Eczema

What's making you itch? You may never know. Eczema is like that. While it sometimes has an identifiable cause, like exposure to an irritating or allergy-triggering substance, eczema often shows up for no apparent reason. It doesn't even look all that unusual-just patches of dry, red, slightly thickened skin. If not for the itching, you may not have noticed that anything was wrong.

Also known as atopic dermatitis, eczema takes many forms. But all of them produce the same primary symptom: areas of inflamed, irritated, itchy skin, sometimes accompanied by small, fluid-filled blisters or coinsize wheals. Eczema can erupt just about anywhere on the body, but it most frequently occurs on the neck, elbows, hands, abdomen, knees, shins, and feet.

By one estimate, eczema affects 4 percent of the U.S. population, or about 10 million Americans. It's especially prevalent among people who have asthma or hay fever. For these folks, eczema flare-ups usually start in infancy and continue into adulthood. The familiar rash appears because of an allergic reaction-often to a food, sometimes to another substance.

This type of eczema, called allergic eczema, has a strong genetic component. If one of your parents has the condition, you have about a one-in-four chance of getting it, too. If both of your parents have allergic eczema, your risk climbs to one in two.

Eczema can also result from contact with irritants. For example, if your job or a hobby requires you to handle certain chemicals, you may develop a rash on your hands and arms-especially if you're wearing a ring or a watch, which can trap the offending substance against your skin. Exposure to soaps, detergents, clothing fibers, and environmental pollutants can also cause your skin to become itchy and inflamed.

You needn't have direct contact with an irritant to get eczema, however. Stress, profuse sweating, a dry environment, and exposure to extreme hot or cold temperatures can trigger flare-ups.

Even knowing all of these potential causes, you may never pinpoint exactly what brought on your eczema. Your skin may start to itch for no obvious reason. And the itching makes you scratch, which can create problems of its own. As your nails scrape away the outer layer of skin, the bacteria that normally stay on the surface seize the opportunity to invade deeper tissues. This can lead to a bacterial skin infection.

Thankfully, your eczema never has to progress so far. The key is to stop the itch, so you no longer have the urge to scratch. Over-the-counter hydrocortisone creams and antihistamines certainly help. But many alternative remedies work just as well. By taking a blended approach, you'll eradicate the itchiness and inflammation, heal your skin, and prevent future eczema flare-ups.

Best choices

Nutrition

Reel in relief. The inflammation associated with eczema occurs because your body produces unusually high levels of compounds called prostaglandins. Essential fatty acids, notably the omega-3's found in fish oil, decrease the production of inflammatory prostaglandins, explains Joseph Pizzorno Jr., N.D. Cold-water fish such as salmon, mackerel, and herring supply generous amounts of omega-3's. Eating more of these fish can help relieve eczema, he says.

Supplements

Opt for fish-oil capsules. If you're not a fan of fish, you can get omega-3 fatty acids from fish-oil supplements. Fish oil is sold in capsule form in health food stores. Take 3 to 4 grams a day for a month, then cut back to 1 gram a day, suggests Alan Gaby, M.D.

Take evening primrose oil. When British researchers analyzed the results of nine separate studies, they concluded that evening primrose oil provides significant relief from eczema. Evening primrose oil is rich in omega-6 fatty acids, especially gamma-linolenic acid. The omega-6's are close chemical relatives of the omega-3's and have similar anti-inflammatory properties.

Clinical nutritionist Shari Lieberman, Ph.D., recommends taking 70 to 240 milligrams of gamma-linolenic acid a day. That's the equivalent of two to six standard capsules of evening primrose oil. Don't take more than that, she cautions, or you may upset your body's fatty-acid balance. You can buy evening primrose oil capsules in health food stores.

Shore up your zinc supply. Dr. Pizzorno and other nutrition-minded practitioners have found that zinc supplements can help ease eczema. He recommends starting with 50 milligrams of zinc a day, then cutting your dosage as your symptoms improve. But be patient, Dr. Pizzorno advises: Zinc takes time to work. A few months may pass before you notice a difference. Check with your doctor first, however, since doses of zinc above 30 milligrams should only be taken under medical supervision.

Elimination Diet

Give up offending foods. Scientific studies from around the world have linked eczema, especially in children, to food intolerances. In one study conducted at the University of Arkansas for Medical Sciences in Little Rock, researchers used standard skin tests to identify food intolerances in 165 children, teens, and young adults with eczema. Sixty percent of the study participants had at least one food sensitivity.

If you suspect that a food intolerance is triggering your eczema, you have several options. You can try eliminating those foods that most often trigger reactions: shellfish, eggs, wheat, milk, soy, peanuts, cashews, oranges, pineapple, chocolate, and soft drinks. Or, with the guidance of a doctor, you can follow a full-fledged elimination diet to identify the specific foods that cause problems. Or you can consult an allergist/immunologist, who will administer skin tests to determine if you have food intolerances.

Visualization

See yourself with healthy skin. Research conducted by lona H. Ginsburg, M.D., a dermatologist in New York City, suggests that anxiety contributes to eczema flare-ups. In her study, Dr. Ginsburg gave standard psychological tests to 34 adults with eczema and 32 without. She found that the people with eczema were significantly more anxious.

Visualization can help alleviate anxiety and prevent eczema flareups. For patients with eczema, Gerald N. Epstein, M.D., director of the Academy of Integrative Medicine and Mental Imagery in New York City, prescribes an exercise that he calls Palm Fingers. You can practice Palm Fingers for a few minutes whenever you feel itchy.

To begin the exercise, close your eyes and take three deep breaths. Imagine your fingers becoming palm leaves. Gently place your palm leaves on the areas with eczema. Imagine that your palm leaves are filled with honey that flows over your itchy skin, healing it. Envision your skin clear and healthy. Open your eyes.

Herbal Medicine

Apply a chamomlle compress. For centuries, Europeans have been adding chamomile flowers to baths as a treatment for skin problems. As it turns out, chamomile oil has significant anti-inflammatory properties, says Michael T. Murray, N.D., a naturopath in Seattle. In fact, it works so well that Commission E, the German panel that evaluates the safety and effectiveness of medicinal herbs, recommends chamomile compresses for eczema and other inflammatory skin conditions.

To make a compress, add 1 to 2 heaping teaspoons of dried chamomile flowers to 1 cup of boiled water. Steep until cool, then dip a clean cloth into the tea. Apply the cloth to the affected skin.

Bring hazel home. Witch hazel is a clear liquid extract that has potent astringent properties that help treat skin problems. When German researchers had 36 people with allergic eczema apply either witch hazel or a nonmedicinalliquid (a placebo) to their eczema rashes, the witch hazel provided substantially greater relief.

Naturopathy

Wash away the itch. In Japan, people often treat their eczema flare-ups by bathing in hot mineral springs. Soaking in a tub filled with comfortably hot water can work just as well, says Anne Simons, M.D. To make your bath even more therapeutic, she suggests adding one of the following to the water:1/2 to 1 cup of baking soda; 1 to 2 cups of Aveeno, a colloidal oatmeal product sold in drugstores; or 1 to 2 cups of finely ground oatmeal. Buy regular oatmeal in the grocery store, then run it through a coffee grinder to get the appropriate consistency.

Be aware that hot baths can aggravate eczema in some people. If this happens to you, discontinue the baths and try another remedy.

Home Remedies

Add bottled moisture. While moisturizers don't cure eczema, they may help break the itch-scratch cycle that can lead to a skin infection. Apply a moisturizing cream, oil, or gel immediately after showering, suggests Charles Camisa, M.D., head of clinical dermatology at the Cleveland Clinic Foundation in Ohio. Reapply as necessary, whenever you feel itchy.

Steer clear of irritants. As much as possible, avoid contact with irritating substances such as soaps, detergents, fragrances, solvents, paints, and tobacco smoke. If you must handle an irritant, Dr. Simons recommends wearing plastic gloves, ideally with cotton gloves underneath. By themselves, plastic gloves can make your hands sweat profusely, which can aggravate eczema.

Change your clothes. If fabrics such as wool and polyester make you itch, build your wardrobe around garments made from cotton and cotton blends.

Switch from baths to showers. For some people, soap and water dries the skin and aggravates eczema. If this happens to you, Dr. Camisa suggests taking quick showers-no more than 5 minutes long-instead of extended baths. Use warm water rather than hot, and experiment with different soaps.

Increase the humidity. If the air in your home or workplace is exceptionally dry, it may trigger eczema flare-ups. Install a humidifier and see if it helps, Dr. Simons recommends.

Go alcohol-free. Many toiletries and personal-care products contain alcohol, which dries your skin, Dr. Camisa notes. Read labels and choose products that are alcohol-free.

Over-The-Counter Drugs

Pop an antihistamine. Over-the­counter antihistamines can relieve the itching associated with eczema, Dr. Camisa says. These medicines tend to cause drowsiness, but this side effect should subside after a few days of regular use. Be sure to follow the package instructions.

Squeeze on hydrocortisone. According to Dr. Simons, another approach to relieving the inflammation associated with eczema is to apply a 0.5 percent over-the­counter hydrocortisone cream. Follow package directions.

Other Good Choices

Homeopathy

Rub on Calendula. Many people with eczema respond well to a homeopathic ointment containing Calendula, says homeopath Dana Ullman. Oral homeopathic medicines-including Kali sulfuricum, Pulsatilla, and Sulfur-can be equally effective. Which medicine will work best for you depends on your individual symptoms. For a recommendation, consult a homeopath.

Chinese Medicine

Fix itching with an herbal formula. While working at a hospital in London, Mary Sheehan, M.D., now chief of pediatric dermatology at Mercy Hospital in Pittsburgh, tested a Chinese medicine and a placebo on 40 adults with eczema. The medicine contained several different herbs, including licorice root, peony root, rehmannia root, and clematis root. While taking the medicine, the participants reported significantly less redness and itching. Their sleep also improved because they didn't feel itchy. To find out whether such an herbal formula would help heal your eczema, consult a practitioner of Chinese medicine.

Point to a cure. The United Nations World Health Organization endorses acupuncture as a treatment for eczema.

If you prefer a do-it-yourself acupressure approach, simply apply steady, penetrating finger pressure for 3 minutes to each point listed below.

• Large Intestine 11, located at the outer end of your elbow crease on the thumb side
• Spleen 10, located on your inner thigh, four finger-widths above your kneecap and just under your thighbone

Ayurvedic Medicine

Minimize Pitta. Ayurvedic physicians attribute most inflammatory skin conditions to an excess of Pitta dosha. Pitta overheats your blood, which turns your skin red and itchy, explains David Frawley, O.M.D. Vata dosha can also playa role, making your skin dry.

The course of treatment recommended by Ayurvedic physicians depends on your specific dosha, or constitutional type. A typical Ayurvedic prescription includes applications of sesame oil, aloe vera gel, and compresses made from licorice and marsh­mallow teas.

Medical Measures

If your eczema hasn't cleared up after 2 weeks of home care, your doctor may put you on prescription-strength antihistamines or hydrocortisone creams. Generally, prescription antihistamines tend to cause less initial drowsiness than over-the-counter antihistamines.

Red Flags

Eczema doesn't affect every person in the same way. What you think is eczema may be another condition requiring a different course of treatment. So when in doubt about any persistent skin problem, consult your doctor.