The Eczema Diagnosis

Eczema diagnosis is generally based on the appearance of inflamed, itchy skin in eczema sensitive areas such as face, chest and other skin crease areas. However, given to the many possible reasons of eczema flare ups, a doctor is likely to ascertain a number of other things before making a judgment:
An insight to family history
Dietary habits
Lifestyle habits
Allergic tendencies
Any prescribed drug intake
Any chemical or material exposure at home or workplace
To determine whether your eczema flare is resulting from an allergen, a doctor may suggest a blood test called radioallergosorbent test (RAST). In the test, blood is mixed with an allergen; antibodies developing in the blood are the sign of an allergy.
The diagnosis may also involve a skin lesion biopsy; removal of a small piece of skin for examination in a laboratory.
Blood test and biopsy are not regular procedure for eczema diagnosis. However, doctors at times do follow it in order to draw a conclusive judgment.

AAD Disagrees With FDA Warnig For Protopic And Elidel

The American Academy of Dermatology (Academy) has issued a statement in response to the U.S. Food and Drug Administration's (FDA) announcement that a black box warning will be added to the labeling and a medication guide will be distributed for the topical calcineurin inhibitors (TCIs), pimecrolimus and tacrolimus.
These topical medications effectively reduce the inflammation and other symptoms associated with the skin disease eczema.
"The American Academy of Dermatology disagrees with this action taken by the FDA. We believe that the data does not prove that the proper topical use of pimecrolimus and tacrolimus is dangerous," said dermatologist Clay J. Cockerell, M.D., president of the American Academy of Dermatology. "Because these medications are applied to the skin, virtually none of it gets inside the body. It's not the same as taking a pill. These are valuable medications, and if used properly, they allow millions of our patients with eczema to live normal lives."
This past summer, the Academy held a conference to discuss the scientific, regulatory, clinical, and public concerns raised by this potential FDA action. The dermatologists, patients, pharmacists and immunologists participating in the conference reviewed the current literature and safety data for these medications. It was determined that the addition of a black box warning and medication guide was unwarranted and could limit access to TCIs, or limit treatment options if qualified patients decide not to use these medications based on fear of a malignancy risk.
"The health, safety and welfare of our patients being treated with these topical medications are of paramount importance to dermatologists," said Dr. Cockerell. "We are concerned that this warning will confuse and unnecessarily worry our patients. We urge patients to get the facts on how to appropriately manage their eczema from their dermatologist."

Elidel And Protopic Receive Black Box Warnings

The labels on two prescription creams to treat eczema will have to bear "black box" warnings of possible cancer risks.
The Food and Drug Administration's action Thursday follows an agency advisory committee recommendation last February that Elidel cream and Protopic ointment carry the label warnings.
The new labeling also will clarify that the two drugs are recommended for use only after other prescription topical medicines have been tried by patients, the FDA said. The agency is also issuing a guide updating patients of its concerns.
A black box warning is the most serious type of warning in prescription drug labeling. The warning will be located lower on the labels of the two drugs than is typical, although a statement higher on the labels will refer to the risk.
"This is something that is a possible risk, is a long-term possibility and is something that still needs to be researched," FDA spokeswoman Susan Cruzan said.
As of October, the FDA has received reports of 78 cases of cancers, including skin and lymphoma, in patients treated with the two drugs, said Dr. Stanka Kukich, the acting director of the FDA's dermatologic and dental drug products division.
Novartis Pharmaceuticals, which makes Elidel, said in a statement Thursday that it remained confident in the safety and efficacy of Elidel.
"While Novartis believes this action is not substantiated by scientific or clinical evidence, Novartis has agreed to make the requested changes," the company said.
Astellas Pharma Inc., formed through the merger of Protopic maker Fujisawa Healthcare Inc. and Yamanouchi Pharmaceutical Co., said in a statement that its drug "is safe and effective when used in a manner consistent with its label."
"It addresses a theoretical risk — a potential risk, not a demonstrated link," Dr. Joyce Rico, vice president for medical sciences research and development at Astellas, said of the warning.
While the two manufacturers dispute whether there is a cancer link, the FDA felt it had to convey notice of the cancer reports to doctors and patients, said Dr. Julie G. Beitz, an acting director of one of the FDA's drug evaluation offices.
Along with the small number of cancers reported in both children and adults treated with the drugs, animal tests have shown an increase in cancer associated with the drugs, the FDA said last year.
No causal link between use of the drugs and cancer has been established, Beitz said.
The long-term safety of the drugs has not been established, according to the FDA. While both companies are studying that issue, the results may not be known for years, the FDA said.
Elidel and Protopic are applied to the skin to control eczema by suppressing the immune system.
The companies estimate that roughly 10 million people combined have used the two drugs.

Chronic Actinic Dermatitis

Written by Dr James Ferguson, consultant dermatologist

Chronic actinic dermatitis (CAD), sometimes known as photosensitivity dermatitis/actinic reticuloid syndrome (PD/AR), is a condition in which the skin becomes inflamed, particularly in areas that have been exposed to sunlight or artificial light.In addition, the majority of CAD patients have allergies to some substances that come into contact with their skin, particularly various flowers, woods, perfumes, sunscreens and rubber compounds.

The condition particularly affects men over the age of 50, but also arises in women and is increasingly found in young male or female patients with atopic eczema.

This is not a life-threatening condition, but it does require significant changes in lifestyle to avoid contact allergies and intense sources of light.

Although the cause is not known, it is suspected that the body's defence system over-reacts to substances within the skin that are made 'allergic' by ultraviolet and visible light.

Many patients are spontaneously cured, but this may take several years and in the intervening period, patients have to learn to live with the condition, managing it by minimising their exposure to ultraviolet and visible light as well as chemicals.

Because the photosensitivity involves non-sunburn wavelengths of light (longwave ultraviolet and visible wavelengths), patients can develop the problem even on cloudy days, and windows and clothing offer no protection (unless the clothing totally blocks the light out). As a result, it is not always obvious that light is the source of the problem, and doctors may have difficulty in diagnosing the condition. One helpful tip is to check the parts of the patient's skin that are not exposed to light, such as under a watchstrap, to see if the condition is present there.

Phototesting using specialised equipment is possible in some university dermatology centres. Phototesting consists of having areas of skin exposed to known amounts of light of specific wavelengths and then looking at the reactions with comparison to the average population response. This procedure is painless and can be repeated to assess improvement. Patch testing, another way of confirming CAD diagnosis, is conducted by most dermatologists. A range of chemicals is applied to the skin and left for two days. The skin is then assessed for reactions.

Treating CAD involves the following:
Avoid direct exposure to sunlight between the hours of 11am and 3pm, with outdoor activities being limited to the earlier and later hours of the day.
Wear appropriate clothing along with a wide-brimmed hat and a neckerchief to protect the back of the neck.
Avoid direct exposure to ultraviolet sources at home or at work (such as fluorescent and metal halide lights).
Use protective plastic film on home and car windows. This can be of the clear, sticky-backed variety and is not noticeable when in place.
Avoid contact allergies.
Use a broad-spectrum sunscreen (seek medical advice).
Topical (ie, applied to the surface of the body) steroid creams/ointments are useful when a flare has occurred. Potent varieties should be used only in the short term.
Occasionally, treatment with tablets, which are prescribed by your dermatologist. Like all other potent therapies, the benefits have to be weighed up against the risks and it is useful to discuss this with your doctor.

There is good evidence that this condition will completely clear in a significant number of patients without the need for therapy. This may, however, take many years and it is important to discuss this with your doctor.

Improve Eczema Skin With Sake

It's often said that master sake brewers have beautiful hands with smooth, white and youthful skin. But now it seems there may actually be some truth behind these words judging by a recent experiment by a major sake brewery.
Ozeki, based in Nishinomiya, Hyogo Prefecture, asked 11 of its employees to drink 270 milliliters of sake, and then measured the moisture content of their skin two hours later. The results showed that the moisture content of the skin on their arms had risen by 30 percent.
In a comparative experiment, the volunteers drank a non-sake alcoholic beverage used as a control, which turned out to produce no effect on their skin.
Many sake breweries are now developing skin care products, utilizing sake-derived substances believed to have moisturizing effects.
Among them is Yushin-Brewer, based in Ryonancho, Kagawa Prefecture.
The company produces sake-derived extracts, which it says have a beautifying effect. The extracts are made using sake brewing techniques, which make use of such microorganisms as koji mold, lactic acid bacteria and yeast. The company says it has discovered 36 active substances in these extracts that produce positive effects.
It has called one of these extracts Rice Power No. 11 and obtained approval from the Health, Labor and Welfare Ministry for its use as a skin moisturizer. The extract promotes the production of ceramide, a type of lipid that fills crevices in the surface layer of the skin. It also prevents dryness and irritation caused by water evaporation and keeps the skin smooth.
According to research by Tokushima University Prof. Seiji Arase, when he applied Rice Power No. 11 to the skin, the surface layer absorbed twice the normal amount of water over a two-hour period. The extract also helped the skin protect itself, potentially making it a suitable treatment for atopic dermatitis.
Yushin-Brewer has started selling lotion containing the extract, and is now working on anti-ulcer products.
Because different bacteria are used at each stage of the brewing process, sake brewers need very precise temperature management--a process that has been developed through a long process of trial and error.
Yushin-Brewer President Takashi Tokuyama says: "As sake-making shows, Japan's brewing culture is a product of wisdom accumulated over a long period of time. I'd like to use that wisdom to produce new foods and other products."

Controlling Eczema In The Winter

Dry winter air can cause skin cracking, chapping and irritation, and the winter sun can be as damaging to skin as it is in the summer, says the American Society for Dermatologic Surgery (ASDA). Dr. Rhoda Narins, a dermasurgeon and past president of the ASDA, offers the following winter skin care advice:
Moisturizers help protect your skin against the harsh winter elements. Apply moisturizer immediately after a bath or shower to seal in necessary waters and oils.
Gloves are a simple, easy way to protect your hands from cold temperatures and dry air that triggers eczema. Gloves can also prevent cracked and splitting cuticles and fingernails.
If you develop dry and itchy skin or eczema, don't let the condition get worse. Consult a doctor.
Apply sunscreen to all exposed skin when you're outdoors.
Protect your lips by using lip balms or lipsticks that have a high SPF.
Don't take long, hot showers, which can strip skin of its natural elements and cause dry skin. Take shorter showers with lukewarm water.

Infections Common With Atopic Dermatitis

The red, cracked, and unbearably itchy skin that develops when atopic dermatitis (AD) flares is not only uncomfortable. It also makes one more susceptible to infection.

Research shows that about 90% of people with AD have the Staphylococcus aureus (staph) bacteria present on their skin. By comparison, less than 5% of people without AD have staph on their skin. When a person with AD scratches, the skin often breaks. This allows microorganisms on the skin, such as bacteria, viruses, and fungi, to enter the body. Additionally, a study shows that people with AD cannot produce effective amounts of two natural antibiotic proteins that the immune system needs to fight infection. With staph constantly present on the skin and the immune system unable to adequately fight infection, it is easy to see why people with AD develop infections when their skin flares and they scratch.

Children and teens with AD are especially prone to developing skin infections caused by staph (bacteria) and herpes simplex (virus). Fungal infections may also occur. It is important to recognize the signs and symptoms of infection, and consult your dermatologist as soon as they appear. An untreated infection may be the reason AD does not respond to treatment.

Signs and symptoms to watch for are:
Honey-colored crusting and pus-filled blisters. When a bacterial infection, such as one caused by staph, occurs, honey-colored crusts usually form. This is a sign of infection. Another sign is the appearance of pus-filled blisters that form over patches of AD. These blisters may pop, weep, and form crusts.
Redness. When the skin becomes infected with bacteria, it becomes very red. Widespread red scaly patches and plaques that may crust and discharge pus, usually indicate a staph infection. Streaking or spreading redness also indicates infection.
Swelling/Inflammation. If the area feels enlarged or unusually warm, it may be infected.
Fever. When infection develops, the body’s temperature sometimes rises to create an unfavorable environment for the microorganisms, such as bacteria, viruses, or fungi, causing the infection.

Lesions that resemble cold sores or fever blisters. These may be signs of eczema herpeticum, a viral infection that also causes cold sores. Eczema herpeticum can spread rapidly. In the early stages, you will see numerous small blisters filled with clear fluid that are surrounded by bright red halos. Within one or two days, the blisters will break, leaving small round breaks in the surface of the skin. The skin may become very sore, and the patient will feel quite ill.

Even a person with mild AD can develop a severe infection from the virus. For this reason, it is important to seek medical attention if you see these signs. In rare cases, eczema herpeticum can be life-threatening.

Be sure to keep children with AD away from anyone who has a cold sore.