By Andy Dean, PA-C
Twenty-fourteen has been pretty easy on us weather-wise so far, but the temperatures will soon drop. For most people, colder weather translates into drier skin, which can result in a mild “winter itch.” But for some, the itching can become so severe as to be distressing and can result in rashes. This is known as eczema.
While eczema has many forms, I would like to focus on two main types that we dermatology providers encounter most frequently this time of year: atopic dermatitis and nummular eczema.
About Atopic Dermatitis (AD)
Atopic dermatitis (AD) is a disease that usually shows up in early childhood, but can start at any age. (When most people say “eczema,” AD is what they’re referring to.) With AD, your skin doesn’t have the barrier function it is supposed to have, and this results in water getting out more easily, which may result in severe dryness. By the same token, things like bacteria, viruses and allergens can get into the skin more easily, making atopic patients much more prone to infections and allergic reactions. Most patients with AD develop allergies and asthma as well. It can occur all over the body, but the most commonly affected areas are the folds of the elbows and knees. The rash is very itchy and the skin typically looks red and thickened like tree bark.
AD Treatment Options
To treat bad flares of AD, we generally use topical steroids to decrease the immune system’s overreaction to the dry skin. (We are careful not to use them for too long, as they can thin your skin!) There are also non-steroidal topicals like Elidel and Protopic that are safer for maintenance and for milder outbreaks. Bleach baths can be helpful, especially if your skin is prone to infections. For very severe, resistant cases, in-office ultraviolet light treatments and certain pills can be used.
The Key to Prevention of AD
The key to prevention, however, is to keep the skin as moisturized as possible. Atopic patients typically can only use certain products because of their sensitive skin. The one we recommend the most is a cream called CeraVe, which gives your skin an excellent barrier. (It contains ceramides, which are fatty-acid-like molecules that help trap water; patients with AD generally don’t have as many ceramides in their skin as other people.) It’s best to apply it while the skin is damp, such as after the shower or bath, and pat dry. Take care to use lukewarm and not hot water. And it takes some time to rebuild that barrier for your skin, so we recommend giving CeraVe about a month to work. Other good moisturizers for AD are RestoraDerm (made by Cetaphil) and Vanicream. AD has no cure, so aggressive moisturization is an important thing for patients to do routinely.
About Nummular Eczema
Nummular eczema (also called nummular dermatitis or discoid eczema) is more common in adults. “Nummular” means coin-shaped (or disc-like/discoid), and the rash usually appears as round red scaly spots with a distinct border that is usually not seen in AD. Legs (especially lower legs) and arms are the most common places to see it, though it can appear in other places. It can frequently be mistaken for infections like ringworm or cellulitis. Like AD, it is usually very itchy, and the treatment is similar – topical steroids and diligent use of moisturizers.
We at KMC hope that you’ll spend more time enjoying the holidays with loved ones than struggling with itchy skin this winter. But if you are having trouble, it’s what we’re here for. Call us at 913-631-6330 to schedule an appointment.
Andy Dean, PA-C
Andy joined KMC in 2012 and has been practicing dermatology as a board-certified physician assistant since 2002. He sees patients at our Shawnee and Lawrence locations. Originally from Maryville, Missouri, Andy studied at Truman State University (Kirksville, MO) and received his master’s degree in physician assistant studies from Midwestern University (Downers Grove, IL). He is a diplomate of the Society of Dermatology Physician Assistants and is a fellow of the American Academy of Physician Assistants.