Eczema, or atopic dermatitis, is a long-term skin disorder that can involves red, scaly and itchy patches.
Cold, dry winter air and changes in the environment – from outdoors to indoors – can aggravate this condition, but relief is on the way!
Dr. Altman will discuss strategies for prevention and treatment of eczema and how to cope with the effects of winter on already sensitive skin.
Selected Podcast
Eczema and Winter Skin
Featured Speaker:
Emily M. Altman, MD, FAAD
Emily M. Altman, MD, FAAD, has expertise in state-of-the-art medical, surgical, and cosmetic dermatological procedures and techniques. Dr. Altman is a member of the American Academy of Dermatology, American Society of Dermatopathology, American Academy of Cosmetic Surgery, American Society of Cosmetic Dermatology and Aesthetic Surgery, Women's Dermatologic Society, and International Society for the Study of Vulvovaginal Disease, among others. She is the coauthor of articles on a range of topics in dermatology, which are published in Annals of Allergy, American Journal of the Diseases of Children, and Journal of Cutaneous Pathology, to name a few. She is a reviewer for Journal of the American Medical Association Dermatology. Dr. Altman has been featured in the New Jersey Monthly "New Jersey's Top Doctors" listings. She is a sought-after writer of and expert consultant for online and interactive content concerning a wide range of topics in dermatology. Transcription:
Eczema and Winter Skin
Melanie Cole (Host): Eczema or atopic dermatitis is a long-term skin disorder that can involve red, scaly, and itchy patches, and we're discussing strategies for prevention and treatment of eczema and how to cope with the effects of winter on already sensitive skin. My guest is Dr. Emily Altman. She's a board-certified dermatologist at Summit Medical Group. Welcome to the show, Dr. Altman. Let's discuss eczema, atopic dermatitis. First of all, what are the symptoms? People want to know what they're seeing. If there's a rash somewhere on their body, how do they know that that's what this is?
Dr. Emily Altman (Guest): There are some typical areas where eczema involves the skin, although it can potentially involve all of the skin. But in little kids, we normally see this red, itchy, broken skin on the arms and legs, and then on the cheeks. Then eventually, as the child grows, we see it localized more to the elbow crooks and behind the knees, so antecubital and popliteal fossa, and that's the typical area of atopic dermatitis or eczema. But potentially, it can involve all of the skin. It used to be called the itch that rashes. The first thing that the person feels, child or adult, is irritation and itch, and then the rash breaks out. As a goal for a dermatologist, we need to teach patients to prevent this step going from dry skin to itching to actual breakouts
.
Melanie: We're going to get to the causes. Once it's broken out, is it contagious?
Dr. Altman: Eczema itself, or atopic dermatitis itself, is not contagious. It certainly can be, on occasion, super infected with either bacteria or even viruses such as herpes viruses. In those cases, it's contagious, but on a regular basis, you cannot spread it to somebody else. You cannot spread it to yourself by touching one area and then touching another.
Melanie: But there is a hereditary component to it, correct?
Dr. Altman: Absolutely, very, very large hereditary component. Atopy is a group of diseases that is very much genetically determined. And in that group we have atopic dermatitis, we have allergies like hay fever or dust mite allergy, and asthma. It's a general overreaction to the environment. So the environmental allergens and irritants that are not a big deal to a person without this genetic component will actually make the skin, the lungs, the nose of a person with atopy react very quickly.
Melanie: There are some things that trigger it, and you're starting to segue into that now, Dr. Altman. Winter skin, winter is very dry anyway. So what are some triggers we should look out for? What are some prevention and treatment options that we can look at?
Dr. Altman: For atopic dermatitis, the skin component of this triad of atopy, the trigger is dryness. Then on top of that dryness, if we have irritants, then that's how the rash starts. What does dryness actually do? Dryness creates these micro-cracks or micro-fissures in the skin that allow the entrants of these allergens and irritants into the skin much more easily, and it allows for more of the water loss from the skin. It's a two-way street. When we have conditions like the winter where outside, the air is cold and dry, and inside, the air is hot and dry, if you have forced air heat, then this accentuates and promotes this fissuring in the skin, the breaking down of the barrier. And at that point, the skin is very vulnerable to irritation and begins to itch. Then the rash begins to break out.
Melanie: Then what do we do about it? First, start with topical treatments. If someone comes to see you, what do you recommend as the first line of defense for this itching and very uncomfortable situation?
Dr. Altman: Removal of any irritants is the first thing. We have to remove fragrances from soaps, laundry detergents, fabric softeners. That's the first thing. The second thing -- and these two are not really you do this first and you do this second because you really have to approach this globally. Everything has to change. Make sure the cleanser that you use is a soap-free cleanser, because soaps strip whatever little oil there is in the skin. You want to use something like Cetaphil bar or Vanicream bar. Bars, not liquids. With liquids, we usually use one of these buff puffs or sponges, or washcloths, which also strip oils from the skin. Just using a free bar to cleanse, making sure that the water is not overly hot, and moisturizing with a pretty heavy sensitive skin moisturizer—again, like Vanicream, like Cetaphil, like Eucerin, or even Aquafor or petroleum jelly. In fact, when I was just starting in dermatology, one of my professors, who was a great big believer in old-style treatments, used to say that Crisco vegetable shortening was the greatest moisturizer ever. It's bland, it doesn't have irritants, and you can get lots of it relatively inexpensively. And it actually works pretty well.
Melanie: Dr. Altman, when you're talking about these thick, thick creams—and my daughter has eczema—and some of these creams sting right away. I always look at the label to make sure there's no alcohol, or as you say, other irritants in there. The creams you're mentioning, Aquafor, petroleum jelly, even Crisco, Cetaphil, these don't have any of those irritants in them, right? They're thick.
Dr. Altman: Right. The majority of the time, the skin is able to tolerate them very well because nothing will turn a little kid off from getting his eczema treatments than putting a cream on and having it sting. The skin is already so uncomfortable, so we really want to just bring back the comfort for the skin. That is accomplished by removing the irritants and by applying these thick, thick creams that, as you mentioned, do not irritate the skin further and do not sting. Many times, I hear my patients say, "I lotion." Lotions are no good. Lotions, first of all, have a lot of things that make them cosmetically elegant. They absorb very nicely, they smell very nice. But all these things irritate the skin more and promote more of a breakout of eczema rather than helping the skin heal.
Melanie: We really just want the ones that are not really cosmetic. They are just true moisturizing creams, very thick creams without alcohol and irritants in them. What about adding a little corticosteroid. If there is a really bad outbreak on the knuckles or the elbows and it's very painful, or the shoulders, putting just a little, mixing it in with the Cetaphil or the Aquafor?
Dr. Altman: Eczema rash is actually painful. We want to make sure, first of all, that there is no crusting or ulcerations there because that would make us think that the rash is infected. If there is not, if it's just cracks and uncomfortable, very dry skin, I would say putting the emollients on first is the most important thing, like Vaseline. You can mix a little hydrocortisone in, but hydrocortisones are relatively weak, the over-the-counter one. So they're not going to add very much to the home treatment of eczema as opposed to just using the emollient. Another thing that makes the skin feel better is taking bleach baths. Bleach baths are really very, very helpful for eczema. The way you do it is you draw a lukewarm bath. It shouldn't be hot. Heat feels nice because it takes away itch for the moment, but it then rebounds. The itch rebounds, and the dryness rebounds if you use very hot water. So it has to be warm water. Mix into it a packet of oatmeal bath and a quarter cup of regular, fragrance-free Clorox bleach. You have to be sure that you swish the water around very well because bleach is heavier than water and it will settle to the bottom. You want to make sure that it is all mixed in. Then have the person with eczema just sit there for 10 minutes and then come out, rinse it out, and immediately, while the skin is still damp, apply the moisturizers, because that will lock in all that moisture inside the skin. Why we use bleach, in the area of everything old is new again, there's an article that recently came out that talks about the itch of atopic dermatitis being provoked by staph, by bacteria on the skin. It's true; in patients with eczema, they have much higher bacterial counts on their skin. It doesn't mean that their skin is infected, but they do have much higher bacterial counts because the skin is broken, there's leeching of all those nutrients that our cells use onto the surface of the skin, and that's like chicken soup for bacteria. Bacteria multiply.
Melanie: This is just such great advice, and I'm writing stuff down even as you're saying it, Dr. Altman. In the last just about 15 seconds here, please give your best advice for eczema, atopic dermatitis for prevention and treatment, just about 15 seconds.
Dr. Altman: Remove all the irritants and moisturize, moisturize, moisturize. That's the best thing that you can do for your skin, and it will prevent breakouts, which is exactly what we want. We don't want you coming into the office miserable with your rash. We want your skin to be nice, healthy, moisturized, and glowing, and we want you to not need us, pretty much.
Melanie: Thank you so much. You're listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. This is Melanie Cole. Thanks for listening.
Eczema and Winter Skin
Melanie Cole (Host): Eczema or atopic dermatitis is a long-term skin disorder that can involve red, scaly, and itchy patches, and we're discussing strategies for prevention and treatment of eczema and how to cope with the effects of winter on already sensitive skin. My guest is Dr. Emily Altman. She's a board-certified dermatologist at Summit Medical Group. Welcome to the show, Dr. Altman. Let's discuss eczema, atopic dermatitis. First of all, what are the symptoms? People want to know what they're seeing. If there's a rash somewhere on their body, how do they know that that's what this is?
Dr. Emily Altman (Guest): There are some typical areas where eczema involves the skin, although it can potentially involve all of the skin. But in little kids, we normally see this red, itchy, broken skin on the arms and legs, and then on the cheeks. Then eventually, as the child grows, we see it localized more to the elbow crooks and behind the knees, so antecubital and popliteal fossa, and that's the typical area of atopic dermatitis or eczema. But potentially, it can involve all of the skin. It used to be called the itch that rashes. The first thing that the person feels, child or adult, is irritation and itch, and then the rash breaks out. As a goal for a dermatologist, we need to teach patients to prevent this step going from dry skin to itching to actual breakouts
.
Melanie: We're going to get to the causes. Once it's broken out, is it contagious?
Dr. Altman: Eczema itself, or atopic dermatitis itself, is not contagious. It certainly can be, on occasion, super infected with either bacteria or even viruses such as herpes viruses. In those cases, it's contagious, but on a regular basis, you cannot spread it to somebody else. You cannot spread it to yourself by touching one area and then touching another.
Melanie: But there is a hereditary component to it, correct?
Dr. Altman: Absolutely, very, very large hereditary component. Atopy is a group of diseases that is very much genetically determined. And in that group we have atopic dermatitis, we have allergies like hay fever or dust mite allergy, and asthma. It's a general overreaction to the environment. So the environmental allergens and irritants that are not a big deal to a person without this genetic component will actually make the skin, the lungs, the nose of a person with atopy react very quickly.
Melanie: There are some things that trigger it, and you're starting to segue into that now, Dr. Altman. Winter skin, winter is very dry anyway. So what are some triggers we should look out for? What are some prevention and treatment options that we can look at?
Dr. Altman: For atopic dermatitis, the skin component of this triad of atopy, the trigger is dryness. Then on top of that dryness, if we have irritants, then that's how the rash starts. What does dryness actually do? Dryness creates these micro-cracks or micro-fissures in the skin that allow the entrants of these allergens and irritants into the skin much more easily, and it allows for more of the water loss from the skin. It's a two-way street. When we have conditions like the winter where outside, the air is cold and dry, and inside, the air is hot and dry, if you have forced air heat, then this accentuates and promotes this fissuring in the skin, the breaking down of the barrier. And at that point, the skin is very vulnerable to irritation and begins to itch. Then the rash begins to break out.
Melanie: Then what do we do about it? First, start with topical treatments. If someone comes to see you, what do you recommend as the first line of defense for this itching and very uncomfortable situation?
Dr. Altman: Removal of any irritants is the first thing. We have to remove fragrances from soaps, laundry detergents, fabric softeners. That's the first thing. The second thing -- and these two are not really you do this first and you do this second because you really have to approach this globally. Everything has to change. Make sure the cleanser that you use is a soap-free cleanser, because soaps strip whatever little oil there is in the skin. You want to use something like Cetaphil bar or Vanicream bar. Bars, not liquids. With liquids, we usually use one of these buff puffs or sponges, or washcloths, which also strip oils from the skin. Just using a free bar to cleanse, making sure that the water is not overly hot, and moisturizing with a pretty heavy sensitive skin moisturizer—again, like Vanicream, like Cetaphil, like Eucerin, or even Aquafor or petroleum jelly. In fact, when I was just starting in dermatology, one of my professors, who was a great big believer in old-style treatments, used to say that Crisco vegetable shortening was the greatest moisturizer ever. It's bland, it doesn't have irritants, and you can get lots of it relatively inexpensively. And it actually works pretty well.
Melanie: Dr. Altman, when you're talking about these thick, thick creams—and my daughter has eczema—and some of these creams sting right away. I always look at the label to make sure there's no alcohol, or as you say, other irritants in there. The creams you're mentioning, Aquafor, petroleum jelly, even Crisco, Cetaphil, these don't have any of those irritants in them, right? They're thick.
Dr. Altman: Right. The majority of the time, the skin is able to tolerate them very well because nothing will turn a little kid off from getting his eczema treatments than putting a cream on and having it sting. The skin is already so uncomfortable, so we really want to just bring back the comfort for the skin. That is accomplished by removing the irritants and by applying these thick, thick creams that, as you mentioned, do not irritate the skin further and do not sting. Many times, I hear my patients say, "I lotion." Lotions are no good. Lotions, first of all, have a lot of things that make them cosmetically elegant. They absorb very nicely, they smell very nice. But all these things irritate the skin more and promote more of a breakout of eczema rather than helping the skin heal.
Melanie: We really just want the ones that are not really cosmetic. They are just true moisturizing creams, very thick creams without alcohol and irritants in them. What about adding a little corticosteroid. If there is a really bad outbreak on the knuckles or the elbows and it's very painful, or the shoulders, putting just a little, mixing it in with the Cetaphil or the Aquafor?
Dr. Altman: Eczema rash is actually painful. We want to make sure, first of all, that there is no crusting or ulcerations there because that would make us think that the rash is infected. If there is not, if it's just cracks and uncomfortable, very dry skin, I would say putting the emollients on first is the most important thing, like Vaseline. You can mix a little hydrocortisone in, but hydrocortisones are relatively weak, the over-the-counter one. So they're not going to add very much to the home treatment of eczema as opposed to just using the emollient. Another thing that makes the skin feel better is taking bleach baths. Bleach baths are really very, very helpful for eczema. The way you do it is you draw a lukewarm bath. It shouldn't be hot. Heat feels nice because it takes away itch for the moment, but it then rebounds. The itch rebounds, and the dryness rebounds if you use very hot water. So it has to be warm water. Mix into it a packet of oatmeal bath and a quarter cup of regular, fragrance-free Clorox bleach. You have to be sure that you swish the water around very well because bleach is heavier than water and it will settle to the bottom. You want to make sure that it is all mixed in. Then have the person with eczema just sit there for 10 minutes and then come out, rinse it out, and immediately, while the skin is still damp, apply the moisturizers, because that will lock in all that moisture inside the skin. Why we use bleach, in the area of everything old is new again, there's an article that recently came out that talks about the itch of atopic dermatitis being provoked by staph, by bacteria on the skin. It's true; in patients with eczema, they have much higher bacterial counts on their skin. It doesn't mean that their skin is infected, but they do have much higher bacterial counts because the skin is broken, there's leeching of all those nutrients that our cells use onto the surface of the skin, and that's like chicken soup for bacteria. Bacteria multiply.
Melanie: This is just such great advice, and I'm writing stuff down even as you're saying it, Dr. Altman. In the last just about 15 seconds here, please give your best advice for eczema, atopic dermatitis for prevention and treatment, just about 15 seconds.
Dr. Altman: Remove all the irritants and moisturize, moisturize, moisturize. That's the best thing that you can do for your skin, and it will prevent breakouts, which is exactly what we want. We don't want you coming into the office miserable with your rash. We want your skin to be nice, healthy, moisturized, and glowing, and we want you to not need us, pretty much.
Melanie: Thank you so much. You're listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. This is Melanie Cole. Thanks for listening.