Eczema, also referred to as atopic dermatitis, is marked by chronic inflammation of the skin. It manifests as raised, red skin patches that can be maddeningly itchy. The skin may appear thickened or scaly. In some cases, it may crack, ooze, and crust over. These cracks can turn into bloody sores that may become infected.
(Pixabay / Hans)
Eczema is far more common today than it was just a few decades ago. According to the American Journal of Managed Care, the incidence of atopic dermatitis has increased two to three-fold in industrialized nations since the 1970s. The National Eczema Association reports that it now affects about 13 percent of all U.S. children.
Case Studies from My Practice
Eczema can be life altering in some cases. Consider these stories from a couple of my patients:
- “Kay” came to my office with adult-onset eczema. She was terribly embarrassed about the unsightly patches that often turned to open sores on her arms and legs. She covered them with long pants and long sleeves, even in the sweltering heat of summer in her home state of Arizona. Showering was a miserable experience, and she would often cry as the water stung her raw skin.
- Four-year-old “Dylan” struggled with eczema since infancy. In his short life, doctors had prescribed over 29 different medications and creams to control the rash that caused him non-stop discomfort. It was hard for him to sleep, which made it hard for his parents to sleep, too. He was often fussy and irritable. He would scratch the itchy patches until they bled, and they would often become infected.
Both of these patients approached me in desperation, and, in both cases, the AllergyEasy program relieved their eczema significantly in just a few months.
Allergies and Eczema: A Link
But what does eczema have to do with allergies, you ask? Doesn’t eczema belong in the realm of dermatologists? And won’t consistently-applied prescription skin cream do the trick? For many people, the answer to that last question is no. I have had plenty of patients try every kind of topical cream out there to no avail. These ointments may calm the symptoms for a while, but the eczema keeps recurring. This clearly shows that the problem is more than skin deep. There is something going on systemically for people who suffer from chronic eczema, and allergy is, in many cases, a clear contributor.
Research presents strong evidence linking eczema with underlying allergies. For example, studies show that 20 to 40 percent of patients with moderate to severe eczema have food allergies (National Eczema Association).
In addition, there is a strong pattern often referred to as “the atopic march.” Atopic denotes a form of allergy in which a reaction (such as eczema or asthma) occurs in a part of the body that has not come into direct contact with an allergen. The atopic march starts with eczema, and often food allergies, in babies. As that baby grows, he or she will commonly develop asthma along with allergies to inhalants in the environment (dust, mold, pet dander) that result in hay-fever type symptoms. This cycle is seen over and over again in clinical practice, suggesting a correlation between eczema and allergy.
Which comes first?
This correlation spawns another question: which comes first the eczema or the allergy? Since we know that allergens can enter the body through the skin, one could argue that the eczema comes first in patients who have not developed a strong skin barrier. That barrier then allows allergens to infiltrate the body, leading to a host of allergies and related symptoms.
Or one could argue that the cycle starts with the allergy, which causes inflammation of the skin and compromises the skin barrier, leading to even greater vulnerability to allergens. Scientists are not yet in agreement over which side of this chicken-or-the-egg debate prevails.
Can you outgrow eczema?
Eczema is most common in childhood. In fact, the vast majority of eczema develops in children under age 5. Two-thirds of these children will outgrow eczema by the time they reach adulthood, though some may continue to have dry skin.
What can I do?
Perhaps you have a child who has eczema. Or maybe you are part of the 7% of adults who suffer from this condition. Whatever the case, you are likely wondering how to manage the eczema so that it will not take such a toll on your quality of life.
I recommend that you start by focusing on the skin. Try to eliminate irritants and dryness, both of which can contribute to eczema. Stay away from harsh soap, and moisturize the skin thoroughly. You might also try using a humidifier to add more moisture to your home environment, particularly if you live in a dry climate.
If things don’t improve with optimized skin care, talk to your doctor about allergy testing. Your doctor can use an allergy test kit to measure your skin’s reaction to different allergens. You may find that you are allergic to food proteins or to environmental allergens (including dust, pollen, mold, or pet dander).
It’s important to note that allergy tests aren’t always full-proof; I have had some patients show negative results on skin tests and yet respond remarkably to allergy treatment. That’s why most doctors will consider not only the results of the test but also the full range of your allergy-related symptoms.
There are a few different approaches to allergy treatment, but I recommend sublingual immunotherapy. It works like allergy shots, exposing the body to a liquid solution containing the very allergens that trigger its symptoms. Over time, the body becomes desensitized to those allergens and stops reacting to them. With sublingual immunotherapy, however, the liquid solution is dispensed as droplets under the tongue instead of being injected into the skin. This method is very popular in Europe, where nearly half of the people receiving desensitization therapy for allergies opt for sublingual immunotherapy instead of shots.
I switched to this method in my clinical practice a few decades ago because I found that it works faster than shots, and it’s safer than shots, too, so patients can administer the drops at home. Because of the convenience of not having to go to the doctor’s office a couple of times a week for shots, it is easier for patients to comply with.
If you’re suffering from eczema that is unrelieved by skin care, talk to an allergist to find out what is going on in your immune system that may be triggering your skin problems.
