Doc: Nonmedical way to aid in eczema treatment

Keith Roach
To Your Health

Dear Dr. Roach: I have very bad eczema on both of my feet. I have been to several skin doctors and my family doctor, but none knows what the cause is. Doctors don’t even look at the rash any more. I find myself being prescribed a different cream each time, but none seems to help.

At the moment, I am using Cetaphil and clobetasol.

Is the cause really unknown? Is it common in people my age (I am 84)? Are there any home treatments to relieve the itching and burning?

L.F.

Dear L.F.: Atopic dermatitis, also called eczema, is indeed very common, with up to a 14 percent rate of prevalence in adults up to age 89. Although much is known about eczema, including some of the genes responsible, it isn’t easy to state the exact cause. Food allergies are important in some, and early exposure to allergens, including pets and farm animals, tends to decrease the likelihood of developing eczema.

First-line treatment includes skin moisturizers and topical steroids, both of which you are using (clobetasol is a powerful steroid). Although there are other prescription treatments, such as tacrolimus cream, you asked me about home remedies.

Avoiding damage to the skin is very important. This includes being careful not to overbathe or bathe in too-hot water and avoiding dry environments and harsh chemicals, such as detergents or solvents on the skin.

Emotional stress and anxiety are detrimental for eczema; while it’s impossible to remove stress entirely, behavioral treatments to help deal with stress can be very helpful when dealing with eczema.

People with eczema are more likely to have allergic skin responses, so I recommend using fragrance-free and dye-free products, such as soaps and laundry detergents as much as possible. I would be cautious with your moisturizers and use thicker creams rather than lighter lotions. Cetaphil and other companies make products specifically for people with eczema.

If itching is a significant problem, I would consider an antihistamine like Zyrtec, Claritin or Allegra. Changing diet can be helpful for some, but there is no specific diet proven to help people with eczema.

Dear Dr. Roach: My left hip bothered me, and I told my doctor. He did an X-ray, then called me and said I have a hip fracture. He sent me for an MRI. They read it and also said I had a hip fracture, and sent me to the orthopedic surgeon.

The surgeon redid the X-rays and looked at the MRI scan, and told me I do not have a fracture. He measured my legs and found that my left was 3/4-inch shorter than the right. He prescribed an insert into my left shoe, and I had no more pain.

L.L.

Dear L.L.: It is certain that some people have differences in the lengths of their legs and that sometimes this leads to symptoms. A relatively small difference such as yours usually is treated with a shoe or a shoe insert, usually by an orthopedic surgeon, podiatrist or physical therapist.

Often, but not always, this results in improvement of the symptoms.

What is surprising about your story is the initial findings of the X-ray and MRI scan. X-ray results certainly can be ambiguous, but the MRI is reported to have 100 percent sensitivity (that is to say, it shouldn’t miss a case).

One study showed that experienced radiologists have 100 percent specificity in reading a fracture, meaning there always is a fracture when they say there is, but less-experienced radiologists have “only” a 93 percent specificity.

It appears to me that your orthopedic surgeon was right and your radiologist wrong, since your symptoms got better.

Most cases of hip fracture are not subtle.

Email questions to ToYourGoodHealth@med.cornell.edu.