The first and most important part of AD management are hydration techniques to clean the skin of any bacteria and irritants and hydration to help seal in moisture and enhance the skin barrier, protecting from irritants and allergens. Allergies should be tested and avoided in the case of foods and treated in the case of environmental allergies. Depending on the severity and acuity, AD is treated with topical steroids, antibiotics, phototherapy, biologics and immunosuppressants to control inflammation that cannot be managed in other ways.
The second most important treatment for eczema is addressing the trigger. Anything that is irritating to the skin can trigger eczema. Below are a list of triggers that make eczema worse:
In eczema, allergies are most commonly immediate, starting within minutes but can be delayed, not affecting the skin for weeks. Skin testing for both foods and environment is critical to pinpointing immediate-type allergies that can be avoided. Patch skin testing can help identify these and other food allergy triggers that are delayed. The most common foods that contribute to eczema are milk, wheat, soy, egg, nut, tree nut, fish, and shellfish.
Avoidance of the food that increases the rash is the best approach to foods. Environmental pollens, mold and pets that cannot be avoided are best treated with allergen immunotherapy, which pivots the immune reaction to a less allergic, more neutral response.
Avoidance of chemicals is key. Some suggestions are to avoid any unnecessary exposure with items like air fresheners, perfumes, and scented candles. Wear cotton-lined gloves while cleaning and avoid using abrasive cleaners that strip the oil from the skin. Attempt to use hypoallergenic soaps, shampoos, and detergents wherever possible, bearing in mind that “hypoallergenic” does not mean nonallergenic and that about 1 of 100 patients develop issues to hypoallergenic substances. However, hypoallergenic, and free & clear chemicals with neutral pH are less likely to be problematic. If determining which product is challenging, patch testing can also be used to find the allergenic substance.
Hot water can be irritating and strip precious oil from eczematous skin. Patting rather than rubbing yourself dry after a shower or bath and applying cream will help lock in moisture and prevent precious skin oils from being wiped away. Taking cooler or lukewarm baths or showers will decrease the irritation.
Weather changes can also be problematic. Sun, heat, and dryness can lead to dehydration of the already fragile skin. Sunscreen sensitivity can be tested with patch testing but mineral versions like zinc oxide or titanium dioxide. Remaining in the shade and staying cool can minimize irritation. Dehydration deforms skin cells and makes the affected cells more fragile, increasing the rash of eczema.
Loose cotton clothes are best. Synthetic materials like polyester can retain sweat and heat, irritating the skin. Materials such as wool may irritate the skin by scratching. Avoid dry cleaning clothes, using wrinkle-free clothes and instead wash new clothes free of the finishing chemicals with free & clear detergents. If still problematic, consider allergy patch testing to the free & clear detergents and fabric softeners.
Stress is an enormous trigger for eczema. The itch habit is increased, which may be a self-soothing technique for some patients. Illness and stress hormones can tip the delicate balance of the immune system, which is already dysfunctional in eczema patients.
Skin infections and bacterial carriage need to be controlled as they further damage the fragile eczematous skin. Preventing infections is key. Regular (but not over-) bathing in lukewarm water is important to control bacteria on the skin.
Next on The Skin-ny on Atopic Dermatitis and Eczema: Part IIb: General Care and Hydration of Skin with Atopic Dermatitis and Eczema, Initial Treatment by you Allergist