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For most people, eczema is an irritating, annoying inconvenience. For some, however, it can be much more challenging.

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Dear Readers:

In January, we began a discussion on non-contagious skin rashes by looking at contact dermatitis. We looked at how frequent unprotected exposure to harsh chemicals or conditions can lead to contact irritant dermatitis, and how Type IV allergies (for instance, to nickel or latex) can lead to contact allergic dermatitis. Most importantly, we concluded that the implications for massage are relatively simple: Be sure the skin is intact and that no triggers for skin reactions are in massage lubricants.

In this issue, we will take on a more complex non-contagious skin rash: eczema. For most people, eczema is an irritating, annoying inconvenience. For some, however, it can be more challenging:

"When I have an outbreak of the red, crusty and swollen eruptions, which is to say, nearly all the time, everyone knows it. My forehead is particularly bad. There I get dry, red, crusty patches. When it gets really bad, it erupts into scabs.

"I get questions and stares on a regular basis. Kids are especially awed. When kids stare at me, I want to say, 'No, I'm not the Creature from the Black Lagoon, but I did meet him once at an autograph signing.' Or, puffing out my chest and striking a suitably heroic cartoon pose: 'Not to fear, young man, I am Eczema Boy, and I defeat evildoers by hypnotizing them with my incessant scratching and picking! Step back, there's some radioactive ooze now!' But, of course I don't. I just pretend I don't see them staring."

- Ben A. Shaberman, "The Further Ad-ventures of Eczema Boy." The Washington Post. Washington, D.C.: July 11, 2000:Z10.

What Is Eczema?

Eczema, from the Greek ekzeo (to boil over), is a fairly common condition that affects about 10 percent to 20 percent of infants and young children, and about 15 million adults. While it was once considered a fairly simple, if poorly understood, skin rash, eczema turns out to be a complex immune system disorder with many overlapping factors. Symptoms are brought about by a combination of many factors, including fatty acid deficits with damage to the protective lipid layer that helps keep skin waterproof; T-cell abnormalities; and the presence of damaging amounts of pro-inflammatory chemicals and antibodies.

Although eczema clearly is related to immune system problems, it can cause reactions to very minor triggers, including a rapid change in temperature, rough textures in clothing, over-exposure to sunlight, detergents, sweating and others. Eczema's relationship to other allergies is easily demonstrated: The vast majority of patients either have severe hay fever and/or asthma, or they have family members who do.

Types of Eczema

Several different types of eczema have been identified. Some of these can be tricky, because they resemble other skin conditions that may be contagious. This is yet another reason why massage therapists shouldn't touch skin anomalies they haven't discussed with their client first!

Atopic dermatitis: This is the most common variety of eczema. It is usually red, flaky and dry, occurring in the creases on the sides of the nose and other skin creases, like knees, elbows, ankles and hands. When the skin gets rough and thick, this is called lichenification.

Seborrheic eczema: This form of eczema involves yellowish, oily patches, usually in the skin folds around the nose or on the scalp.

Dyshidrosis: In this condition, intensely itchy blisters filled with fluid appear on the hands and feet. It is of particular interest to massage therapists for two reasons: It resembles athlete's foot, a contagious condition, and it involves breaks in the skin - possible portals of entry for infection.

Nummular eczema: This form of eczema appears in small circular lesions, often on the legs and buttocks. It looks just like ringworm, another contagious condition, and it can be intensely itchy.

How Is Eczema Treated?

Mild cases of eczema often can be treated successfully with careful choices about skin triggers; mild soap, well-tolerated emollients, and gentle textures may be all that some people need. Essential fatty acid supplements that help to strengthen the lipid layer in the skin also might be recommended. If food-related triggers can be identified, then these must also be avoided, of course.

More severe cases may be treated medically with topical or systemic anti-histamines or steroidal anti-inflammatories. Steroids have serious long-term side effects, however, and ultimately lead to more skin damage, so they are temporary solutions at best.

One new development in the treatment of this kind of immune system overreaction is a group of drugs called topical immunomodulators. Originally designed to help limit tissue rejection for organ recipients, some of these have been re-purposed for skin problems with significant success. In adults, they can help clear up the signs of eczema without long-term skin damage. In children, however, they have been linked with a low but significant risk for developing some types of cancer, so they are being watched carefully.

Massage

The key question for massage and this type of non-contagious rash is whether the skin is intact. If no breaks, cracks, scabs or oozing is present, massage with a soothing, non-irritating lotion or oil can be extremely helpful. It is important to take care not to increase itching at affected areas, of course. Although it won't change the way this hyperactive immune system behaves, massage may at least offer some temporary relief from the discomfort and frustration that this stubborn condition can cause.

Mr. Shaberman documented his experiences with eczema in a series of articles in The Washington Post, starting here: www.shaberman.com/eczemaboy_post.htm. His last piece was on his experience in clinical trials using a topical immunomodulator, which cleared up his eczema in a period of two weeks.

Next Time

It's up to you, readers! We can keep going with skin conditions (tell me which ones you'd like to learn more about), or we can pick up something new. Let me know: What's on your table?

Many thanks and blessings.

Resources

1. "American Academy of Dermatology Issues Statement in Response to FDA Decision Related to Two Eczema Medications." 2006 American Academy of Dermatology. www.aad.org/public/News/NewsReleases/fda_decision.htm.
2. Eczema/Atopic Dermatitis. 2006 American Academy of Dermatology. www.aad.org/public/Publications/pamphlets/
   EczemaAtopicDermatitis.htm.
3. FDA Public Health Advisory on
   Elidel (pimecrolimus) cream and Protopic (tacrolimus) ointment. FDA/Center for Drug Evaluation and Research. www.fda.gov/cder/drug/advisory/elidel_protopic.htm.
4. Krafchik, Bernice R. Atopic Dermatitis. http://emedicine.com/derm/topic38.htm.
5. Shaberman, Ben A. "Coping with Skin Disease." American Academy of Dermatology, 2000. www.aad.org/DermInsights/Fall2000/COPING.html.
6. Shaberman, Ben A. "Eczema Boy: The Final Chapter?" www.shaberman.com/eczema_boy_final_chapter.htm.
7. Shaberman, Ben A. "The Further Adventures of Eczema Boy." www.shaberman.com/eczemaboy_post.htm.
8. "Topical Immunomodulators Prove Effective in Treating Eczema Patients Itching for Some Relief." 2006 American Academy of Dermatology. www.aad.org/public/News/NewsReleases/Press+Release+
   Archives/Skin+Conditions/topical.htm.