Eczema is a general term used for several common types of skin rashes, which share the features of skin irritation, redness, weeping, scaling, and itching. The two main drivers of eczema are skin barrier disruption and an exaggerated immune response. People who live in dry climates such as Denver, Colorado are more likely to develop eczema.
When eczema is due to contact allergy (such as poison ivy), avoidance of the offending allergen will usually prevent the rash from recurring. Individuals with a tendency toward chronic eczema must develop a good skin care routine, avoid things that lead to flares, and treat symptoms when they occur.
Taking a warm (not very hot) bath for 20 minutes, using a soap-free cleanser, followed by the application of an occlusive moisturizer, can retain water in the skin and give relief from itching. The newer ceramide-containing moisturizers (e.g. Cerave cream) can be very helpful. In Colorado, moisturizing is particularly important, and use of humidifiers in the winter months is recommended. For skin that is oozy or crusty, it can sometimes be helpful to add a small amount of bleach to the bathtub (a quarter cup of regular, not concentrated bleach to a half tub of water) for anti-bacterial purposes (bleach baths).
Some people can improve their eczema by avoiding allergens such as certain foods (e.g. eggs, peanuts, milk, soy, or wheat), dust mites, mold, pollen, and dog or cat dander. Eczema may also be worsened by irritants such as wool, soaps, perfumes, makeup, dust, or cigarette smoke.
Patch testing is used to test a panel of allergens on the patient’s skin to check for any positive reactions. Many doctors will start with the TRUE Test but testing with additional allergens may be necessary. Patch testing is non-invasive and does not involve any needle sticks. Patches with small amounts of various allergens are taped to the back and left on for two days. When the patches are removed, the skin is examined for any evidence of reaction to any of the allergens.
Topical steroids are a first-line treatment for eczema flares and are usually effective. However, topical steroids are best used as a short-term or intermittent treatment to avoid the side effect of skin atrophy or thinning. Newer steroid-free products such as Eucrisa ointment can be very helpful. For severe eczema flares, a brief course of oral prednisone may be required. If an individual has infected eczema, an oral antibiotic may be necessary. Oral antihistamines can be useful to reduce itching and scratching.
Dupixent (dupilumab) is an exciting breakthrough treatment for the treatment of severe or recalcitrant eczema. It is given as an injection at home every other week. Dupixent targets a specific part of the immune system (IL-4 and IL-13), which decreases inflammation and improves the skin barrier. Dupixent can provide dramatic relief from eczema, without risking some of the harsh side effects of older medications.