Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
To diagnose eczema, doctors rely on a thorough physical examination of the
skin as well as the patient's account of the history of the condition. In
particular, the doctor will ask when the condition appeared, if the condition is
associated with any changes in environment or contact with certain materials,
and whether it is aggravated in any specific situations. Eczema may have a
similar appearance to other diseases of the skin, including infections or reactions to certain medications, so the diagnosis is not always
simple. In some cases, a biopsy of the skin may be taken in order to rule out other skin diseases that may be producing signs and symptoms similar to
eczema.
If a doctor suspects that a patient has allergic contact dermatitis,
allergy
tests, possibly including a skin "patch test," may be carried out in an attempt
to identify the specific trigger of the condition.
There are no laboratory or blood tests that can be used to establish the
diagnosis of eczema.
What is the treatment for eczema?
The goals for the treatment of eczema are to prevent
itching, inflammation, and worsening of the condition. Treatment of eczema may
involve both lifestyle changes and the use of medications. Treatment is always
based upon an individual's age, overall health status, and the type and severity of the
condition.
Keeping the skin well hydrated through the application of creams or ointments (with a low water and high oil content) as well as avoiding over-bathing (see "Can eczema be prevented?" section) is an important step in treatment. It is recommended to apply emollient creams such as petrolatum-based creams to the body immediately after a five-minute lukewarm bath in order to seal in moisture while the body is still wet. Lifestyle modifications to avoid triggers for the condition are also recommended.
Corticosteroid creams are sometimes prescribed to decrease the inflammatory
reaction in the skin. These may be mild-, medium-, or high-potency
corticosteroid creams depending upon the severity of the symptoms. If itching
is severe, oral antihistamines may be prescribed. To control itching, the
sedative type antihistamine
drugs (for example, diphenhydramine
[Benadryl], hydroxyzine
[Atarax, Vistaril], and cyproheptadine) appear to be most effective.
In some cases, a short course of oral corticosteroids
(such as prednisone) is prescribed to control an acute outbreak of eczema, although their long-term use
is discouraged in the treatment of this non life-threatening condition because
of unpleasant and potentially harmful side effects. The oral immunosuppressant drug
cyclosporine has also been used to treat some cases of eczema. Ultraviolet light
therapy (phototherapy) is another treatment option for some people with
eczema.
Finally, two topical (cream) medications have been approved by the U.S. FDA
for the treatment of eczema: tacrolimus (Protopic) and
pimecrolimus (Elidel). These drugs belong to a class of immune suppressant drugs known as calcineurin inhibitors and are indicated only in patients over 2 years of age. In January 2006, the FDA issued a black box warning stating the long-term safety of calcineurin inhibitors has not been established. Although a causal relationship has not been established, rare cases of malignancy have been reported with their use. It is recommended that these drugs only be used as second-line therapy for cases that are unresponsive to other forms of treatment and that their use be limited to the minimum time periods needed to control symptoms. Use of these drugs should also be limited in people who have compromised immune systems.
The word "rash" means an outbreak of red bumps on the body. The way people use this term, "a rash" can refer to many different skin conditions. The most common of these are scaly patches of skin and red, itchy bumps or patches all over the place.
Hives, also called urticaria, is a raised, itchy area of skin that is usually a sign of an
allergic reaction. The allergy may be to food or medications, but usually the
cause of the allergy (the allergen) is unknown.
Cellulitis is an acute spreading bacterial infection below the surface of the skin characterized by redness, warmth, inflammation, and pain. The most common cause of cellulitis is the bacteria Staph (Staphylococcus aureus).
Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching to include: infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.
Heat rash is a skin irritation caused by excessive sweating. It can occur at any age and it appears as a rash that itches or feels prickly, and looks like a red cluster of pimples or small blisters. Pictures of heat rash are included.
Rosacea is a skin disease that causes redness of the forehead, chin, and lower half of the nose. In addition to inflammation of the facial skin, symptoms include dilation of the blood vessels and pimples (acne rosacea) in the middle third of the face. Oral and topical antibiotics are treatments for rosacea. If left untreated, rhinophyma (a disfiguring nose condition) may result.
Impetigo is a contagious skin infection caused by staph and strep bacteria. There are two types of impetigo: non-bullous and bullous. Symptoms of non-bullous impetigo include small blisters on the nose, face, arms, or legs and possibly swollen glands. Bullous impetigo symptoms include blisters in various areas, particularly in the buttocks area. Treatment involves gentle cleansing, removing the crusts of popped blisters, and the application of prescription-strength mupirocin antibiotic ointment.
The most common food allergies are to eggs, nuts, milk, peanuts, fish, shellfish, strawberries and tomatoes. Symptoms and signs include nausea, vomiting, diarrhea, abdominal pain, itching, hives, eczema, asthma, lightheadedness, and anaphylaxis. Allergy skin tests, RAST, and ELISA tests may be used to diagnose a food allergy. Though dietary avoidance may be sufficient treatment for mild allergies, the use of an Epipen may be necessary for severe food allergies.
Asthma is a common disorder in which
chronic inflammation of the bronchial tubes (bronchi) makes them swell, narrowing the airways. Signs and symptoms include shortness of breath, chest tightness,
cough and wheezing.
Tinea versicolor is a fungus infection that mainly affects the skin of young people. Recognized by light or reddish brown spots, and areas lighter than the surrounding skin. Tinea versicolor is caused by yeast actually found in our skin. Factors like heat, humidity, and sweat help it proliferate in people, resulting in a rash that is not contagious to others.
An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
Keratosis pilaris (KP) is a common skin disorder in which small white or red bumps appear around hair follicles on the upper arms, thighs, buttocks, and cheeks. The cause of KP is unknown. There is no cure for keratosis pilaris, and the condition may resolve on its own. Gentle exfoliation, professional manual extraction, chemical peels, and microdermabrasion, along with topical products, are the best treatments for this condition.
Eye allergy (or allergic eye disease) are typically associated with hay fever and atopic dermatitis. Medications and cosmetics may cause eye allergies. Allergic eye conditions include allergic conjunctivitis, conjunctivitis with atopic dermatitis, vernal keratoconjunctivitis, and giant papillary conjunctivitis. Dry eye, tear-duct obstruction, and conjunctivitis due to infection are frequently confused with eye allergies. Eye allergies may be treated with topical antihistamines, decongestants, topical mast-cell stabilizers, topical antiinflammatory drugs, systemic medications, and allergy shots.
Mercury is a naturally occurring element found in water, soil, and the air. Mercury is also contained in some fish, some of the products we use in the home, school, or dentist. Information about sources of mercury exposure, potential health effects, symptoms of exposure, fish that may contain mercury, consumer products that contain mercury, and ways to reduce your exposure to mercury is important for the health of you, and your family.
Dandruff (seborrhea) is a skin disorder that results from neither too much moisture nor too much oil. Dandruff can be treated with shampoos that contain tar, salicylic acid, zinc, selenium sulfide, or ketoconazole.
Asthma, the main cause of chronic illness in children, has signs and symptoms in children that include frequent coughing spells, low energy while playing, complaints of chest "hurting," wheezing while breathing, shortness of breath, and feelings of tiredness. Treatment will involve a doctor creating an asthma action plan which will describe the use of asthma medications and when to seek emergency care for the child.
Birthmarks and other abnormal skin pigmentation is caused by the body's inability to produce enough melanin. Abnormal skin pigmentation can cause conditions such as vitiligo, pigmentation loss, melasma, albinism, port wine stains, macular stains and hemangioma.
Poison ivy, oak, and sumac are plants that cause an itchy skin rash and skin inflamation when contacted directly. This poison can be treated with medications such as calamine lotion and cortisone drugs.
Sunburn is caused by overexposure to UV radiation from the sun. UV rays can also damage the eyes. Repeated overexposure to UV rays also increases the risk for scarring, freckles, wrinkles, and dry skin. Symptoms of sunburn include painful, red, tender, and hot skin. The skin may blister, swell, and peel. Sun poisoning (severe sunburn) include nausea, fever, chills, rapid pulse, dizziness and more. Treatment for sunburn depends upon the severity. Sun protection and sunscreen for an individual's skin type is recommended to decrease the chance of sunburn.
Common sources of indoor allergens include dust mites, cockroaches, molds, pets, and plants. Managing allergies caused by indoor allergens means reducing your exposure to them.
Fragrances and preservatives in cosmetics may cause allergic reactions in some people. Symptoms include redness, itching, and swelling after the product comes in contact with the person's skin. Treatment typically involves the use of over-the-counter cortisone creams.
Occupational asthma is a type of asthma caused by exposure to a substance in the workplace. Symptoms and signs include wheezing, chest tightness, and shortness of breath. The usual treatment for occupational asthma involves removal from exposure and the use of bronchodilators and inhaled anti-inflammatory medicines.
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