My Doctor Online The Permanente Medical Group

Causes

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The cause of eczema is not well understood. Eczema appears to develop as a result of interaction among environmental factors, your immune system, and heredity. People with eczema seem to have sensitive immune systems that are more likely to react to irritants and allergens.

Most people with eczema have a personal or family history of allergic conditions such as hay fever and asthma. The skin inflammation that causes eczema is considered a type of allergic response.

The following factors can trigger the itching and subsequent rash:

• Exposure to allergens, such as pollen, animal dander, or molds
• Exposure to irritants, such as soaps, wool, or chemicals
• Dry, cold winters
• Sudden changes in temperature
• Emotional stress
• Excessive washing

Certain foods cause eczema to worsen in some people. Studies show that 30 to 40 percent of people with moderate to severe eczema do have food allergies. If you notice a pattern of flare-ups associated with specific foods (e.g., cow's milk, eggs, or peanuts) please discuss this with us.

Symptoms

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Eczema symptoms flare up and then improve. The most common symptoms of eczema are dry, itchy skin and rashes. Scratching the skin may lead to the following symptoms:

• Redness
• Swelling
• Cracking
• Weeping clear fluid
• Crusting
• Thickening skin
• Scaling

The following complications can occur:

• Changes in skin color due to chronic scratching or rubbing of the skin. Skin may become lighter or darker. Once the eczema is under control, your skin color usually returns to normal.
• A skin infection caused by bacteria.

Call us if the rash looks infected. Symptoms of infection include:

• Increased redness and swelling, with tenderness or pain
• Red streaks and/or pus originating from the rash
• A fever of 100.4°F or higher

Diagnosis

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We will examine the appearance of your rash and ask questions about your symptoms and family history. We may advise you to be tested for allergies in order to determine what triggers the rash.

Treatments

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There is no cure for eczema. It can be managed with preventive measures and medicines. Treatment helps keep the rash from reoccurring and controls itching. Treatment may include the following:

Preventing dry skin. People with eczema often have difficulty retaining moisture in their skin. The condition gets worse in winter, when the heat is turned on and the humidity drops. There are other common causes of dry skin, like bathing too frequently or for too long, washing with drying soaps, and using hot water. These remove the natural moisturizers from the skin. To prevent dryness, we recommend the following:

• Take a bath or shower in cool to warm water for 10 to 15 minutes every day.
• Never use a wash cloth.
• Do not use drying soaps such as Ivory, Irish Spring, Coast, or Safeguard. Soaps with moisturizer are okay, and these include Dove, Oil of Olay, Neutrogena, or Basis. It is important to rinse thoroughly to remove all traces of soap.
• If you take a bath, talk to us first before adding anything to the water.
• Apply moisturizer or cortisone cream 2 to 4 times per day, alternating between moisturizers and cortisone creams.

Immediately after bathing, pat your skin dry gently (do not rub your skin). Apply medicine creams to the rash areas only. Do not put moisturizer on top of cortisone creams because it dilutes their potency. Petroleum jelly (such as Vaseline) keeps moisture in but does not have its own moisturizing properties. It may be used after a bath to trap the moisture on the skin. At other times of the day, moisturizers such as Aveeno, Cetaphil, Eucerine, or Lubriderm should be used because they work better for eczema.

Avoiding irritants. There are many substances outside the body that can cause the skin to become red, dry, or itchy. They include:

• Wool or other rough, scratchy clothing. (Wearing cotton is best.)
• Harsh chemicals, soaps, and bubble baths.
• Dust mites.
• Fabric softeners and static removers.

Avoid overheating your house and dressing too warmly. Perspiration can worsen eczema.

Avoiding allergens. These include animal dander, dust mites, pollen, and mold. It is important to dust and vacuum your home frequently using a special filter to control dust. If you have pets, keep them out of the bedroom.

Avoiding scratching. Secondary bacterial infections may be prevented by keeping fingernails trimmed and hands clean. Children or infants may require the use of mittens to keep them from scratching.

Medications

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Medicine may be necessary to heal your rash and relieve itching. The following medications may be used in the treatment of eczema:

Corticosteroids. Topical corticosteroids are most often used to treat eczema. They are available over-the-counter and in stronger prescription products. Apply directly to the skin until your rash clears up and to prevent flare-ups. Side effects, such as skin thinning and loss of effectiveness, are rare when used as prescribed. Oral corticosteroids may be used in severe cases for a limited period of time.

Antihistamines. These may alleviate itching. They are available by prescription or over-the-counter. Drowsiness is a side effect, so you may prefer to use them at night because they will help with nighttime itching and improve your ability to rest.

Topical calcineuron inhibitors (TCIs). TCIs include Elidel (pimecrolimus) and Protopic (tacrolimus). They are topical creams that are also used to treat eczema. They are not steroids so they do not have steroid side effects. It is common for these drugs to burn for the first few days, but as the rash improves this becomes less of a problem. They are sometimes used when steroid creams are not helping or are causing side effects.

Antibiotics. If your rash becomes infected, we may prescribe antibiotics. Be sure to take them exactly as directed and for as long as prescribed.

Coping and Support

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In addition to your treatment plan and doctor's recommendations, the following tips may improve results:

• Behavior modification techniques may reduce scratching and improve use of medications and moisturizer, which will allow your skin to heal.
• Participation in a support group, camp, or conference for people with eczema can provide emotional support.
• Identifying ways to relieve stress can have a positive effect on your eczema and your life.

Your Care with Me

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If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

Before your first office visit, we need for you to complete an Allergy new patient questionnaire. This will be provided by your personal physician when she or he schedules our visit. It is also available online, or you may arrive 15 minutes early and complete the form before your appointment.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

During your first appointment, I will ask you questions about your medical history and do a physical exam. I will review any lab tests ordered by your personal physician and order any further tests that may be necessary to complete a thorough diagnosis. You may not need an allergy test.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.
  

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