In Miami, the land of the "Beautiful People" - where sun and sand mean that skin is always exposed, Dr. Andrea Trowers, Board Certified Dermatologist based in North Miami Beach, helps enhance all of her client's beauty.
Dr. Trowers exclusively addresses many of your biggest skin care questions in our ongoing series of columns. Her latest column is one that you or someone in your life may find extremely helpful - she is sharing with all of us exactly what the very common skin condition called Eczema is (and when it's not) and how to treat these skin conditions. - RLB
Every day in my practice I have patients who come in and say they have eczema. For patients this is a word that describes anything itchy, red and scaly. However in dermatology eczema is only a descriptive word and is in no way related to the underlying cause, as many conditions can result in this presentation.
Many times when patients claim they have eczema, especially in children, they actually have atopic dermatitis. This is caused by an underlying malfunction in the barrier abilities of the skin that results in the its’ inability to hold onto moisture. As a result the skin cracks and secondary inflammation and infection occur. I often describe these individuals’ skin as similar to the dessert. Moisture, moisture and trapping that moisture in are the key to repairing the skin.
Ointments and creams (Aquaphor, Cetaphil and Lipikar are my favorite brands) trap the moisture into moist skin and help to repair the skin barrier. It is important to apply them quickly after a bath or shower or else the water evaporates from your skin and leaves it drier than it was before. Not all lotions are created equal…so the one you choose makes a huge difference.
Topical steroids (which are not absorbed into the blood stream if used correctly) and topical immunomodulatoers (such as protopic and elidel) are required to calm the inflammation in more severe cases of atopic dermatitis. As I frequently have to explain to parents and patients, in order to allow them to overcome their fear of topical steroids, they would have to lock themselves in a room and continuously apply it to their skin for it to be absorbed into their blood…and I never prescribe enough for that to happen! Their skin is steroid deficient and they need it to get better! Once they are better regular moisturization can help to prevent flares. But sometimes because of an illness, change in weather or just because… flares occur…but now they are educated enough to know how to treat it.
Another condition that patients frequently describe as eczema is allergic contact dermatitis. This is also itchy, red and scaly. Even though you may have been in contact with something for years on end…BOOM…one day you can develop an allergy to it. This is a concept many patients find difficult to grasp, especially if it is an allergy to a perfume they have used for the past ten years. I like help patients grasp this concept by asking them if they have ever had a friend turn on them…since most people have this helps them to grasp the concept.
Once the offending agent has been removed the condition quickly resolves. Topical steroids are usually prescribed to hasten the resolution or until the patient figures out the offending agent. Unfortunately no biopsy or test can determine the allergy. The biopsy of the skin just shows a reaction pattern and patch tests only test for specific things. So it’s no guarantee that the positive allergy test correlates to the allergy the patient is having.
So remember what you call eczema may require a dermatologist’s evaluation to determine the best treatment and the cause! - Dr. Andrea Trowers
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Office contact info: 10800 Biscayne Boulevard Suite #650 Miami, FL 33161