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Category Archives: Eczema

Atopic dermatitis – Wikipedia

Posted: January 20, 2017 at 11:44 pm

Atopic dermatitis (AD), also known as atopic eczema, is a type of inflammation of the skin (dermatitis). It results in itchy, red, swollen, and cracked skin. Clear fluid may come from the affected areas, which often thicken over time.[1] The condition typically starts in childhood with changing severity over the years.[1][2] In children under one year of age much of the body may be affected. As people get older, the back of the knees and front of the elbows are the most common areas affected. In adults the hands and feet are the most commonly affected areas.[2] Scratching worsens symptoms and affected people have an increased risk of skin infections. Many people with atopic dermatitis develop hay fever or asthma.[1]

The cause is unknown but believed to involve genetics, immune system dysfunction, environmental exposures, and difficulties with the permeability of the skin.[1][2] If one identical twin is affected, there is an 85% chance the other also has the condition.[3] Those who live in cities and dry climates are more commonly affected. Exposure to certain chemicals or frequent hand washing makes symptoms worse. While emotional stress may make the symptoms worse it is not a cause. The disorder is not contagious.[1] The diagnosis is typically based on the signs and symptoms. Other diseases that must be excluded before making a diagnosis include contact dermatitis, psoriasis, and seborrheic dermatitis.[2]

Treatment involves avoiding things that make the condition worse, daily bathing with application of a moisturising cream afterwards, applying steroid creams when flares occur, and medications to help with itchiness.[2] Things that commonly make it worse include wool clothing, soaps, perfumes, chlorine, dust, and cigarette smoke. Phototherapy may be useful in some people. Steroid pills or creams based on calcineurin inhibitors may occasionally be used if other measures are not effective.[1][4] Antibiotics (either by mouth or topically) may be needed if a bacterial infection develops.[2] Dietary changes are only needed if food allergies are suspected.[1]

Atopic dermatitis affects about 20% of people at some point in their lives.[1][5] It is more common in younger children.[2] Males and females are equally affected.[1] Many people outgrow the condition.[2] Atopic dermatitis is sometimes called eczema, a term that also refers to a larger group of skin conditions.[1] Other names include "infantile eczema", "flexural eczema", "prurigo Besnier", "allergic eczema", and "neurodermatitis".[6]

People with AD often have dry and scaly skin that spans the entire body, except perhaps the diaper area, and intensely itchy red, splotchy, raised lesions to form in the bends of the arms or legs, face, and neck.[7][8][9][10][11]

AD commonly occurs on the eyelids where signs such as Dennie-Morgan infraorbital fold, infra-auricular fissure, periorbital pigmentation can be seen.[12] Post-inflammatory hyperpigmentation on the neck gives the classic 'dirty neck' appearance. Lichenification, excoriation and erosion or crusting on the trunk may indicate secondary infection. Flexural distribution with ill-defined edges with or without hyperlinearily on the wrist, finger knuckles, ankle, feet and hand are also commonly seen.[13]

The cause of AD is not known, although there is some evidence of genetic factors, and some evidence that growing up in a sanitary environment encourages AD.[8]

It seems to have a genetic component. Many people with AD have a family history of atopy. Atopy is an immediate-onset allergic reaction (type 1 hypersensitivity reaction) as asthma, food allergies, AD or hay fever.[7][8] In 2006 it was discovered that mutations in the gene for the production of filaggrin strongly increased the risk for developing atopic dermatitis. Most importantly two mutations were found that affect approximately 5% of people in Western Europe that may disrupt the production of filaggrin. Filaggrin is a protein that plays an important role in the retention of water in the stratum corneum. People who have these mutations often have dry skin.[14] Filaggrin also plays an important role in keeping the skin surface slightly acidic, hence giving it anti-microbial effects. It breaks down into trans-urocanic acid, which keeps the pH low.[15]

According to the hygiene hypothesis, when children are brought up exposed to allergens in the environment at a young age, their immune system is more likely to tolerate them, while children brought up in a modern "sanitary" environment are less likely to be exposed to those allergens at a young age, and, when they are finally exposed, develop allergies. There is some support for this hypothesis with respect to AD.

Those exposed to dogs while growing up have a lower risk of atopic dermatitis.[16] There is also support from epidemiological studies for a protective role for helminths against AD.[17] Likewise children with poor hygiene are at a lower risk for developing AD, as are children who drink unpasteurised milk.[17] Exposure to dust mites is believed to contribute to one's risk of developing AD.[18]

A diet high in fruits seems to have a protective effect against AD, whereas the opposite seems true for fast foods.[17]

Atopic dermatitis sometimes appears associated with celiac disease and non-celiac gluten sensitivity.[19][20]

An atopy patch test can be used to determine whether or not a specific allergen is the cause of the rash. The test involves applying a series of allergens to the skin surface and evaluating the results in one to three days.[21][22]

People with atopic dermatitis are more likely to have Staphylococcus aureus living on them.[23]

There is no known cure for AD, although treatments may reduce the severity and frequency of flares.[7]

Applying moisturisers may prevent the skin from drying out and decrease the need for other medications.[24] Affected persons often report that improvement of skin hydration parallels with improvement in AD symptoms.[7]

Health professionals often recommend that persons with AD bathe regularly in lukewarm baths, especially in salt water, to moisten their skin.[8][25] Avoiding woollen clothing is usually good for those with AD. Likewise silk, silver-coated clothing may help.[25] Dilute bleach baths have also been reported effective at managing AD.[25]

Vitamin D is an effective treatment for AD.[26]

Studies have investigated the role of long chain polyunsaturated fatty acids (LCPUFA) supplementation and LCPUFA status in the prevention and treatment of atopic diseases, but the results are controversial. It remains unclear if the nutritional intake of n-3 fatty acids has a clear preventive or therapeutic role, or if n-6 fatty acids consumption promotes atopic diseases.[27]

Several probiotics seem to have a positive effect with a roughly 20% reduction in the rate of atopic dermatitis.[28] The best evidence is for multiple strains of bacteria.[29]

In people with celiac disease or non-celiac gluten sensitivity, a gluten free diet improves their symptoms and prevents the occurrence of new outbreaks.[19][20]

Topical corticosteroids, such as hydrocortisone have proven themselves effective in managing AD.[7][8] If topical corticosteroids and moisturisers fail, short-term treatment with topical calcineurin inhibitors like tacrolimus or pimecrolimus may be tried, although they are usually avoided as they can cause skin cancer or lymphoma.[7][30] Alternatively systemic immunosuppressants may be tried such as ciclosporin, methotrexate, interferon gamma-1b, mycophenolate mofetil and azathioprine.[7][31] Antidepressants and naltrexone may be used to control pruritus (itchiness).[32]

A more novel form of treatment involves exposure to broad or narrow-band ultraviolet (UV) light. UV radiation exposure has been found to have a localized immunomodulatory effect on affected tissues and may be used to decrease the severity and frequency of flares.[33][34] In particular, the usage of UVA1 is more effective in treating acute flares, whereas narrow-band UVB is more effective in long-term management scenarios.[35] However, UV radiation has also been implicated in various types of skin cancer, and thus UV treatment is not without risk.[36]

Since the beginning of the twentieth century, many mucosal inflammatory disorders have become more common; atopic eczema (AE) is a classic example of such a disease. It now affects 1530% of children and 210% of adults in developed countries and in the United States has nearly tripled in the past thirty to forty years.[8][37] Over 15 million American adults and children have atopic dermatitis.[38]

Evidence suggests that IL-4 is central in the pathogenesis of AD.[39] Therefore, there is a rationale for targeting IL-4 with anti-IL-4 inhibitors.[40]

Diseases of the skin and appendages by morphology

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Eczema (Atopic Dermatitis) Causes, Symptoms, Treatment

Posted: January 13, 2017 at 6:43 am

What Is Eczema?

Eczema is a descriptive term for a chronic skin condition that usually begins in early childhood. It is seen most commonly in individuals who have family members who have asthma and hay fever. This is not to say that eczema is a classical allergic disease. There seems to be general agreement that this condition is inherited because of the complete loss or relative lack of a skin protein.

There are criteria that must be met before the diagnosis of eczema is considered. In most patients, the condition began in childhood. Patients develop plaques of weeping, oozing skin that are very itchy. A personal or family history of eczema, asthma, and/or inhalant allergies is helpful. In older children or adults, the lesions of eczema tend to occur in the folds of the skin in front of the elbows and in the folds of skin behind the knees. Eczema tends to improve in most patients as they get older.

The belief that the cause of eczema seems to be a defect in the production of a particular skin protein (filaggrin) is currently quite popular. All of the other problems that seem to be present in those afflicted include dry skin, hyper-reactivity to wool, itching during sweating, colonization by pathogenic staph bacteria, predisposition to disseminated herpes simplex infections, and a variety of immunologic abnormalities.

There is a debate about which comes first in atopic eczema, the itching or the rash. This is analogous to the chicken and egg controversy. It really does not matter. When the rash is in an acute stage, it is weepy and oozy. Later after the patient has been rubbing and scratching for some weeks, it becomes a plaque of thickened skin. This is called lichenification.

Atopic eczema has a typical distribution on the surface of the skin; this can be quite helpful in making the correct diagnosis. In crawling children in diapers, the rash is frequently seen on the elbows and knees but spares the diaper area. In older children and adults, the rash is often present in the folds of skin opposite to the elbow and kneecap but spares the armpits. Other areas commonly involved include the cheeks, neck, wrists, and ankles.

Atopic eczema (atopic dermatitis) is one of a number of eczematous eruptions that need to be distinguished. This is important because treatment depends on the correct diagnosis. We'll take a look at the listed types on the following slides.

Atopic eczema is an inherited skin condition more common in individuals with a personal or family history of eczema, inhalant allergies like asthma or hay fever. Patients develop weeping, oozing, itchy lesions in a characteristic distribution. The severity depends to a great extent on the amount of moisture in the skin.

Atopic eczema is less common in very humid environments and is harder to control in arid areas in the wintertime. It often begins in infancy and improves in most people as they reach adulthood.

Contact dermatitis is a dermatitis that occurs in response to exposure to an irritant or allergenic substance. Irritants cause skin damage by producing direct toxic damage to the skin cells. Contact allergens are not necessarily irritating or toxic but are recognized by the immune system. Once the immune response is stimulated, a dermatitis occurs at the site of exposure.

Seborrheic dermatitis is a chronic recurrent dermatitis, and it is probably the most common of all rashes in adults. The rash characteristically appears on the scalp, forehead, brows, ears, the folds that extend from the nose to the lips (nasolabial folds), middle of the chest, and middle of the back. It occurs in infants as cradle cap. Its course is distinguished by periods of improvement followed by flares.

With nummular eczema, round plaques of eczematous skin often appear on the lower legs. It often is seen in the elderly and seems to be associated with dry skin.

Lichen simplex chronicus is a localized, thickened area of skin caused by itching and rubbing. Although there is usually some inciting cause, the origin of the problem is entirely obscured by the eruption. Any of the eczematous eruptions can evolve into lichen simplex chronicus if rubbed long enough.

Stasis dermatitis usually occurs on the lower legs of patients who have sustained damage to the valves present in the large veins responsible for returning blood to the heart. These valves, along with muscular contractions of the leg muscles, help propel venous blood from the periphery to the lungs and heart. Damage to these valves causes a long column of blood to produce enough hydrostatic pressure on the wall of the vein so small leaks occur. The lower legs swell and brownish blood pigment is deposited in the skin from degradation of hemoglobin. A dermatitis often occurs, and skin ulcers are common.

Dyshidrotic eczema (pompholyx) is a common but poorly understood condition in which very itchy small blisters occur on the lateral surface of the fingers, toes, hands, and feet. Many patients note exacerbations during periods of high stress (for example, finals week).

In order to make an accurate diagnosis of eczema, it is important for your physician to take a complete history and examine all of the areas of skin that are affected. Occasionally, certain laboratory tests can be helpful in distinguishing various types of eczema. A pathologist may need to examine skin scrapings and even a small piece of biopsied skin.

Once the diagnosis of atopic eczema is established, there are certain well-established approaches to treating this condition. One of the most important is to keep the skin well moisturized. There are many inexpensive approaches to maintaining the moisture content of the skin. Once the skin is wet, a thin layer of a cream or ointment is applied to prevent the moisture from evaporating. Judicious use of such substances (emollients) can be very effective in limiting flares of atopic eczema.

Corticosteroid creams are very effective at controlling the inflammatory component of atopic eczema. The thickened, itchy, weepy lesions respond well to the applications of such creams. In addition, oral antihistamines are effective in suppressing the itching sensation as well as acting as a sleep aid during flares.

Newer drugs have become available for the treatment of atopic eczema; they claim to be devoid of the side effects of topical steroids. These newer medications inhibit the immune response by inhibiting calcineurin, an enzyme necessary for a normal inflammatory response. Though they are quite effective, they are also quite expensive and seem to lack potency when compared to the strongest topical steroids. Ultraviolet light exposure can effectively control eczema in certain patients because of its effect on inflammatory cells in the skin.

Applying a good moisturizer to damp skin is the most effective method for limiting flares of atopic eczema. Try the measures listed on this and the following slide to control and help prevent outbreaks of eczema.

Since the condition is inherited, it would be very difficult to prevent its development entirely. Living in a warm, humid environment seems to limit flares of atopic dermatitis. Sleeping with a humidifier in the bedroom can be of some help. In some patients, adding chlorine bleach to bathwater can be quite helpful (1/2 cup of bleach to a bathtub of warm water). It is important to rinse off before applying an emollient.

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Eczema and Atopic Dermatitis – familydoctor.org

Posted: January 6, 2017 at 10:44 pm

What can I do about eczema and atopic dermatitis?

Eczema and atopic dermatitis cant be cured, but they can be managed, and you can learn to avoid the things that trigger them.

Some things that may irritate your skin include household cleansers, detergents, aftershave lotions, soap, gasoline, turpentine and other solvents. Try to avoid contact with things that make you break out with eczema. Soaps and wetness can cause skin irritation. Wash your hands only when necessary and use a mild unscented soap such as Dove, Basis or Oil of Olay, especially if you have eczema on your hands. Dry your hands completely after you wash them.

Wear vinyl or plastic gloves for work that requires you to have your hands in water. Also, wear gloves when your hands will be exposed to anything that can irritate your skin. Wear cotton gloves under plastic gloves to soak up sweat from your hands. Take occasional breaks and remove your gloves to prevent a buildup of sweat inside your gloves.

Wear gloves when you go outside during the winter. Cold air and low humidity can dry your skin, and dryness can make your eczema worse.

Wool and some synthetic fabrics can irritate your skin.

Bathe only with a mild unscented soap, such as Dove, Basis or Oil of Olay. Use a small amount of soap. Keep the water temperature cool or warm, not hot. Soaking in the tub for a short time can be good for your skin because the skins outer layer can absorb water and become less dry. Soak for 15 to 20 minutes. Then use a soft towel to pat your skin dry without rubbing. Immediately after drying, apply a moisturizer to your skin. This helps seal in the moisture.

Moisturizers help keep your skin soft and flexible. They prevent skin cracks. A plain moisturizer is best. Avoid moisturizers with fragrances (perfume) and a lot of extra ingredients. A good, cheap moisturizer is plain petroleum jelly (such as Vaseline). Use moisturizers that are more greasy than creamy, because creams usually have more preservatives in them.

Regular use of a moisturizer can help prevent the dry skin that is common in winter.

Too much heat and sweat can make your skin more irritated and itchy. Try to avoid activities that make you hot and sweaty.

Eczema can flare up when you are under stress. Learn how to recognize and cope with stress. Stress reduction techniques can help. Changing your activities to reduce daily stress can also be helpful.

The area where you had the eczema may easily get irritated again, so it needs special care. Continue to follow the tips in this handout even after your skin has healed.

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Not All Fruits and Veggies Are Eczema-Friendly (The 4 …

Posted: January 4, 2017 at 5:47 pm

Not all fruits and veggies are good the eczema body.

Eat more fruits and veggies because they are super healthy!

You need vitamins from fruits and fiber from veggies!

As cliches go, it sounds like these plant foods are mandatory in our lives or else we will die, or at least, be in poor health.

However, speaking in the perspective of an eczema sufferer, not all fruits and vegetables are created equal not all of them are eczema-friendly.

As an eczema sufferer, we need to avoid certain fruits and veggies.

In this article, Ill list them out and explain why, even though plant foods are nutritious and beneficial in many ways, they are disadvantageous to eczema patients overall.

This article is not designed to defame fruits and vegetables. Fruits and veggies are indeed high in different types of nutritional values and are extremely good for the human body, but not every body responds the same way, so each individual needs to adapt to his/her body needs.

When I mean certain plants are NOT friendly to eczema sufferers, its just the consequences of eating them to an eczema body overrides the nutritional benefits of eating them.

In essence, we need to find out our bodys list of accepted foods and also, to avoid specifically to eczema-unfriendly plant foods.

Nightshades is the family of foods: potatoes (but not sweet potatoes and I highly encourage you to eat them regularly), tomatoes, tobacco, red and green peppers, paprika, eggplants (these are the common ones).

Nightshades naturally contain a group of chemicals called alkaloids.

Plants produce alkaloids as a regular part of their biochemical activity, and these alkaloids are primarily designed to help protect the plants from insects that would otherwise eat them.

And these plant protective mechanisms when ingested just hinder our recovery. For a meaty explanation, read this article.

Some of these foods may be a staple food in your diet, but you can always find substitutes. For nightshades, you can switch for:

Sarah, who runs Vegetalion, with nightshade allergies, wrote four great articles on finding alternatives:

A common problem today is that many people consume way too much sugar.

But assuming that you have no intake of any man-made snacks and drinks. It is still possible to consume a lot of sugar with natural foods.

Vegetables are not a problem, the highest sugar content of veggies are potatoes (which you dont have to care), carrots and beets. But the sugar content of veggies is too low for you to need to reduce intake. So dont worry too much about this.

The reason why sugar intake needs to be limited is because the more sugar you ingest, the more food you give to harmful micro-organisms to feed on in your gut. Yeasts, especially, live on sugar.

As for fruits, avoid these high sugary fruits: tangerines, oranges, cherries, grapes, pomegranates, mangoes, guavas, lychees, figs, bananas and especially dried fruit.

Instead, choose low sugar fruits: lemon, lime, raspberries, blackberries, cranberries, papayas, watermelon and most others are okay. Just avoid the ones mentioned above.

For a more details, go check out Fruits And Vegetable : List of Low and High Sugar Fruit and Vegetable.

The Dirty Dozen is the official term coined by the Environmental Working Group (EWG) that refers to the annual top 12 plants contaminated most heavily by pesticides.

Dirty Dozen: top 12 most contaminated plants are:

New extras: Kale/collard greens and Summer squash.

Clean 15: the top 15 least likely to be contaminated are:

Check out the EWGs 2013 Shoppers Guide to Pesticides in Produce for the official lists.

The reason why Im telling you this is to warn you that when you consume one of the Dirty Dozen (you dont have to completely avoid it), you should cook it long enough, soak it in water overnight, or even peel off the skin to eliminate the residue of pesticides, so you dont end up suffering from the chemicals more than the nutrients you get from the food.

Acidifying refer to foods that leave an acidifying effect in the body after digestion, not its pH value upon tasting.

For a person with eczema, we should aim for a 80-20 balance where 80% of our food is alkalizing and 20% acidifying. Essentially, that means mainly veggies and less meats.

You should be aware that many fruits are actually acidifying. Fruits are great but shouldnt be consumed in mass.

Common strongly acidifying foods include:

Instead, indulge yourself in strongly alkalizing foods:

There are other categories: acidifying, alkalizing, strongly alkalizing; this is only a small list.

Read more on Acid-Alkaline Food Charts (also usable as a grocery shopping list).

You now know what NOT to eat, so what should you be eating?

Here are 10 choices that are highly specifically beneficial to improve skin conditions:

Sweet potatoes are one of the best foods in the world. I eat several daily.

Fermented foods.

Fruits are not normally fermented veggies are the main target e.g. kimchi, pickled veggies, sauerkraut and more. Any plants can be fermented.

Fermented foods are extremely good for people with eczema because fermented foods contain live cultures beneficial micro-organisms that help digestion and the removal of toxins in the gut, which is crucial for healing up eczema.

Ive personally made my own kimchi before, and wrote a guide about it, added with other fermentation resources.

Check it out: How To Make Fermented Kimchi (For Fresh Gut Bacteria)

In brevity, avoid the four evil categories as mentioned above:

Again, if a particular fruit or vegetable gives you a sensitivity, you know what not to eat. This differs with everyone. For me, I have a sensitivity to papayas, green capsicums and kiwis (as far as I know) the skin area my mouth turns red.

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Our evidence | Cochrane

Posted: December 14, 2016 at 3:42 am

1

Prescribing roles for health professionals other than doctors

New

2

Vitamin C for preventing and treating the common cold

3

Early skin-to-skin contact for mothers and their healthy newborn infants

Updated

4

Vaccines to prevent influenza in healthy adults

5

Gabapentin for chronic neuropathic pain and fibromyalgia in adults

6

Bronchodilators for bronchiolitis for infants with first-time wheezing

7

Vitamin E supplementation in pregnancy

8

Corticosteroids for bacterial meningitis

9

Weaning from mechanical ventilation using pressure support or a T-tube for a spontaneous breathing trial

10

Intravenous infusion of lidocaine starting at the time of surgery for reduction of pain and improvement of recovery after surgery

11

Magnesium sulfate for treating exacerbations of acute asthma in the emergency department

12

Amitriptyline for neuropathic pain in adults

13

Loop diuretics for patients receiving blood transfusions

14

Treatments for delusional disorder

15

Acupuncture for preventing migraine attacks

16

Two different laparoscopic techniques for repairing a hernia in the groin

17

T-tube drainage versus no T-tube drainage after open common bile duct exploration

18

Oral dextrose gel for treatment of newborn infants with low blood glucose levels

19

Routine abdominal drainage versus no drainage for patients undergoing uncomplicated laparoscopic cholecystectomy

20

Oral misoprostol for induction of labour

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Air pollution – Simple English Wikipedia, the free …

Posted: December 10, 2016 at 1:44 pm

Air pollution is the pollution of air by smoke and harmful gases, mainly oxides of carbon, sulfur, and nitrogen.

Many of the world's large cities today have bad air quality.[1] Even 2,000 years ago, the Romans were complaining about the bad air in their cities. At that time, the air was thick with smoke from fires and the smell of sewers.[1] Air pollution has been a danger to human health and Earth's many ecosystems for a long time.

It has many pollutants (things that pollute the air) from natural sources. These pollutants include dust, sea salt, volcanic ashes and gases, smoke from forest fires, pollen, and many other materials.[1] In fact, there are many more natural pollutants than pollutants that humans make.[1] However, humans have adapted to most of these natural pollutants.[1]

Air pollution may be personal, occupational or community air pollution.

Air pollution is usually described as either primary pollutants or secondary pollutants. Primary pollutants are pollutants that are put directly into the air by humans or natural sources. Examples of primary pollutants are exhaust fumes (gas) from cars, soot from smoke, dust storms and ash from volcanic eruptions (as seen in the picture on the left).[1]

Secondary pollutants are pollutants that are made from chemical reactions when pollutants mix with other primary pollutants or natural substances like water vapor.[1] Many secondary pollutants are made when a primary pollutant reacts with sunlight. Ozone and smog are secondary pollutants. Ozone is a gas that stops harmful ultraviolet rays from the sun. When it is near the ground, though, it can poison people and other organisms.[1]

Human-made air pollution comes from many things. Most air pollution made by humans today is because of transportation. Cars, for instance, make about 60% of the human-made air pollution. The gases inside car exhaust, like nitrogen oxide, make smog and acid rain.

Human-made air pollution is also caused when humans set their farmlands or forest on wildfires producing soot ( a black powder composed mainly of carbon, produced when coal, grasses, wood etc. is burned ) from smoke, that can affect people and other living when exposed to the atmosphere.

Many industrial power plants burn fossil fuels to get their energy. However, burning fossil fuels can make a lot of oxides (chemical compounds that have oxygen and other elements inside). In fact, the burning of fossil fuels makes 96% of the sulfur oxides in the atmosphere. Some industries also make chemicals that make poisonous fumes (smoke).

Air pollution is not only on the outside. Homes, schools, and buildings can also have air pollution. Sometimes the air inside a building is even worse than the air outside.[1] Many things which humans use every day can pollute the air. Compounds inside carpets, paints, building materials and furniture also pollute the air, especially when they are new.

In buildings where the windows are tightly shut to stop air leaks, the air inside can be polluted more than the air outside.[1]

Acid precipitation is precipitation, like rain, sleet, or snow, that contains acids from air pollution. When fossil fuels are burned, they let out oxides into the air. When these oxides mix with water in the atmosphere, they make acid, which fall as precipitation.[1] Acid precipitation can kill living things like fish and trees, by making the place where they live too acidic. Acid rain can also damage buildings made of limestone and concrete.

A global concern is the greenhouse gases and the hole in the ozone layer in the stratosphere. The Earth's ozone layer protects life from the Sun's harmful ultraviolet rays, but in the 1970s, scientists found out that some chemicals let out into the atmosphere makes the ozone turn into oxygen. This lets more ultraviolet rays reach the Earth. During the 1980s, scientists found that the ozone layer above the South Pole had thinned by 50 to 98 percent.

On March 17, 1992, in Mexico City, all children under the age of 14 could not go to school because of air pollution. This does not often happen, but being exposed to air pollution every day can make people have many health problems. Children, elderly (old) people, and people with allergies especially, can have a lot of problems because of air pollution. Studies from the University of Birmingham showed that deaths because of pneumonia and air pollution from motor vehicles like cars are related.[2]

The World Health Organization said that 2.4 million people died because of the direct problems of air pollution.[3][4] Some of the problems include:[1]

In India in 2014, it was reported that air pollution had cut crop yields in the most affected areas by almost half in 2010 when compared to 1980 levels. There can also be increased yield of crops due to some air quality conditions.

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Eczema Symptoms, Causes, Treatment – MedicineNet

Posted: November 21, 2016 at 10:57 am

What are eczema symptoms and signs?

Almost all patients with eczema complain of itching. Since the appearance of most types of eczema is similar, the distribution of the eruption can be of great help in distinguishing one type from another. For example, stasis dermatitis occurs most often on the lower leg while atopic dermatitis occurs in the front of the elbow and behind the knee.

An accurate diagnosis requires an examination of the entire skin surface and a careful history. It is important to rule out curable conditions caused by infectious organisms. Occasionally, a sample of skin (biopsy) may be sent for examination in a laboratory.

The treatment of acute eczema requires repeated cycles of application of dilute aqueous solutions followed by evaporation. This is most often conveniently performed by placing the affected body part in front of a fan after the compress. Once the acute weeping has diminished, then topical steroids (such as triamcinolone cream) application can be an effective treatment. In extensive disease, systemic steroids may need to be utilized either orally or by an injection (shot).

Mild eczema may respond to compresses composed of tepid water followed by room air evaporation. Chronic eczema can be improved by applying water followed by an emollient (moisturizing cream or lotion).

Medically Reviewed by a Doctor on 2/24/2016

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Dermatitis – Wikipedia

Posted: October 20, 2016 at 11:31 pm

Dermatitis, also known as eczema, is a group of diseases that results in inflammation of the skin.[1] These diseases are characterized by itchiness, red skin, and a rash.[1] In cases of short duration there may be small blisters while in long term cases the skin may become thickened.[1] The area of skin involved can vary from small to the entire body.[1][2]

Dermatitis is a group of skin conditions that includes atopic dermatitis, allergic contact dermatitis, irritant contact dermatitis, and stasis dermatitis.[1][2] The exact cause of dermatitis is often unclear.[2] Cases are believed to often involve a combination of irritation, allergy, and poor venous return. The type of dermatitis is generally determined by the person's history and the location of the rash. For example, irritant dermatitis often occurs on the hands of people who frequently get them wet. Allergic contact dermatitis; however, can occur following brief exposures to specific substances to which a person is sensitive.[1]

Treatment of atopic dermatitis is typically with moisturizers and steroid creams.[3] The steroid creams should generally be of mid to high strength and used for less than two weeks at a time as side effects can occur.[4]Antibiotics may be required if there are signs of skin infection.[2] Contact dermatitis is typically treated by avoiding the allergen or irritant.[5][6]Antihistamines may be used to help with sleep and to decrease nighttime scratching.[2]

Dermatitis was estimated to affect 334 million people globally in 2013.[7] Atopic dermatitis is the most common type and generally starts in childhood.[1][2] In the United States it affects about 10-30% of people.[2] Contact dermatitis is two times more common in females than males.[8] Allergic contact dermatitis affects about 7% of people at some point in time.[9] Irritant contact dermatitis is common, especially among people who do certain jobs, however exact rates are unclear.[10]

Dermatitis symptoms vary with all different forms of the condition. They range from skin rashes to bumpy rashes or including blisters. Although every type of dermatitis has different symptoms, there are certain signs that are common for all of them, including redness of the skin, swelling, itching and skin lesions with sometimes oozing and scarring. Also, the area of the skin on which the symptoms appear tends to be different with every type of dermatitis, whether on the neck, wrist, forearm, thigh or ankle. Although the location may vary, the primary symptom of this condition is itchy skin. More rarely, it may appear on the genital area, such as the vulva or scrotum.[11] Symptoms of this type of dermatitis may be very intense and may come and go. Irritant contact dermatitis is usually more painful than itchy.

Although the symptoms of atopic dermatitis vary from person to person, the most common symptoms are dry, itchy, red skin. Typical affected skin areas include the folds of the arms, the back of the knees, wrists, face and hands.

Dermatitis herpetiformis symptoms include itching, stinging and a burning sensation. Papules and vesicles are commonly present. The small red bumps experienced in this type of dermatitis are usually about 1cm in size, red in color and may be found symmetrically grouped or distributed on the upper or lower back, buttocks, elbows, knees, neck, shoulders, and scalp.[12] Less frequently, the rash may appear inside the mouth or near the hairline.

The symptoms of seborrheic dermatitis on the other hand, tend to appear gradually, from dry or greasy scaling of the scalp (dandruff) to hair loss. In severe cases, pimples may appear along the hairline, behind the ears, on the eyebrows, on the bridge of the nose, around the nose, on the chest, and on the upper back.[13] In newborns, the condition causes a thick and yellowish scalp rash, often accompanied by a diaper rash.

Perioral dermatitis refers to a red bumpy rash around the mouth.[14]

A patch of dermatitis that has been scratched

The cause of dermatitis is unknown but is presumed to be a combination of genetic and environmental factors.[2]

The hygiene hypothesis postulates that the cause of asthma, eczema, and other allergic diseases is an unusually clean environment. It is supported by epidemiologic studies for asthma.[15] The hypothesis states that exposure to bacteria and other immune system modulators is important during development, and missing out on this exposure increases risk for asthma and allergy.

While it has been suggested that eczema may sometimes be an allergic reaction to the excrement from house dust mites,[16] with up to 5% of people showing antibodies to the mites,[17] the overall role this plays awaits further corroboration.[18]

A number of genes have been associated with eczema, one of which is filaggrin.[3] Genome-wide studies found three new genetic variants associated with eczema: OVOL1, ACTL9 and IL4-KIF3A.[19]

Eczema occurs about three times more frequently in individuals with celiac disease and about two times more frequently in relatives of those with celiac disease, potentially indicating a genetic link between the two conditions.[20][21]

Diagnosis of eczema is based mostly on the history and physical examination.[3] However, in uncertain cases, skin biopsy may be useful.[22] Those with eczema may be especially prone to misdiagnosis of food allergies.[23]

Patch tests are used in the diagnosis of allergic contact dermatitis.[24][25]

The term "eczema" refers to a set of clinical characteristics. Classification of the underlying diseases has been haphazard and unsystematic, with many synonyms being used to describe the same condition.

A type of dermatitis may be described by location (e.g. hand eczema), by specific appearance (eczema craquele or discoid), or by possible cause (varicose eczema). Further adding to the confusion, many sources use the term eczema interchangeably for the most common type of eczema (atopic dermatitis) .

The European Academy of Allergology and Clinical Immunology (EAACI) published a position paper in 2001, which simplifies the nomenclature of allergy-related diseases, including atopic and allergic contact eczemas.[26] Non-allergic eczemas are not affected by this proposal.

There are several different types of dermatitis including atopic dermatitis, contact dermatitis, stasis dermatitis, and seborrheic eczema.[2] Many use the term dermatitis and eczema synonymously.[1]

Others use the term eczema to specifically mean atopic dermatitis.[27][28][29] Atopic dermatitis is also known as atopic eczema.[3] In some languages, dermatitis and eczema mean the same thing, while in other languages dermatitis implies an acute condition and eczema a chronic one.[30]

There is no good evidence that a mother's diet during pregnancy, the formula used, or breastfeeding changes the risk.[32] There is tentative evidence that probiotics in infancy may reduce rates but it is insufficient to recommend its use.[33]

People with eczema should not get the smallpox vaccination due to risk of developing eczema vaccinatum, a potentially severe and sometimes fatal complication.[34]

There is no known cure for some types of dermatitis, with treatment aiming to control symptoms by reducing inflammation and relieving itching. Contact dermatitis is treated by avoiding what is causing it.

Bathing once or more a day is recommended.[3] It is a misconception that bathing dries the skin in people with eczema.[35]Soaps should be avoided as they tend to strip the skin of natural oils and lead to excessive dryness.[36] It is not clear whether dust mite reduction helps with eczema.

There has not been adequate evaluation of changing the diet to reduce eczema.[37][38] There is some evidence that infants with an established egg allergy may have a reduction in symptoms if eggs are eliminated from their diets.[37] Benefits have not been shown for other elimination diets, though the studies are small and poorly executed.[37][38] Establishing that there is a food allergy before dietary change could avoid unnecessary lifestyle changes.[37]

People can also wear clothing designed to manage the itching, scratching and peeling.[39]

Moisturizing agents (also known as emollients) are recommended at least once or twice a day.[3] Oilier formulations appear to be better and water-based formulations are not recommended.[3] It is unclear if moisturizers that contain ceramides are more or less effective than others.[40] Products that contain dyes, perfumes, or peanuts should not be used.[3]Occlusive dressings at night may be useful.[3]

There is little evidence for antihistamine and they are thus not generally recommended.[3] Sedative antihistamines, such as diphenhydramine, may be tried in those who are unable to sleep due to eczema.[3]

If symptoms are well controlled with moisturizers, steroids may only be required when flares occur.[3]Corticosteroids are effective in controlling and suppressing symptoms in most cases.[41] Once daily use is generally enough.[3] For mild-moderate eczema a weak steroid may be used (e.g. hydrocortisone), while in more severe cases a higher-potency steroid (e.g. clobetasol propionate) may be used. In severe cases, oral or injectable corticosteroids may be used. While these usually bring about rapid improvements, they have greater side effects.

Long term use of topical steroids may result in skin atrophy, stria, telangiectasia.[3] Their use on delicate skin (face or groin) is therefore typically with caution.[3] They are, however, generally well tolerated.[42]Red burning skin, where the skin turns red upon stopping steroid use, has been reported among adults who use topical steroids at least daily for more than a year.[43]

Topical immunosuppressants like pimecrolimus and tacrolimus may be better in the short term and appear equal to steroids after a year of use.[44] Their use is reasonable in those who do not respond to or are not tolerant of steroids.[45] Treatments are typically recommended for short or fixed periods of time rather than indefinitely.[3] Tacrolimus 0.1% has generally proved more effective than picrolimus, and equal in effect to mid-potency topical steroids.[32]

The United States Food and Drug Administration has issued a health advisory a possible risk of lymph node or skin cancer from these products,[46] however subsequent research has not supported these concerns.[45] A major debate, in the UK, has been about the cost of these medications and, given only finite NHS resources, when they are most appropriate to use.[47]

When eczema is severe and does not respond to other forms of treatment, systemic immunosuppressants are sometimes used. Immunosuppressants can cause significant side effects and some require regular blood tests. The most commonly used are ciclosporin, azathioprine, and methotrexate.

Light therapy using ultraviolet light has tentative support but the quality of the evidence is not very good.[48] A number of different types of light may be used including UVA and UVB;[49] in some forms of treatment, light sensitive chemicals such as psoralen are also used. Overexposure to ultraviolet light carries its own risks, particularly that of skin cancer.[50]

There is currently no scientific evidence for the claim that sulfur treatment relieves eczema.[51] It is unclear whether Chinese herbs help or harm.[52] Dietary supplements are commonly used by people with eczema.[53] Neither evening primrose oil nor borage seed oil taken orally have been shown to be effective.[54] Both are associated with gastrointestinal upset.[54]Probiotics do not appear to be effective.[55] There is insufficient evidence to support the use of zinc, selenium, vitamin D, vitamin E, pyridoxine (vitamin B6), sea buckthorn oil, hempseed oil, sunflower oil, or fish oil as dietary supplements.[53]

Other remedies lacking evidence to support them include chiropractic spinal manipulation and acupuncture.[56] There is little evidence supporting the use of psychological treatments.[57][needs update] While dilute bleach baths have been used for infected dermatitis there is little evidence for this practice.[58]

Most cases are well managed with topical treatments and ultraviolet light.[3] About 2% of cases however are not.[3] In more than 60% the condition goes away by adolescence.[3]

Globally dermatitis affected approximately 230million people as of 2010 (3.5% of the population).[59] Dermatitis is most commonly seen in infancy, with female predominance of eczema presentations occurring during the reproductive period of 1549 years.[60] In the UK about 20% of children have the condition, while in the United States about 10% are affected.[3]

Although little data on the rates of eczema over time exists prior to the 1940s, the rate of eczema has been found to have increased substantially in the latter half of the 20th Century, with eczema in school-aged children being found to increase between the late 1940s and 2000.[61] In the developed world there has been rise in the rate of eczema over time. The incidence and lifetime prevalence of eczema in England has been seen to increase in recent times.[3][62]

Dermatitis affected about 10% of U.S. workers in 2010, representing over 15 million workers with dermatitis. Prevalence rates were higher among females than among males, and among those with some college education or a college degree compared to those with a high school diploma or less. Workers employed in healthcare and social assistance industries and life, physical, and social science occupations had the highest rates of reported dermatitis. About 6% of dermatitis cases among U.S. workers were attributed to work by a healthcare professional, indicating that the prevalence rate of work-related dermatitis among workers was at least 0.6%.[63]

from Ancient Greek kzema,[64] from - ekz-ein, from ek "out" + - z-ein "to boil"

The term "atopic dermatitis" was coined in 1933 by Wise and Sulzberger.[65]Sulfur as a topical treatment for eczema was fashionable in the Victorian and Edwardian eras.[51]

The word dermatitis is from the Greek derma "skin" and - -itis "inflammation" and eczema is from Greek: ekzema "eruption".[66]

The terms "hypoallergenic" and "doctor tested" are not regulated,[67] and no research has been done showing that products labeled "hypoallergenic" are in fact less problematic than any others.

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Atopic eczema | DermNet New Zealand

Posted: September 18, 2016 at 8:09 am

Home Topics AZ Atopic eczema

Author: Dr Amy Stanway, Department of Dermatology, Waikato Hospital, February 2004.

Atopic eczema is a chronic, itchy skin condition that is very common in children but may occur at any age. It is also known as eczema, atopic dermatitis and neurodermatitis. It is the most common form of dermatitis.

Atopic eczema usually occurs in people who have an 'atopic tendency'. This means they may develop any or all of three closely linked conditions; atopic eczema, asthma and hay fever (allergic rhinitis). Often these conditions run within families with a parent, child or sibling also affected. A family history of asthma, eczema or hay fever is particularly useful in diagnosing atopic eczema in infants.

Atopic eczema arises because of a complex interaction of genetic and environmental factors. These include defects in skin barrier function making the skin more susceptible to irritation by soap and other contact irritants, the weather, temperature and non-specific triggers: see Causes of atopic eczema.

There is quite a variation in the appearance of atopic eczema between individuals. From time to time, most people have acute flares with inflamed, red, sometimes blistered and weepy patches. In between flares, the skin may appear normal or suffer from chronic eczema with dry, thickened and itchy areas.

The presence of infection or an additional skin condition, the creams applied, the age of the person, their ethnic origin and other factors can alter the way eczema looks and feels.

There are however some general patterns to where the eczema is found on the body according to the age of the affected person.

More images of atopic eczema and flexural dermatitis.

Atopic eczema affects 15-20% of children but is much less common in adults. It is impossible to predict whether eczema will improve by itself or not in an individual. Sensitive skin persists life-long.

It is unusual for an infant to be affected with atopic eczema before the age of four months but they may suffer from infantile seborrhoeic dermatitis or other rashes prior to this. The onset of atopic eczema is usually before two years of age although it can manifest itself in older people for the first time.

Atopic eczema is often worst between the ages of two and four but it generally improves after this and may clear altogether by the teens.

Certain occupations such as farming, hairdressing, domestic and industrial cleaning, domestic duties and care-giving expose the skin to various irritants and, sometimes, allergens. This aggravates atopic eczema. It is wise to bear this in mind when considering career options it is usually easier to choose a more suitable occupation from the outset than to change it later.

Treatment of atopic eczema may be required for many months and possibly years.

It nearly always requires:

In some cases, management may also include one of more of the following:

Longstanding and severe eczema may be treated with an immunosuppressive agent.

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Atopic Dermatitis / Eczema – Allergy UK

Posted: September 11, 2016 at 5:19 pm

Symptoms

Eczema, also known as atopic eczema or atopic dermatitis, is a skin condition causing inflammation and intense irritation. Eczema symptoms tend to be caused by dry skin. The skin becomes hot, itchy and inflamed; it may also be red and appear irritated. Atopy, or being atopic, means having a genetic tendency for your immune system to make increased levels of IgE antibodies to certain allergens. An atopic individual is likely to have more than one allergic condition during their lifetime, such as eczema, asthma, hay fever or food allergy.

In young children, patches of dry, scaly skin, or (less commonly) wet, weepy skin, can appear anywhere on the body. In older children, the eczema usually appears on wrists, ankles, elbows, knees and face, including the eyelids. In adults, it may localise, affecting the face, hands, neck and scalp although it can affect any part of the body.

Skin that is affected by eczema gets sore and broken when it is scratched, it can look wet and may bleed. Scratching is hard to avoid since the main distressing symptom of eczema is unbearable itching but once the skin gets broken and cracked, infections can set in, causing even more discomfort. Those with severe eczema often feel cold when others are hot. This is because the skin is the largest organ of the body and one of its roles is helping to regulate body temperature. Conversely, being hot in bed causes severe irritation.

This skin condition can affect any age range and it is thought to be caused by a defect in the skin barrier that makes it more susceptible to inflammation and allows allergens and bacteria to make contact with the immune system.

Eczema can affect ones quality of life significantly and may also affect sleep patterns. Whilst this can make you irritable and frustrated, good management can help alleviate these problems. This skin condition is well understood and dermatologists (skin doctors) have developed effective skin treatment regimens to control and manage the symptoms. It can take some time to find the most suitable therapy for each individual, often causing embarrassment and daily frustration with the symptoms in the meantime. Many people do not understand that eczema is neither infectious nor contagious.

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Generally, GPs can diagnose eczema and differentiate whether you have eczema or another skin condition. Seasons of the year (for example, in winter), or even emotional responses (such as stress), may cause eczema to worsen. However, a large number of eczema sufferers are not able to link a cause to their symptoms. It is essential that any known triggers are avoided and sometimes keeping a trigger symptom diary at home may help you to realise what might be causing flares. Important things to consider include bubble baths, shampoos, make-up products, chemicals such as cleaning products and occupational irritants such as hairdressing products or heavy oils and lubricants used in the motor industry or allergens, such as latex gloves, leather, cement or certain plants.

If further investigation is needed, or the skins condition is not improving with barrier protection and prescribed treatment, your GP may make a referral to see a dermatologist to pinpoint the exact cause of the condition. Allergy patch tests can identify substances causing contact allergy. Allergy tests (either skin prick testing or a specific IgE blood test) may help to identify airborne or food allergens involved in flares, as many people with atopic dermatitis/eczema may also have asthma, allergic rhinitis/hay fever. Allergens that trigger these may also trigger symptoms in eczema, such as house dust mite, animal dander, mould spores, pollen or foods. You may need to be referred to an allergy clinic for skin prick or specific IgE blood tests.

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No. Children are born with the tendency to have eczema and many things can make their eczema worse. These are known as triggers for the eczema. Foods can be triggers for eczema especially in infants but the foods are not the primary cause of the eczema. If a food is found to make eczema worse, excluding that food may significantly improve symptoms but not cure the condition. A food that is not eaten often but causes symptoms may be easier to identify than one that is eaten daily, such as milk/dairy products, wheat or soya.

Some patients with the IgE-associated variety of AEDS suffer from worsening of their skin symptoms after contact with certain airborne allergens, such as house dust mite, pollens, or animal hairs, and improve after appropriate allergen avoidance strategies are introduced.

Emollient lotions and creams are prescribed for eczema and dry skin, and are, in their simplest form, mixtures of oil and water. Some emollients may also contain slight amounts of antibacterial chemicals (to avoid infection in broken skin), or steroids (to reduce inflammation).

Emollient products range in their consistency, from being runny lotions to thick creams, and while they can be a very cooling and soothing treatment for eczema, the stickiness of the thicker products can sometimes make them a source of annoyance. It is important to find a product that is suitable for you.

Dry skin is more susceptible to eczema, and once the skin barrier is broken, it is open to potential infection and further irritation from allergens and other chemical irritants. Scratching also causes the body to release histamine, which further aggravates the symptoms. Emollients work to reduce eczema symptoms by creating a protective barrier on the top layer of the skin, moisturising it and reducing water loss. The oil also provides lubrication so that the dry skin, which is often itchy and rough, will not be as easily irritated.

Although emollients do not stop the underlying cause of eczema, they calm and soothe the skin, and give it time to repair itself. For emollients to work effectively, they need to be used as part of a regular treatment regimen. This means that they should be applied at set times of day, and should be used whether they appear to be needed or not.

Eczema can flare up at any time, in some instances due to infection, hormonal changes, stress or allergens, but also for no obvious reason. Even when emollients are used, there may be times when eczema seems to get worse. However, regular treatment can help to minimise the number and severity of flare ups.

Emollients should be continued, even when all traces of eczema have vanished. By keeping the skin moisturised, it will be better hydrated and with less chance of the skin barrier being broken, the risk of allergens and other irritants causing eczema is reduced.

Emollients are available as lotions, creams, ointments, shower and bath products and soap substitutes. These products should be used every day as emollients support the skins barrier function by helping it to retain water and form a protective layer against allergens or bacteria. They can also help to relieve the itchy symptoms typical of eczema.

Water can have a drying effect on skin and so emollients are also available as bath products, which help to hydrate and protect the skin while soaking in the water, although it is no longer advised to soak for more than 15 minutes. In addition, soap can also make eczema worse because it dries the skin further. Soap substitute emollients can also be prescribed, which can be rubbed on and rinsed off skin just like liquid soap.

You may find that you are prescribed several creams if your eczema symptoms vary and different creams may be more suitable for different times. For example, you may prefer to use a less oily cream during the day and use a thicker cream or ointment treatment at night. Ointment also have the advantage of needing less or no preservatives, to which a few people can eventually react.

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It is sometimes necessary to apply topical corticosteroids (e.g. hydrocortisone), as these reduce inflammation in the skin.

Many people worry when steroids are mentioned as a treatment option because of stories they may have heard in the media, particularly related to anabolic steroid abuse in sports. These, however, are not the same steroids that are used as medical treatments and, when used as directed by a physician, steroids have an important role to play in treating a range of ailments, including eczema.

Topical steroids are safe to use but it is important to always follow the instructions provided, making sure you understand which areas you apply the cream to and exactly how much. If you have any questions, then ask your doctor or nurse for further advice and information.

Steroid creams only need to be applied to the inflamed areas of skin. One fingertip of cream (where the cream is squeezed along the fingertip as far as the first joint) is usually enough to cover an area of skin twice the size of an adults hand. Fingertip units are used as a guide for the amounts needed for different parts of the body.

Sometimes emollients and other creams (i.e. steroids and antibiotics) are needed in combination. It is important to leave an adequate gap between applying the different creams to allow one cream to be absorbed before applying another, ideally at least 10 minutes. If creams are applied too soon after each other they may be diluted so healing and control of the symptoms can take longer. Steroid creams, when used for a long time at a high dose, can cause skin to be thinned. This will not happen when steroid creams are prescribed at the appropriate strength, with less potent steroids being prescribed on the face than on the body. It is also important to use steroid creams as early into flares as possible, as this will avoid the need for higher strength preparations, required when the eczema is severe. Doctors are also increasingly using steroid creams proactively for only a couple of days a week (weekend therapy), even when the eczema is well controlled, to prevent future flares, as this has been shown to reduce the amount of steroids needed in the long-term.

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Sometimes, special pyjama-like garments (known as wet wraps) that are used for children, may also help certain areas of your body that have not responded to the usual topical application of emollients and steroids. Wet wraps can also be useful if you suffer from itch at night and cannot sleep, allowing you to have a better quality of sleep during times when the eczema is particularly bad. There are various ways of applying these garments and your nurse or doctor will be able to demonstrate the best way of application.

It important to follow the advice of your treating practitioner for the length of time of wet wrap treatment, and it is important to have your skin re-assessed when the treatment comes to an end.

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Calcineurin inhibitors are an alternative to steroid creams. There are two different preparations, Tacrolimus (0.03% and 0.1%) and 1% Pimecrolimus (also known as Protopic and Elidel), licensed for use in children over the age of two. Like steroid creams, they reduce the skin inflammation and can lessen itching.

These creams are suitable for use on almost every part of the body, as they do not thin the skin and are often used when steroids have proved unsuccessful, or are not suitable, for example, on sensitive skin around the eyes. Emollients should continue to be used as well as these creams.

A common side effect of these creams is a short-lived burning sensation on application, which is harmless and generally settles down after a few applications. These drugs are thought to be safe and effective in the short-term but their safety for long-term use has yet to be proven.

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There are many other types of dermatitis/eczema, which are non-atopic, i.e. not triggered by allergens or related to allergy, such as seborrhoeic; pompholyx; irritant contact; gravitational/asteototic; discoid/nummular. Information on these is available from http://www.eczema.org

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