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http://www.omniture.com --> Email Story to a Friend June 12, 2006 Eczema can be helped by creams, a little sunlight editor's note: This weekly column by reporter Bill Kettler answers readers' questions about topics of general medical interest with information provided by doctors from PrimeCare, Jackson County's independent practice association. I suffer from fairly severe eczema, mostly on my legs. I have been prescribed a cream that controls the itching, but the rash never completely goes away. What causes eczema? Is there anything further I can do to get rid of the rash? -- Mark E., Medford Eczema, also known as "atopic dermatitis," has a variety of causes, and can be affected by everything from your emotions to how often you bathe, says Dr. Doug Naversen, a Medford dermatologist. Naversen says there are at least 10 varieties of this skin condition. Atopic eczema is the kind that develops in childhood and may carry over into adulthood as hand dermatitis. Another variant, commonly known as "winter itch" asteatotic dermatitis can be caused by poor circulation, low humidity or too much bathing. Naversen says the rash that characterizes atopic dermatitis is caused by genetically sensitive skin that reacts to soap and other irritants, such as excessive bathing or temperature extremes. Most cases of childhood eczema probably are not caused by a true allergy, but simply from having sensitive skin. "Ten percent of us have atopic eczema-sensitive skin," Naversen says. "It can be really troublesome if you have genetically-sensitive skin. While the actual causes are difficult to pin down, it tends to run in families, Naversen says, along with other allergy-related conditions such as asthma and hay fever. Someone with eczema can also develop allergic contact dermatitis on top of their underlying sensitive skin. Naversen counsels his patients to avoid hot beverages, especially those with caffeine, because they can "jazz up" the system and cause more itching. Often the skin is irritated because it's too dry. Bathing with less soap and tepid water may reduce the dry-skin problem for some people. Others get relief from non-prescription skin moisturizers such as Cetaphil, which can help prevent ordinary dryness from escalating into dermatitis. "Cetaphil cream is excellent," Naversen says, "and a lotion is available, too, but I prefer the cream." Brief exposure to sunlight about 15 minutes seems to help some people, too. "Sunlight helps lots of inflammatory skin conditions," Naversen notes. People who work in occupations that require lots of hand washing are especially vulnerable to dermatitis. Physicians, nurses, dentists, mechanics and housewives often have to struggle to keep their skin from drying out. Sometimes people develop allergies to the very things they use to try to control dermatitis. Substances such as antibacterial ointments, tea tree oil melaleuca, aloe vera and the various "-caine" anesthetics can backfire and actually aggravate dermatitis. Naversen says neomycin in "triple antibiotic" ointments is the main culprit. Better choices are Polysporin an over the counter medication or Bactroban, available by prescription only. Steroids help stop the itch, and many people get relief from over-the-counter topical creams that are 1 percent cortisone. More severe cases have to be treated with stronger steroids available by prescription. None of the cortisone creams should be used indefinitely, so physicians try to help their patients find the cause of the irritation. Some people test 40 or 50 different products trying to track down the source of their itch. Naversen says prednisone by mouth or a Kenalog injection are highly effective in controlling "train wreck" eczema. They can be followed by steroid creams and moisturizers and careful, limited bathing to maintain control. Dermatologists and allergists may use patch testing as a precise way to find offending allergens. A patch test kit is applied to the patient's back for 48 hours, and any red itch areas of dermatitis confirm an allergy. By avoiding the allergen, the patient may improve significantly. Naversen counsels his patients to avoid putting a lot of "junk" on their skin. "Find a few good products that work for your skin and then stick with them. Some people literally rub 20 different creams on their skin and they get allergic to one or more of them." Call Bill Kettler with your medical questions at 776-4492, or e-mail them to: [email protected] or send them to: Mail Tribune, Ask Your Doctors, P.O. Box 1108, Medford OR 97501. 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