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An "Eczema" Story

In the Well section of the NY Times there is an excellent article on "Waking Up With Eczema" (December 25, 2011).  This essay will appeal to patients with "atopic dermatitis" as well as those who itch for other reasons.  There are well over a 100 comments, and some are very good, as well.  Itching, eczema, and atopic dermatitis are frustrating to live with and diffiuclt to treat.  This is a valuable introduction.

Breast Feeding and Eczema

New York Times August 29, 2011
Nutrition: Breast-Feeding Does Not Prevent Eczema
By NICHOLAS BAKALAR

   Prolonged breast-feeding is widely believed to protect infants against developing eczema and other allergic diseases. But a new study has found no evidence for the belief.
   Researchers in Britain gathered data on more than 50,000 children ages 8 to 12 in 21 countries, assessing the prevalence and severity of eczema with skin examinations of the children, family medical histories and questionnaires about past symptoms. The children also received skin-prick tests for common allergens.
   Even among children who had been breast-fed for six months or longer, there was no evidence that breast-feeding prevented eczema or limited its severity. The results were the same for children whose mothers had a history of allergy and for those who had a positive reaction to the allergens used in the skin-prick test.
   In more affluent countries, breast-feeding actually was associated with a slight increase in the risk for eczema. The researchers suspect that this is because mothers who see an allergic reaction in an infant may try to breast-feed longer, not because breast-feeding causes the allergy.
“We’re not questioning the benefits of breast-feeding,” said Carsten Flohr, the lead author and a senior lecturer in pediatrics at Kings College London. “But when it comes to prevention of eczema, neither breast-feeding itself nor prolonged breast-feeding seems to be protective.”
   The study appears online in The British Journal of Dermatology.  See: 

Br J Dermatol. 2009 Aug;161(2):373-83. Epub 2009 Feb 23.
Exclusive breastfeeding and incident atopic dermatitis in childhood: a systematic review and meta-analysis of prospective cohort studies.
Yang YW, Tsai CL, Lu CY.
Conclusion: There is no strong evidence of a protective effect of exclusive breastfeeding for at least 3 months against AD, even among children with a positive family history.

Allergy to Natural and Organic Products

While most skincare and hair care is filled with potential allergy triggers, it turns out that organic versions are, to green proponents’ dismay, among the worst offenders.  Allergies Can Be Natural, Too is a good article on this topic that appeared in the Thursday, April 28, 2011 NY Times.  It should be particularly useful to parents of kids with atopic dermatitis.

Topical Steroid Potency Chart

 Topical steroid preparations are grouped according to relative anti-inflammatory activity, but activity may vary considerably depending upon the vehicle (cream, ointment, solution, foam, etc.), the site of application (face, skin folds and genitalia), disease, the individual patient and whether or not an occlusive dressing is used.  In addition,there are a number of these charts and they are not entirely consistent.  The National Psoriasis Foundation's Potency Chart is well-prepared and a good general guide.

Topical steroids should be used under your doctor's direction, since overuse can cause thinning of the skin, rosacea, acne, stretch marks if used on the wrong part of the body and for too long.  .

Bleach in Bath

Treatment of Staphylococcus aureus Colonization in Atopic Dermatitis Decreases Disease Severity

Jennifer T. Huang, MD  et. al.
PEDIATRICS Vol. 123 No. 5 May 2009, pp. e808-e814 (doi:10.1542/peds.2008-2217)

Departments of Dermatology and Pediatrics
Northwestern University, Feinberg School of Medicine, Chicago, Illinois

OBJECTIVES. The goals were to determine the prevalence of community-acquired methicillin-resistant Staphylococcus aureus colonization in patients with atopic dermatitis and to determine whether suppression of S aureus growth with sodium hypochlorite (bleach) baths and intranasal mupirocin treatment improves eczema severity.

METHODS. A randomized, investigator-blinded, placebo-controlled study was conducted with 31 patients, 6 months to 17 years of age, with moderate to severe atopic dermatitis and clinical signs of secondary bacterial infections. All patients received orally administered cephalexin for 14 days and were assigned randomly to receive intranasal mupirocin ointment treatment and sodium hypochlorite (bleach) baths (treatment arm) or intranasal petrolatum ointment treatment and plain water baths (placebo arm) for 3 months. The primary outcome measure was the Eczema Area and Severity Index score.

RESULTS. The prevalence of community-acquired methicillin-resistant S aureus in our study (7.4% of our S aureus–positive skin cultures and 4% of our S aureus–positive nasal cultures) was much lower than that in the general population with cultures at Children's Memorial Hospital (75%–85%). Patients in the group that received both the dilute bleach baths and intranasal mupirocin treatment showed significantly greater mean reductions from baseline in Eczema Area and Severity Index scores, compared with the placebo group, at the 1-month and 3-month visits. The mean Eczema Area and Severity Index scores for the head and neck did not decrease for patients in the treatment group, whereas scores for other body sites (submerged in the dilute bleach baths) decreased at 1 and 3 months, in comparison with placebo-treated patients.

CONCLUSIONS. Chronic use of dilute bleach baths with intermittent intranasal application of mupirocin ointment decreased the clinical severity of atopic dermatitis in patients with clinical signs of secondary bacterial infections. Patients with atopic dermatitis do not seem to have increased susceptibility to infection or colonization with resistant strains of S aureus.

Here is the protocol for Bleach Baths

1.  All patients received cephalexin at 50 mg/kg per day (maximum of 2 g/day), divided into 3 daily doses, for 2 weeks to treat their staphylococcal infections.
2.  Patients were instructed to add 0.5 cup of 6% bleach (final concentration: 0.005%; treatment arm)  to a full bathtub of water (40 gallons); the amount of administered bleach solution or water can be adjusted by the family on the basis of the bathtub size and estimated height of bathtub water.
3.  Patients were instructed to bathe in the dilute bleach bath for 5 to 10 minutes twice weekly. The frequency and number of baths without bleach  were not restricted.
4. Patients and their household members also were instructed to apply mupirocin ointment intranasally twice daily for 5 consecutive days of each month.
6.  The patient should maintained a stable regimen of topical antiinflammatory medication and emollient therapy.