Eczema - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about Eczema or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery
Eczema (Atopic Dermatitis)
Atopic dermatitis is a chronic, very itchy skin condition that can affect people of all ages. Eczema is its common name. Children are most likely to develop atopic dermatitis, which is associated with a family history of asthma, seasonal allergies, and penicillin allergy. While atopic dermatitis may resolve over time, some individuals still experience flares into adulthood.
Picture 1: Wide spread Alopecia Areata
Diagnosis
Actinic keratoses develop on sun-exposed skin. There may be a single or multiple lesions. The signs and symptoms of actinic keratosis include a rough or scaly, flat or slightly raised bump that ranges in color from red to brown. The affected area may occasionally be itching, burning, or feel tender. The condition is easily diagnosed after a professional examination. Occasionally, a skin biopsy, in which a small piece of skin is taken and analyzed under a microscope, is necessary.
Management
When atopic dermatitis is active, topical steroids are often needed to control it. Topical steroids should not be used for prolonged periods of time or to prevent flare-ups. Two weeks should suffice to calm a flare. It is also possible to control itching with an oral antihistamine. A course of oral steroids (prednisone) may be required for very severe widespread flares.
Proper daily skincare is essential for the management of atopic dermatitis. After bathing, it is important to apply a moisturizer liberally and to use gentle soap in cooler water.
Avoiding irritating fabrics such as wool can also be helpful. In some children food allergies may play a role and evaluation by an allergist may be necessary.
Prevention
SAtopic dermatitis flares can be triggered by extreme heat or cold, rapid temperature fluctuations, and sweating, so maintaining the proper temperature without excessive humidity or dryness is ideal. Clothing should be made from breathable, non-irritating material and washed in fragrance-free and dye-free detergent, and rinsed well. The use of dryer fabric softener sheets should be avoided.
Excessive bathing should be avoided. Excessive washing can strip the skin of oils. It is important to use a gentle soap, cool water, and moisturize liberally every day to prevent dry skin. Bubble baths should be avoided since the detergent can be drying to the skin.
Atopic dermatitis can also be triggered by stress. Getting adequate rest can help. The management of stressful life situations should be done with professional guidance or relaxation techniques, such as yoga.
By seeking medical attention at the onset of symptoms, you can prevent widespread flares.
Do you offer Dupixent? I have moderate (embarrassing) eczema on my face, neck, arms, chest and legs. Last dermatologist I visited was in Orlando, FL about a year ago. Dr. Naveed Sami prescribed several topical ointments that did not seem to help. He recommended Dupixent, but then I moved to Cincinnati. The eczema is manageable, but then I’ll have a flare up and have to start all over. If you do prescribe Dupixent, I would like to schedule an appointment. Monday mornings work the best for me.
While our office prescribes dupilumab when appropriate,we are located a far stretch from Cincinnati. Please check the dermatologist locator at http://www.aad.org for a dermatologist near you.
When you have patients coming from out of state it would be professional to let them know their insurance was not accepted. I had the appointment over 30 days and no one veritified it. My child miss a day of school, I missed work and I had to pay for toll, gas, and parking. So your staff need to be courteous of our state patients.
Hi
My daughter is being treated for eczema and I was told to put the cream where ever the eczema is. But I noticed her face started to lighten up. Will her pigment return after we stop using the steroid cream?
Thank you
Paula
I recommend that you discuss this with her dermatologist as he/she knows hat was prescribed.
Hi there,
I have severe eczema on my lower limbs. I have been on both oral and topical steroids and I am not interested in using either again. Would I qualify for dipilumab? And what are the costs for this new treatment? I would love to get any information about this. Thank you
You might very well qualify for THE immune system enhancer, dupilumab. It has changed the treatment for those with moderate or severe atopic dermatitis entirely. Itch often goes away within just a weeks.It is usually insurance covered. Cost is outrageous if you do not have insurance but the company has a program in place for those who cannot afford the medication. Please speak to your dermatologist. If you do not have a dermatologist, you may schedule an appointment with any of our dermatologist.
I’m 43 and have had eczema on one finger for 25+ years, and occasionally it spreads to the adjacent finger. I also sometimes get it (little, itchy red bumps with a shiny/waxy, red surrounding area) under my wedding ring (on the other hand). I’ve tried cortizone creams, Elidel, and countless natural remedies and dietary changes. I believe it started when I was a dishwasher at a seafood restaurant in high school, but I’m allergic to seafood and haven’t exposed myself to it since, so I’m not sure if this could be a connection). It seems to be partially seasonal (worse in the winter) but using gentle, natural soaps and moisturizing doesn’t seem to help much. It’s been diagnosed as simple atopic dermatitis by multiple dermatologists and the most I’ve gotten from other doctors are shoulder shrugs and topical treatments that barely help. Are there any new products I may not have tried or anything else I could consider.
The condition that you describe is Pomphylox, also known as dishydrotic dermatitis. It is more common when you have an atopic trait. It is triggered by intense water contact with skin, hence its occurrence under the wedding band where water can get trapped. It commonly is triggered with wearing vinyl pr plastic gloves for long periods of time. Potent steroids and Domeboro’s solution soaks for several days are helpful for an acute flare. Prevention aims at reducing water contact with skin and rebuilding the locally damaged barrier. This is no trivial task and takes effort for at least 6 months. Wear waterproof gloves for all wetwork, including washing dishes and take the gloves off as soon as possible after the activity to avoid sweating inside the gloves. Many of my patients take their rings off for hand washing to be able to completely dry their hands. Immediately after every hand washing and drying, you should apply a barrier cream, such as “Gloves in a bottle”, “Eczema relief skin protectant hand cream ” by Eucerin, or “Excipial daily protection handcream” by Galderma. Moisturizers that contain humectants are excellent for night time use. Neutrogena hand cream Norwegian formula is my favorite because of its high content of glycerin, but Aveeno cream and Cetaphil hand cream will work, too. The Eucerin and Galderma barrier products that I mentioned above will also work as night time moisturizers. You may use cotton gloves at night over your hydrating cream.
I am 38 yo African American female with a chronic eczema flare up. I have tried everything known to man. I used essential oils, steroids prescribed by the dermatologist, nothing seems to work. it has spread to my hair, inner ears, legs, stomach, back arms, literally all over my body.
I am desperately seeking medical help from a medical profession that specializes in eczema and African American skin.
Eczema or atopic dermatitis can be stubborn and difficult to manage with topical medication when wide spread. Allergic contact dermatitis is increased in people who have atopic dermatitis and a pat ch test might be needed at times to see of topical substances such as cleansers or moisturizer might actually contribute to the unmanageable atopic dermatitis. Allergies to pet dander or dust mite can contribute to severe atopic dermatitis and much more rarely, food allergies.
You environment should be as clear as possible of items that hold on to dust mites. Fabric curtains, carpets or bedding that contains down/feather should be avoided. If you were allergic to animal dander you need to assure that you do not have a pet that you are allergic to. Oral anti-histamines (Claritin, Zyrtec or Allegra) might still be needed daily with dust mite allergies. It is important to keep showers brief and water temperature to luke warm. It is also important to remove irritants such as sweat or pollen from the skin as soon as possible after exposure. A daily moisturizer such as Aveeno cream with colloidal oatmeal to reduce itching or Eucerin Eczema Relief should be applied daily after the shower. They will also serve as a barrier to irritants.
Treatment for widespread atopic dermatitis that is not controlled with topical agents includes systemic treatment that reduces a hyperactive immune system. Cyclosporine is a good option and soon, dupilumab, will be available. Treatment of acute atopic dermatitis is not dependent on color of skin but the darker your color, the more likely you have post inflammatory hyperpigmentation. Once the acute atopic dermatitis is controlled, fading agents can be used to help restore natural skin color. These include cocoa butter and the plant derived agents kojic acid and glycolic acid among others. Our office would customize this to your skin.
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Hello!
I had three questions:
Do you treat dermatitis of the scalp in people of color (I’m African American)? Does Dr. Ringpfeil see patients at every location or just at the Haverford location? Is there anyone in particular or at a particular location who is especially skilled in laser hair removal for brown skin?
Thank you!
1. Yes. All of our associates treat scalp dermatitis in skin of color all the time. At least 50% of our patients have a distinct ethnic background.
2. You can schedule an appointment with any of my associates in Haverford or Center City. I currently practice only at the Haverford office and my schedule is limited to my existing patients in order to maintain uncompromised quality. In case of clinical challenges, all of us put our heads together to devise the best treatment plan.
3. Hair removal on skin with a larger amount of pigment is carried out with the Nd:YAG laser because this laser does not damage the skin. We have Nd:YAG lasers in both the Center City and the Haverford office. All of our technicians undergo vigorous training for several months in the office on our lasers, even if they have operated lasers at other offices before. They are very qualified, if they pass the training and we then allow scheduling. In other words, if you chose laser hair removal online or by phone, you will only be scheduled with a very qualified technician.
My son is in his second semester of school at Temple University, moving there from Chicago. Since moving there his eczema had been full blown. When he returns home it clears up. I am sure that there is something environmental but i don’t know how to pin point it. He has a cream that will help his body, but it’s recently moved to his forehead. Is there anything that you can suggest to help. He has tried Hydrocortisone 10 an it is not working.
Atopic dermatitis (eczema) is indeed often tied to the environment and exacerbates with stress. Most people with atopic dermatitis will benefit from stress management, e.g. exercise, meditation or Yoga, in addition to meticulous hydration of the skin and topical medication with flares. If the over the counter medicine is not working because the skin became too inflamed, prescriptions might be needed. Please have seem see a dermatologist.
Hello. I have had eczema all my life (I am 26 yo now). I had bad flare-ups on my legs for several years as a child. Time and topical cremes have since healed the rashes, but they left behind extremely large, dark, scaly patches covering the full areas between my knees and ankles. I’ve had these for most of my life now, and they are very unsightly. Is there any way to even out these large patches of pih to make them look like normal skin?
Reducing post inflammatory hyperpigmentation after longstanding atopic dermatitis is not trivial, especially in areas most distal to center of our body. At the least, you should start with a regimen of lotions containing glycolic acid (Aqua glycolic) in the morning and cocoa butter (e.g. Palmers) at night. Other fading topicals can then be added if found appropriate during consultation. Additional modalities might include peels and microdermabrasion. Treatment with picolaser might be possible.
Hello. My son is 7 and has had eczema for 4+years. He is having the worst flair up ever. Along with patches all over of the dry skin. He has hardly slept due to itching and pain. I can not find a pediatric dermatology office. Do you care for children?
Yes, we provide pediatric dermatology services. Others in Philadelphia include Dr Treat and colleagues at Children’s Hospital of Philadelphia, Dr Patrice Hyde at Jefferson and Dr Roslyn Varki in Bryn Mawr and at Nemours.