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Eczema

What is eczema?

Eczema is a common skin condition marked by itchy and inflamed patches of skin. It’s also known as atopic dermatitis. It is more common in babies and young children, and often occurs on the faces of infants. It also often appears inside the elbows and behind the knees of children, teenagers, and adults.

In rare cases, atopic dermatitis can first appear during puberty or adulthood. It affects males and females equally.

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Pictures

Pictures of eczema

Types

What are the types of eczema?

When people refer to eczema, they usually mean atopic dermatitis. This is the common and chronic type of eczema. Other types include:

  • Contact dermatitis is caused by contact with irritants. Burning, itching, and redness occur. The inflammation goes away when the irritant is removed.
  • Dyshidrotic dermatitis affects fingers, palms of the hands, and soles of the feet. It causes itchy, scaly patches of skin that flake or become red, cracked, and painful. The condition is more common in women.
  • Nummular dermatitis causes dry, round patches of skin in the winter months. It usually affects the legs. It is more common in men.
  • Seborrheic dermatitis causes itchy, red, scaly rashes, particularly on the scalp, on the eyebrows, on the eyelids, on the sides of the nose, and behind the ears.
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Symptoms

What are the symptoms of eczema?

Eczema is characterized by itchy, dry, rough, flakey, inflamed, and irritated skin. It can flare up, subside, and then flare up again. It can occur anywhere but usually affects the arms, inner elbows, backs of the knees, or head (particularly the cheeks and the scalp). It is not contagious and becomes less severe with age.

Red or brownish-gray patches are common symptoms. Small, raised bumps that ooze fluid when scratched are another symptom. Scratching causes them to become crusty, which can signal infection. Thickened, scaly skin is another symptom.

Eczema can cause intense itching. Scratching further irritates and inflames the skin. This can cause infections that must be treated with antibiotics.

Causes

What causes eczema?

The cause of eczema is not fully understood. But it is thought to be triggered by an overactive immune system that responds aggressively to the presence of irritants.

Eczema is sometimes caused by an abnormal response to proteins that are part of the body. Normally, the immune system ignores proteins that are part of the human body and attacks only the proteins of invaders, such as bacteria or viruses. In eczema, the immune system loses the ability to distinguish between the two, which causes inflammation.

An eczema flare-up is when one or more eczema symptoms appear on the skin. Common triggers of eczema flare-ups include:

  • chemicals found in cleaners and detergents that dry out the skin
  • rough scratchy material like wool
  • synthetic fabrics
  • raised body temperature
  • sweating
  • temperature changes
  • sudden drop in humidity
  • stress
  • food allergies
  • animal dander
  • upper respiratory infections
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Risk factors

What are the risk factors of eczema?

Several factors can increase the risk of developing eczema.

Eczema is more common in children who suffer from asthma or hay fever, or adults who develop these conditions later, usually before the age of 30.

People with family members who have eczema are also at higher risk of developing the condition.

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Diagnosis

How is eczema diagnosed?

To diagnose eczema, a doctor will order a complete physical exam and ask you questions about your symptoms.

There’s no specific test that can be used to diagnose eczema. But a patch test can pinpoint certain allergens that trigger symptoms, like skin allergies associated with contact dermatitis (a type of eczema).

During a patch test, an allergen is applied to a patch that is placed on the skin. If you are allergic to that allergen, your skin will become inflamed and irritated.

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Treatment

How is eczema treated?

A dermatologist, allergist, or primary care physician can help you identify the correct treatment for eczema. Some options include:

Medications

Oral over-the-counter (OTC) antihistamines may relieve itching. They work by blocking histamine, which triggers allergic reactions. Examples include:

Several antihistamines can cause drowsiness and should be taken at night.

Cortisone (steroid) creams and ointments relieve itching and scaling. But they should not be used long-term because of side effects, which include:

  • thinning of the skin
  • irritation
  • discoloration

Low-potency steroids like hydrocortisone are available over the counter. High-potency steroids may help people who don’t respond to low-potency steroids. In severe cases, a doctor may prescribe oral corticosteroids. These can cause serious side effects including bone loss.

If there is an infection, a doctor may prescribe a topical or oral antibiotic.

Immunosuppressants are prescription medications that prevent the immune system from overreacting. This prevents flare-ups of eczema. Side effects include an increased risk of developing cancer, high blood pressure, and kidney disease.

Therapies

Light therapy, or phototherapy, uses ultraviolet light or sunlamps to help prevent immune system responses that trigger eczema. It requires a series of treatments, and can help reduce or clear up eczema. It can also prevent bacterial skin infections.

Lifestyle changes

Stress can trigger or exacerbate symptoms. Ways to reduce stress include:

  • doing deep breathing exercises
  • practicing yoga
  • meditating
  • listening to relaxing music
  • prioritizing a good night’s sleep

A cold compress can help alleviate itching, as can soaking for 15 to 20 minutes in a warm or lukewarm bath.

Alternative treatments

Alternative treatments may help calm the symptoms of eczema. Because of potential side effects, always check with your doctor before using an herbal supplement or beginning an exercise routine. Popular home remedies include:

  • green, black, or oolong tea
  • coconut, sunflower, borage, and primrose oils
  • acupuncture
  • aromatherapy
  • relaxation techniques like meditation, yoga, progressive muscle relaxation, or guided imagery

Prevention

How is eczema prevented?

Lifestyle changes such as stress reduction and improved sleep can reduce the likelihood of an eczema flare-up. Avoid irritants like rough fabrics, harsh soaps, and detergents. Cold weather can also dry out the skin and trigger flare-ups.

People with atopic dermatitis should avoid scratching. To prevent breaking the skin, it can help to rub rather than scratch the areas that are itchy.

Because dry skin can trigger an eczema flare-up, a dermatologist can recommend an ointment- or cream-based moisturizer that will help soothe your skin.

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Outlook

What is the outlook for eczema?

There is no cure for eczema. In some cases, eczema can cause additional health complications.

Skin infections such as impetigo are brought on by constant itching. When scratching breaks the skin, bacteria and viruses can enter. Symptoms include:

  • redness
  • pus-filled bumps
  • cold sores
  • fever blisters

If these symptoms appear, contact a doctor.

Neurodermatitis is also caused by frequent itching. It leaves skin thickened, red, raw, and darker in color. This is not a dangerous condition but may result in permanent discoloration and thickening of skin even when eczema is not active. Scratching can also cause scarring.

Many people with eczema report feeling embarrassed and self-conscious about their skin. Receiving proper treatment and getting stress under control can help calm symptoms. Support groups can also help people cope.

Vigorous exercise can be difficult for people with eczema because sweating can bring on a bout of itching. Dress in layers so you can cool down while exercising. You may also want to avoid intense physical activity during an eczema flare-up.

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