& Skin Allergies
Rashes are a very broad topic, but this Advisory has a narrow focus: dry
skin and eczematous rashes. Dry skin is a problem faced by almost all of us on occasion,
but its always a problem if you have eczema.
What is Eczema?
Eczema is a term used for a group of skin conditions having several
things in common: dryness, itching, inflammation and thickening of skin, and recurrence.
See the table below for descriptions of the usual types.
|Atopic dermatitis (common in
kids with allergies or asthma, often gone by adulthood)
||See body map
||Thickened, red, dry skin;
sometimes crusty and oozing.
|Contact dermatitis (skin
allergy or sensitivity to a substance)
||See body map
||Itching, dry skin
||Dry, thickened, cracked skin.
|Hand dermatitis (usually caused
||Hands, sides of fingers
||Itchy, dry, painful; sometimes
small blisters at sides of fingers
||Dry, red, skin; sometimes
cracked and bleeding.
|Dry (chapped) skin
||Backs of hands, lower legs, or
||None or sometimes itching
||Scaly, flaky; not thickened.
Sometimes cracked if severe.
What Causes It?
Nobody knows exactly why some people are affected by these rashes and
others with the same exposure arent. Those with atopic dermatitis often have
non-skin allergies (like hay fever and asthma) but their rashes arent caused by skin
allergies. On the other hand, those with contact dermatitis do have true skin
allergies, but usually not other allergic problems like someone with atopic dermatitis.
Contact dermatitis occurs at all ages, whereas atopic dermatitis is most often a problem
in kids. Hand dermatitis is caused by skin irritants such as detergents or chemicals. Dry
(chapped) skin occurs because of lack of water in the stratum corneum (outermost layer of skin). If
your skin surface doesnt have enough oil, theres more evaporation of water
which contributes to the dryness.
The Itch/Scratch Cycle
|Characteristic sites of atopic dermatitis.
Scratching can actually trigger eczematous rashes. Initial mild itching makes you want
to scratch, of course. But scratching damages the skin, worsens inflammation, irritates
surface nerves, and leads to even more intense itching than you had before. This cycle
aggravates and prolongs all of these rashes. In fact some eczematous rashes completely
disappear without any treatment if you just stop scratching.
As you can tell, these rashes differ in many ways. So why do we lump
them together? Because the underlying chronic inflammation makes them all look, feel and
respond to treatment in the same ways.
If you have eczema or dry skin, you’ll probably have it again
unless you take preventive steps. Advice below applies to all varieties of
eczema and dry skin.
Avoiding Eczema and Dry (chapped) Skin
- use moisturizers twice daily (more often on hands) to hydrate and soften
skin, and reduce itching.
- humidify dry air, especially in your bedroom.
- clip fingernails short and even wear light cotton gloves to stop
- wear gloves when washing dishes or clothing, and dont allow your
hands to be constantly wet.
- use any skin products or laundry products with added fragrances.
- allow wool clothing or blankets against your skin.
- expose your skin to very cold or hot air.
|Eczematous dermatitis (contact) (a) Airborne
allergens (plants, pollens, sprays;
(b) jewelry, clothing, furs; (c) clothing straps; (d) deodorant, antiperspirant;
(e) metal tags; (g) trunks and panties; (h) shoes or hose.
The Dos and Dont in the Prevention section are really the key to minimizing your eczema or dry
skin, but there are medications and other products that help further.
- Hydrocortisone is an anti-inflammatory steroid cream. Its
low potency makes it safe for self-care. Hydrocortisone blocks allergic/immune skin
reactions which trigger eczematous rashes, and can speed healing of inflamed and cracked
skin regardless of the cause. Hydrocortisone is probably the strongest anti-itching cream
- Colloidal oatmeal baths and cleansers re-moisturize the dry
stratum corneum skin layer, lubricate and help control your itching. Use oatmeal-based
cleansing bars as soap replacements since they wont strip your skin of helpful
- Moisturizers and humectants. Most of us call moisturizers
"lotion" or "hand cream." They simply leave an oily coating on your
skin which prevents more evaporation and dryness. Humectants take this a step further and
actually draw moisture from the air into your skin. Both soften the rash and stop
you from itching.
- Keratolytics actually break down dead, thickened skin and
help remove flakes and heavy crusts. This speeds up your bodys natural skin healing
process, and exposes the healthier skin below more quickly. Keratolytics should be used in
combination with moisturizers or humectants to maintain hydration of the new skin.
When treating eczematous skin, always keep the old dermatologists
refrain in mind: "If its wet, dry it. If its dry, wet it."
Translation: solution or gel forms of medications are better to dry out puffy, moist or
oozing skin. Lotion and cream types are for neutral or slightly dry skin, and ointments
(greasy petrolatum-based products) are the ultimate for "wetting" your extremely
dry or cracked skin problems.
- Wild Naturals Skin Cream
is an interesting new product we have found. It is all natural, and quickly works to
bring relief to damaged skin and stop the itching. It has none of the
dangerous side effects of steroids, and for many people is even more
effective. Other treatments include:
- Cortaid cream (hydrocortisone 1% cream). See the description of
hydrocortisone above in the Treatment section. This particular brand of
hydrocortisone cream has an excellent moisturizing base and vanishes after a thorough
application, instead of clumping like some off-brands.
- Aveeno Cleansing Bar. As discussed above, this product may be
substituted instead of soap to allow more of your skins natural oils to remain in
the stratum corneum layer. Allowing those natural oils to remain and build up further is
crucial to prevention and treatment of dry and damaged eczematous skin.
- Eucerin. The unscented form of this product contains standard
emollients such as mineral oil and lanolin, but also the humectants sorbitol and propylene
glycol (discussed above under Treatment). The humectants are what
make this lotion more effective than other oil or lanolin based moisturizers.
- Eucerin Plus (keratolytic: urea). This is a slightly different
formulation than the Eucerin moisturizing lotion, and is especially helpful for breaking
down thickened, dry, crusty skin while helping to moisturize the new skin beneath.
- Aveeno Bath Treatment Soothing Formula (colloidal oatmeal). The
exact mode of action of colloidal oatmeal is unknown, but it is proven to relieve itching
for up to several hours. It leaves a rather slippery, smooth texture to the skin.
Many cases of eczema are too severe for self-care. Prescription steroid
creams and other techniques can be a far more effective addition to the above measures if
your rash gets out of control. Here are some signs that you are losing the battle:
- Enlargement, spread, or worsening of the rash despite your best efforts.
- Uncontrollable itching causing itch/scratch cycle.
- Signs of infection like intense redness, tenderness, or suddenly
increased swelling around damaged skin areas.
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