Eczema and atopic dermatitis: the good and the bad antibodies.
We need our immune system to defend us from the infectious agents that are trying to invade us. Sometimes it does not work as well as we would like it to, and it plays tricks on us.
The terms eczema, atopic dermatitis or atopic eczema are used to describe a chronic inflammatory skin disease with allergic causes, in which the skin itches and there is some scaling, crusting and/or oozing (rather than just erythema or inflammation). Skin affected by eczema is more prone to bacterial infection, as the skin barrier breaks, facilitating attack by microorganisms.
People who have eczema also tend to have other manifestations of allergy, like allergic rhinitis or asthma. Atopic dermatitis is very frequent, affecting about 10% of the population, and it can start as early as 2 months of age.
Atopy is characterized by high concentrations of serum IgE, a high incidence of IgE-mediated responses on skin testing to common inhaled antigens, and many other manifestations of an over-sensitive and "skewed" immune system. For the time being, there is little that can be done about atopy at the molecular level, but if things get tough we can always go for time-proven Benadryl or the newer Allegra o Claritin.
What can you do if you or a loved one has atopic dermatitis? It may help to avoid common allergens such as dust mites, animal danders and saliva, and pollen. Children can have food allergies so it is worthwhile to explore this aspect with the help of an MD, always remembering that the common "exclusion diets" where several common foods are avoided at a time can deprive the child of essential nutrients. Immunotherapy, i.e. desensitization by "allergy shots", does not seem to work for atopic dermatitis, in contrast to its relative success in treating patients with other allergic disorders.
Avoid factors that may worsen atopic dermatitis: excessive bathing, low humidity environments, emotional stress, dry skin, rapid temperature changes, and exposure to solvents and detergents. Doctors do not agree on whether showering or bathing is preferable in patients with atopic dermatitis. Some doctors recommend a hydrating bath followed by immediate application of emollients (oils), and others recommend a shower of short duration, which better removes surface antigens that may be acting as trigger factors. If you take baths you can add to the bath water rosehip oil.
The itchiness of eczema leads to scratching, and scratching leads to rashes. This vicious circle must be stopped because the scratching can lead to permanent changes in the skin, including scars, and infections. Although cortisone is a good idea for emergencies, it cannot be used long term because it may lead to skin thinning, depigmentation, and stretch marks. Also, corticosteroid will reach the blood stream, suppressing the activity of the adrenals.
Evaporation of skin humidity leads to dry skin in patients with atopic dermatitis, and this is why skin hydration is a key component of overall management. Lotions have a high water and low oil contents; can worsen dry skin via evaporation, thus triggering flares of eczema. Conversely, thick creams with low water content, or ointments, which have zero water content, protect better against dry skin (and eczema flares). Apply emollients immediately after bathing to keep the skin well hydrated.
To alleviate the itching you can use instead calamine, rosehip or pomegranate seed oil, or take a warm bath with oat glucan and rose hip oil. To decrease inflammation, use bisabolol, white willow bark extract, chamomile, rosehip seed oil, oat glucan, all of them anti-inflammatories without the side effects of the corticosteroids.