Questions on eczema answered by a specialist
Body & Soul recently spoke with Mary Sheu, assistant professor in the dermatology department at Johns Hopkins School of Medicine, about eczema.
B&S: How severe can eczema be?
Dr Sheu: Eczema can range from very mild small patches of dry skin to severe, widespread, extremely itchy rashes that may predispose to infections and prevent the affected person from functioning normally. In severe cases, it can prevent children from growing properly. I have seen one patient who was so itchy he would slap his own face, and after many years of doing this he developed retinal detachments and was unable to see.
B&S: What treatments are available?
Dr Sheu: They range from topical creams to phototherapy (medical-grade UV light booth in a doctor’s office), and systemic medications.
B&S: When do you need to see a specialist?
Dr Sheu: If someone with eczema is unable to control the condition with conventional treatments, or is unable to discontinue topical steroid creams without having a flare; anyone with widespread or severe eczema; anyone whose ability to function in their occupation is compromised as a result of the eczema.
B&S: Can sun exposure and diet contribute to it?
Dr Sheu: For some individuals, sun exposure improves eczema, for others it worsens their eczema. Diet can affect eczema in individuals who have a food allergy that results in eczema flares.
B&S: What are other contributing factors?
Dr Sheu: Genetics play a role in predisposition to eczema. Atopic dermatitis (a form of eczema that usually starts in childhood), asthma and allergic rhinitis (hay fever) tend to run in families, either in the same individual or within different members of the same family.
B&S: What are the main myths and misconceptions related to eczema?
Dr Sheu: One widespread misconception is that individuals with eczema should bathe infrequently so that the skin does not dry out. In truth, individuals with eczema can and should bathe at least every other day (or even every day), in warm (not too hot) water, with a mild non-drying soap, then immediately after the bath or shower, should apply a thick moisturising cream within one minute after getting out of the water in order to lock in the moisture from the bath or shower (before the skin has a chance to dry out). Individuals with eczema are more prone to developing skin infections, therefore regular bathing is recommended. One mistake we often encounter in dermatology is patients with eczema who use lotions that come out of a pump bottle. In general, these contain a high percentage of water, and do not provide adequate moisturising. For those with dry skin and eczema, I recommend a thick cream, which usually comes in a jar or tube, rather than lotion from a pump.