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Eczema is a form of dermatitis, or inflammation of the upper layers of the skin. The term eczema is broadly applied to a range of persistent or recurring skin rashes characterized by redness, skin edema, itching and dryness, with possible crusting, flaking, blistering, cracking, oozing or bleeding. Areas of temporary skin discoloration sometimes characterize healed lesions, though scarring is rare. Diagnosis Eczema diagnosis is generally based on the appearance of inflamed, itchy skin in eczema sensitive areas such as face, chest and other skin crease areas. However, given the many possible reasons for eczema flare ups, a doctor is likely to ascertain a number of other things before making a judgment: An insight to family history Dietary habits Lifestyle habits Allergic tendencies Any prescribed drug intake Any chemical or material exposure at home or workplace To determine whether an eczema flare is the result of an allergen, a doctor may test the blood for the levels of antibodies and the numbers of certain types of cells. In eczema, the blood may show a raised IgE or an eosinophilia. The blood can also be sent for a specific test called Radioallergosorbent Test (RAST) or a Paper Radioimmunosorbent Test (PRIST). In the test, blood is mixed separately with many different allergens and the antibody levels measured. High levels of antibodies in the blood signify an allergy to that substance. Another test for eczema is skin patch testing. The suspected irritant is applied to the skin and held in place with an adhesive patch. Another patch with nothing is also applied as a control. After 24 to 48 hours, the patch is removed. If the skin under the suspect patch is red and swollen, the result is positive and the person is probably allergic to that substance. Occasionally, the diagnosis may also involve a skin lesion biopsy: removal of a small piece of skin for microscopic examination in a laboratory. Blood tests and biopsies are not always necessary for eczema diagnosis. However, doctors will at times require them if the symptoms are unusual, severe or in order to identify particular triggers. Moisturizing Dermatitis severely dries out the skin,and keeping the affected area moistened can promote healing and retain natural moisture. This is the most important self-care treatment that one can use in atopic eczema. The use of anything that may dry out the skin should be discontinued and this includes both normal soaps and bubble baths that remove the natural oils from the skin. The moistening agents are called 'emollients'. The rule to use is: match the thicker ointments to the driest, flakiest skin. Light emollients like Aqueous Cream may dry the skin if it is very flaky and whilst it is the moisturiser traditionally prescribed by doctors in the UK, it is in fact only licensed for use as a soap substitute on washing Emollient bath oils should be added to bath water and then suitable agents applied after patting the skin dry. Generally twice daily applications of emollients work best and whilst creams are easy to apply, they are quickly absorbed into the skin and so need frequent re-application. Ointments, with their lesser water content, stay on the skin for longer and so need fewer applications but they must be applied sparingly if to avoid a sticky mess. Typical emollients in the U.K. are: Oilatum or Balneum bath oils, Aqueous cream for washing with, Diprobase or Doublebase pump-action creams also used for washing and may be later applied directly to the skin. The preferred moisturiser of dermatologists is a mix of liquid and white-soft paraffins. Sebexol, Epaderm ointment and Eucerin lotion or cream may be helpful with itching. Moisturizing gloves can be worn while sleeping. Some report improvement of symptoms after treatment of the skin with porridge oats, either directly or with an extract. Eczema and detergents The first and primary recommendation is that people suffering from eczema shouldn't use detergents of any kind unless absolutely necessary. The current medical school of thought is that people wash too much and that eczema sufferers should use cleansers only when water is not sufficient to remove dirt from skin. Another point of view is that detergents are so ubiquitous in modern environments and so persistent in tissues and surfaces, safe soaps are necessary to remove them in order to eliminate the eczema in a percentage of cases. Although most recommendations use the terms "detergents" and "soaps" interchangeably, and tell eczema sufferers to avoid both, detergents and soaps are not the same and are not equally problematic to eczema sufferers. Detergents increase the permeability of skin membranes in a way that soaps and water alone do not. Sodium lauryl sulfate, the most common household detergent, has been shown to amplify the allergenicity of other substances ("increase antigen penetration"). (For example, Corazza M, Virgili A, Allergic contact dermatitis from ophthalmic products: can pre-treatment with sodium lauryl sulfate increase patch test sensitivity? Contact Dermatitis. 2005 May;52(5):239-41.) The use of detergents in recent decades has increased dramatically, while the use of soaps began to decline when detergents were invented, and leveled off to a constant around the '60s. Complicating this picture is the recent development of mild plant-based detergents for the natural products sector. Unfortunately there is no one agreed upon best kind of cleanser for eczema sufferers. Different clinical tests, sponsored by different personal product companies, unsurprisingly tout various brands as the most skin friendly based on specific properties of various products and different underlying assumptions as to what really determines skin friendliness. The terms "hypoallergenic" and "doctor tested" are not regulated (according to Consumer Reports), and no research has been done showing that products labeled "hypoallergenic" are in fact less problematic than any others. Dermatological recommendations in choosing a soap generally include: Avoid harsh detergents or drying soaps. Choose a soap that has an oil or fat base; a "superfatted" soap is best. Use an unscented soap. Patch test your soap choice, by using it only on a chosen area until you are sure of its results. Use a non-soap based cleanser. How to use soap when one must Bathe in warm water - not hot. Use soap sparingly. Avoid using washcloths, sponges, or loofahs. Use soap only on areas where it is necessary. Soap up only at the very end of your bath. Use a fragrance free barrier type moisturizer such as vaseline or aquaphor before drying off. Never use any kind of lotion, soap, or fragrance unless your doctor tells you to or it's allergen free Never rub your skin dry, elsewise your skin's oil/moisture will be on the towel and not your body. Itch Relief Antihistamine medication may reduce the itch during a flare up of ezcema, and the reduced scratching in turn reduces damage & irritation to the skin (the Itch cycle). Capsaicin applied to the skin acts as a counter irritant (see Gate control theory of nerve signal transmission). Other agents that act on nerve transmissions, like menthol, also have been found to mitigate the body's itch signals, providing some relief. Whilst research has suggested Naloxone hydrochloride and dibucaine suppress the itch cycle in atopic-dermatitis model mice. Corticosteroids Dermatitis is often treated by doctors with prescribed Glucocorticoid (a corticosteroid steroid) ointments or creams. For mild-moderate eczema a weak steroid may be used (e.g. Hydrocortisone or Desonide), whilst more severe cases require a higher-potency steroid (e.g. Clobetasol propionate). They are highly effective in most cases, but must be used sparingly to avoid possible side effects, the most significant of which is that their prolonged use can cause the skin to thin and become fragile (atrophy). High strength steroids used over large areas may be significantly absorbed into the body causing bone demineralisation (osteoporosis). Finally by their immunosuppression action they can, if used alone, exacerbate some skin infections (fungal or viral). If using on the face, only a low strength steroid should be used and care must be taken to avoid the eyes. Hence a steroid of an appropriate strength to promptly settle an episode of eczema should be sparingly applied. Once the desired response has been achieved, it should be discontinued and not used for long-term prevention. Immunomodulators Topical immunomodulators like pimecrolimus (Elidel® and Douglan®) and tacrolimus (Protopic®) were developed after corticosteroid treatments, effectively suppressing the immune system in the affected area, and appear to yield better results in some populations. The US Food and Drug Administration has issued a public health advisory about the possible risk of lymph node or skin cancer from use of these products, but many professional medical organizations disagree with the FDA's findings: The postulation is that the immune system may help remove some pre-cancerous abnormal cells which is prevented by these drugs. However, any chronic inflammatory condition such as eczema, by the very nature of increased metabolism and cell replication, has a tiny associated risk of cancer (see Bowen's disease). Current practice by UK dermatologists is not to consider this a significant real concern and they are increasingly recommending the use of these new drugs. The dramatic improvement on the condition can significantly improve the quality of life of sufferers (and families kept awake by the distress of affected children). The major debate, in the UK, has been about the cost of such newer treatments and, given only finite NHS resources, when they are most appropriate to use. Antibiotics The disruption to the skin's normal barrier protection through dry and cracked skin allows easy entry for bacteria and fungi. Scratching by the patient both introduces infection and spreads it from one area to another. Any skin infection further irritates the skin and a rapid detoriation in the condition may ensue; the appropriate antibiotic should be given. Psychological Effects Eczema often comes and goes in cycles, meaning that at some times of the year sufferers are able to feel normal, while at other times they will distance themselves from social contact. Sufferers with visible marks can act normal, but when it is mentioned they become withdrawn and self-conscious. Since it is a condition made worse by scratching, a sufferer with highly visible sores aggrivated by scratching often feel as if everyone is looking at the marks and that it is their own fault. Although scratching does give pain, the sense of release can lead to problems with constant scratching. Sufferers often shy away from scratching in public, but the solution is to scratch in privacy. In cases of children with eczema, visible scars or scratch marks can lead to suspicion of home abuse or self-mutilation, which causes possible peer rejection and may add to a general level of stress. Information referenced from en.wikipedia.org/wiki/eczema

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