A Picture of Eczema in Winter

As the temperature outside drops, the humidity dips and indoor heat rises. That combination dries out the skin, and if you're prone to eczema, chances are high that it will flare. Officially, atopic dermatitis. Unofficially, up to 35 million people in the United States experience eczema. That's because eczema is a blanket term often used to describe skin irritated by soaps, some wools or environmental factors. Atopic dermatitis, however, refers to the chronic, long-lasting condition also known as eczema that affects nearly 15 million Americans, according to the National Eczema Association for Science and Education in San Rafael, Calif.

The first signs of eczema often appear in babies."At the beginning it often manifests as a red, scaly rash in the creases of the elbows and the knees," said Dr. Deborah Sarnoff, a dermatologist at Cosmetique in Greenvale. "But almost anywhere on the body is fair game."

Country music star LeAnn Rimes has had it since she was 2 years old. "By the time I was 7 I was covered over 80 percent of my body. I had it on my face, around my hairline and scalp."Rimes said it was hard to cope with as a child. "I was always teased in school. I didn't want to go out in the summer with a bathing suit or shorts on." A report by the American Academy of Dermatology says one-fifth of school-age children experience it. Eczema continued to plague Rimes as she grew up. "It hurt to perform sometimes," she said, adding she would often wear two pairs of pantyhose on stage to hide her legs. "It caused a lot of mental anguish."That's common, said Dr. Joann N. Salvemini, chief of dermatology for the North Shore-LIJ Health System, based in Manhasset." In some people it can be difficult to maintain," she said. "They are constantly scratching. You become self-conscious. Other people don't understand your problem and are hesitant to come near you. They think you have something that's catching. It changes the appearance of your skin, including your face, eyelids or your hands. You feel scaly and rough." Although her condition has mellowed with age, Rimes is now a spokeswoman for a national public awareness campaign on how eczema can be managed effectively with the right prevention and treatment. "It made me strong as a woman to have to deal with it," she said. "It's a job taking care of your skin. I'm here to hopefully help people understand that they aren't alone. I know what they're going through."

While no one is sure what causes eczema, doctors suspect that it's an inherited condition and runs in families where hay fever and asthma are also present. In fact, research has shown that when eczema starts in children under the age of 1, they have a higher risk of developing either asthma or hay fever later in life. The cleaner you are, the worse your eczema is likely to be. "By constantly cleaning your skin, you're removing waxes and oils that are needed to maintain the skin's integrity," says Salvemini, adding that constant bathing alters your body's "normal protection from the environment."In addition to environmental factors like the weather and allergies, daily stress and skin infections resulting from too much scratching can also cause eczema to flare.

Flare-ups can be prevented. The good news is that flare-ups can be prevented by avoiding known allergens, scratchy materials like some wools that can irritate the skin, and taking the right precautions. For example, although a warm bath or hot shower may feel soothing and momentarily relieve the itch, doctors say that's one of the worst things you can do."The heat damages the skin and in the long run, the eczema will flare," explains Dr. Richard S. Kalish, acting chairman of dermatology at Stony Brook University Hospital. "We tell our patients that it's OK to shower and wash every day," but to keep showers short. Use mild soaps and avoid abrasive sponges or washcloths that can harm the skin. Towel off immediately and apply a greasy, thick moisturizer - like Eucerin, Aquaphor or Lubriderm - to create a barrier to hold the skin's moisture in. If flare-ups still occur, a variety of treatments are available. Prescription steroid creams work well to reduce the inflammation. But if used for too long or in strengths that are too powerful, side effects can result. "It can permanently thin the skin and cause damage," Kalish said. When used on the face, steroid creams can cause acne and rosacea. They can also be absorbed through the skin and "cause suppression of your own body's cortisone production," said Salvemini. That can make you more susceptible to infection and bone loss in the long run.Anthistamines are sometimes used in combination with steroid creams. While they may soothe the itch, they don't treat the rash. "They help people get a good night sleep," Kalish said.

When eczema is severe and doesn't respond to any other treatment, a series of photo therapy sessions - exposure to ultraviolet light - sometimes heals the rash. However, there are concerns about long-term use, says Sarnoff, and exposure to ultraviolet light has been linked to skin cancer, glaucoma and cataracts.

New drugs, new hopeA new class of drugs, called immuno-modulating agents, is showing promise as the first non-steroidal treatments. With brand names like Elidel and Protopic, the drugs work by suppressing the immune response that causes eczema to flare."They seem to act on the lymphocytes in the immune system," and chronic use doesn't appear to cause the same long-term harm to the skin that results from chronic use of steroids, Sarnoff said. Side effects include a mild burning sensation that can last up to five days, headache and feverish symptoms. But for the most part, Sarnoff says, they are safe and well-tolerated. Although Kalish believes the newer drugs are expensive and over-prescribed, Sarnoff says that's because "they're the newest kids on the block." Plus, a massive marketing campaign is prompting patients to ask for them more frequently.

Sarnoff thinks the best approach to treating eczema is a combination of therapies and lifestyle habits that can reduce risk. "Prevention is the main thing," she says. For many people, "this is a way of life."Lifestyle tips to help control eczema flare-ups. Lifestyle changes make a big difference in controlling eczema.

If you're prone to flare-ups, keep these tips in mind:Keep skin hydrated with a thick, greasy moisturizer. Wear outdoor gloves all the time, not just when it's extremely cold. Avoid allergens, including dust mites, pollen, foods like egg yolks or dairy products, and pets if you know you are allergic.Stay away from irritating soaps and moisturizers that contain alpha-hydroxy acids, which can be rough on the skin. Likewise, avoid bubble baths and perfumes that can trigger flares. Certain detergents and fabric softeners may also be culprits. Avoid wool and synthetics that don't breathe. Stick with softer fabrics like cotton. Stay away from harsh cleaning products and consider wearing cotton-lined rubber gloves when cleaning. Be aware that airborne fumes such as those in a nail salon or from materials used in home construction can also set off eczema.

Debbe Geiger is a freelance writer.