelling, cracking, skin that weeps fluid and scaling, and thickening of the skin. Some eczema lesions crust over or develop blisters or ulcers. In dark-skinned people, eczema can even affect the pigment of their skin.
Eczema can affect anyone at any age, but it is most common in children. Infants affected by eczema conditions such as “cradle cap” usually outgrow them by the time they leave toddlerhood, and for the small percentage of people who experience eczema flare-ups throughout life, outbreaks usually get less severe with age. As people age, the type of eczema from which they suffer is likely to change. Infants and children suffer more from simple atopic dermatitis and seborrheic dermatitis, while the elderly are more likely to experience conditions like statis dermatitis or varicose eczema, both caused by poor blood circulation in the lower body.
Triggers and Tribulations
Doctors don’t know exactly what causes eczema. They do know, however, that there’s a strong genetic component, and that eczema sufferers often have families with long histories of other allergies or asthma. Many flare-ups and outbreaks tend to be in reaction to external triggers, so the best guess is that eczema is an overblown immune system response similar to common nasal allergies. When faced with an allergen or trigger, histamines rush to protect the skin, leaving it itchy and uncomfortable.
Environmental factors such as soaps, perfumes, sand, smoke, detergents, or wool clothing often trigger symptoms of eczema. Some other factors can contribute to the uncomfortable symptoms, such as living in a dry climate, excessive sweating, or taking hot showers. Climate has an effect on skin, and people living in hot, arid climates are more prone to eczema flare-ups than people who live in humid areas. Even in temperate zones, winter’s low humidity can be agonizing for eczema sufferers, as the harsh cold and dry indoor heat create an uncomfortable “winter itch.”
Soothing the Savage Skin
So what’s an itchy eczema-sufferer to do, besides scratch themselves into oblivion? As hard as it may be to refrain, scratching is very bad for skin, since it rakes off layers of cells, invites bacteria to nest, and can aggravate the histamine response. To combat mild or moderate eczema, a good skin-care routine should include taking tepid showers, managing stress, and using gentle, fragrance-free cosmetics and beauty products, such as a gentle moisturizer every day upon exiting the shower or bath. Kids with eczema can also benefit from home remedies, like olive oil and shea butter. It’s also important to avoid known eczema triggers such as perfumes, cigarette smoke, or excessive sweating. For occasional flare-ups, over-the-counter corticosteroid creams like Benadryl can reduce itching.
If stubborn eczema won’t respond to lifestyle changes, doctors and dermatologists can prescribe medications or topical creams to help combat the inflammation. Regular antihistamines can reduce itching, but they are not often used long term because they can cause drowsiness. Prescription steroid creams pack more punch, but they can have side effects such as skin thinning and loss of effectiveness, so many doctors try to limit the use of these products. In recent years, new daily creams such as Elidel and Protopic have been developed, which work by modifying the skin’s immune system; however, these cream are associated with their own risk factors.
For extremely problematic eczema, more intense solutions may be necessary. UV light therapy has been shown to help alleviate the effects of atopic dermatitis, alone or in conjunction with a drug called psoralen, which increases skin’s photosensitivity. As a last resort, dermatologists may prescribe a drug called cyclosporine A, which can systemically alter the body’s immune response, although it has potentially serious side effects.
Life with chronic eczema or atopic dermatitis can feel like a frustrating battle against your own skin. For the many people who aren’t even aware that their problems are the result of eczema, it can be maddening. A dermatologist can help you figure out if your skin troubles are eczema, and help make itching and discomfort things of the past.