Eczema or Chapped, Dry Skin?
By Lisa Glickstein, Ph.D, Triplet Mom
Originally printed in February, 2006

Winter is upon us and along with it comes dry, itchy skin.  Yuck!  For most 
of us, with a little extra exfoliation and lotion, we can cope until the 
April thaw.  But some children and adults suffer with red, scaly skin as a 
year-round condition.  They may have a condition known as eczema.

Why does skin dry out so much faster in the winter months?
The colder the air, the less water can be held in it.  Plus, we heat our homes 
with gas, oil, or wood-burning heaters that further dry out the air.  Winter 
air therefore tends to be drier.  Since the trees and grasses are dormant and 
not producing the allergenic pollens, and the dry air doesn’t allow as 
much growth of molds, this can be a good thing for allergy sufferers.  
Our bodies consist mostly of water, though, and it is the job of the skin 
to hold most of the moisture in and to keep most of the germs out.  As the 
air gets drier, water evaporates from the skin faster and can’t be replaced 
at the same rate.  The normal skin oils that also help slow down evaporation 
are removed with soaps.  This leads to the skin drying out and in extreme 
cases can lead to chapping and even cracking.

Why does skin itch?
Itching is a type of nerve stimulation that can be caused by two different 
mechanisms.  Itching is actually the first signal to the body of damage, 
before the pain threshold is reached.  This type of itching is typically 
felt in the winter months as a result of dry skin, but can also be experienced 
with a wound healing, or due to poor circulation in the legs due to varicose 
veins or diabetic complications.

Another type of itching, usually more intense, is associated with allergic 
reactions and is caused by the release of histamines by specialized cells 
called “mast cells” into the skin.  This can be triggered after an insect 
bite if you are sensitized to the insect’s saliva, by contact with an 
allergen (e.g. peanut butter, or poison ivy) to which you are allergic, or 
by contact with some chemicals (e.g. laundry detergent) if you are sensitive.  
This type of itching is normally accompanied by swelling and redness – in the 
form of a typical bug bite, clusters of bumps called “hives,” or a diffuse 
rash, depending on the person, the cause, and the severity of the allergy or 
sensitivity.

What is eczema?
Eczema is a group of related conditions that together are typified by dry, 
red, scaly, itchy skin.  It can occur over large areas or in smaller 
patches.  It is not the same as dry skin, but is more likely to occur 
where skin is washed frequently or is dry.  If scratching is not controlled, 
eczema lesions can become infected when bacteria are introduced directly by 
fingernails, or indirectly by contact through open sores or scratches.

One group of eczema conditions is not associated with allergy or contact 
sensitivity.  This includes cradle cap in infants, and adult eczema associated 
with skin yeast infection or diabetic or varicose circulatory problems.  
Cradle cap is usually not itchy, and infants normally grow out of it in a 
few months.

Most eczema is associated with allergy or chemical sensitivity.  Cases in 
which the skin reaction is the only manifestation of the allergy are usually 
easier to treat.  If eczema is associated with asthma or food allergies, 
the disease can be more pernicious and treatment can be more difficult.

How is eczema treated?
If eczema lesions become infected, it is important to see a doctor so that 
they can be treated promptly with antibiotics (by mouth or applied directly).  
Eczema does not usually “weep” – that is a sign that bacteria have taken 
up residence in the skin.  Other signs may be a change in color, swelling 
of the lesion, and pain.

Curing the infection or improving the circulation treats non-allergic 
eczema in adults.

Treatment of allergic eczema is three-pronged: 1) avoidance of the allergen 
or chemical, 2) calming of inflammation with steroid creams (or less often 
with anti-histamines such as Benadryl), and 3) protecting the skin with 
occlusive (blocking) or emollient (moisturizing) creams.  Particularly in 
infants or children, an allergic cause should be sought with the help of 
an allergist.  It may be a food such as eggs, wheat, dairy, soy, tree nuts, 
or peanuts.  It may simply be a laundry detergent, perfumed lotion, scented 
wipe or diaper, or pet hair or dander.  If a cause can be identified, the 
food or product should be avoided.  A steroid cream can obtained over the 
counter, or a stronger formulation by prescription, and should be used 
according to the doctor’s direction.  Over the counter steroid creams should 
not be used on infants without first speaking with the pediatrician.  
Unscented emollient or occlusive creams can be used on the lesions and 
other skin to reduce evaporation and dryness, and to protect it.  Again, 
in mild cases products can be obtained over the counter, and should be labeled 
as hypoallergenic (and unscented).  In more severe cases a doctor should be 
consulted.  Medical grade lanolin, such as Lansinoh, is extremely occlusive 
and may be helpful for patchy eczema, particularly on the cheeks or hands 
that receive a lot of washing.

Where can I get help with my or my child’s eczema?
The first step should be your primary care physician or pediatrician.  
Particularly in adults with non-allergic eczema, or a small, localized 
lesion on a hand from contact with detergent, the primary care doctor can 
rule out or treat any other conditions and prescribe treatment with prescription 
or even over the counter medications.  The next step for an adult patient 
might be either an allergist, particularly if asthma or food allergy is suspected, 
or a dermatologist if another condition is to blame.  For a child, mild eczema 
may be diagnosed and treated by the pediatrician.  If food allergies or 
asthma are involved or suspected, a consult with a pediatric allergist is 
highly recommended.

What is the prognosis of eczema?
The goal of treatment is to 1) treat any infections, 2) reduce inflammation, 
and 3) treat dry skin so that inflammation does not recur.  Non-inflamed 
lesions resolve slowly over time.  In children, most eczema resolves by 
the mid-teens.  In adults with yeast infection prognosis is excellent, 
while in patients with diabetes success can be more variable.  If food 
or contact triggers are avoided, eczema is substantially reduced but may 
be recurrent throughout life.