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Thursday, December 13, 2012

Eczema: The itch that rashes

As published in the Washington Observer-Reporter.

When preparing to send her 8-year-old son, Jonathan, to his first day of third grade, Amy Berry had more to worry about than assembling a backback or learning a few teachers’ names.

Jon, who had been diagnosed with eczema – also called atopic dermatitis – just a few months prior, had a breakout of the red, flakey rash all over his face. 

"He didn't want to go to school,” said Berry, a Pancake resident and mother of two. “He was going to be embarrassed, and [he felt like] all the kids were going to stare at him.”

Unfortunately for kids like Jonathan, many misunderstand the habits of eczema, an incurable but non-contagious skin disorder. 

In order to increase awareness, November marks National Eczema Awareness month as promoted by the National Eczema Association (NEA). 

Often recognized in childhood, eczema can lead to a full-body, cracking rash that can sometimes leave children ostracized. It can also result in days of work or school missed and those afflicted feeling isolated.

These individuals, however, couldn't be further from "alone.”

Up to 20 percent of Americans now suffer from eczema – a proportion that has been on the rise since World War II. While the exact mechanism has yet to be discovered, experts have identified oddities in the skin barrier – the fats and oils that protect our skin – as a part of the cause. When this defense is weakened, substances in the environment are able to penetrate the relatively tough outer layers of our largest organ, to reach the more sensitive layers of skin beneath. For those with eczema, this leads to an allergic-type of reaction. 

What happens next is the hallmark of this chronic skin condition. 

"Eczema is 'the itch that rashes' ” explained Dr. Paul Ruschak, a board-certified dermatologist practicing in Monongahela. “Usually, itching precedes the rash, and one induces the eczema by itching and scratching.

“It's imperative to really make the effort not to rub and scratch."

Why are so many more people, both children and adults, suffering from this itchy and sometimes disfiguring disease? The answer might surprise you.

"I think we're too clean," says Dr. Ruschak. "I think we're not being exposed to the entities like cockroaches and fungi early in our life, and, as a result, we are having more incidences of atopic dermatitis."

The theory, referred to as the Hygiene Hypothesis, associates our society's near-obsession with cleanliness and the avoidance of disease – in the form of anti-bacterial wipes, hand sanitizer, vaccines, etc. – with a hypersensitivity of our immune systems. 

In other words, without enough exposure to common "germs" in childhood, our immune system views too many of these substances as threatening. So, when our bodies encounter these germs – however non-threatening – our body mounts a response to fight against them.

Dr. Peter Lio, an eczema researcher and NEA Scientific Advisory Board member, couldn't agree more. 

"I don't want to vilify vaccines because they get vilified for lots of other stuff, but in the best possible way, they've done such a good job of rooting out these illnesses,” Lio said. “Kids don't get sick any more in the same way, and we have these idle immune systems."

Another culprit: Over-bathing.

"The first thing I tell a patient is to avoid over-bathing," says Dr. Ruschak. "Bathe briefly: in and out in 5 minutes."

In fact, a vigilant skin care regimen – to avoid stripping the skin of natural oils and avoiding irritants – Is central to controlling eczema.

After a day out searching for Native American artifacts with his father – a favorite pastime of theirs – Jonathan Berry is forced to have a higher priority than displaying his discoveries. To prevent an outbreak, he has to immediately get into the shower, then slather himself in lotion and steroid cream.

Not exactly a favorite activity for an 8-year-old boy.

Other tips for those with eczema from Dr. Ruschak: Showers should be taken with tepid, not hot, water. Soap should only be used on the body areas that require it, meaning underarms, genitals, etc. Pat yourself dry with a towel – don't rub. Lock in the moisture immediately after a shower with a non-fragranced moisturizer.

When skincare regimens and over-the-counter hydrocortisone creams aren't enough, a visit to a dermatologist or allergist is in order.

But even their recommendations may be on the verge of changing.

"We've never seen so much active research in eczema," said Dr. Lio. "We're going to understand that eczema isn't just one disease. We're going to see subtypes better, and that is going to be huge catalyst for treatment." 

For now, kids like Jonathan can be helped by awareness, understanding and good advice from their mothers.

"I try to explain to him,” Amy Berry said, “ 'It's a part of life, unfortunately, and it could be a lot worse.' "