Index
It is also known as atopic dermatitis, it is a type of chronic inflammation of the skin (ongoing or recurrent).
People with eczema have dry and irritable skin.
The normal protective barrier of the skin is not effective in many people with eczema, and this allows substances to enter and irritate the skin.
Also, itching and scratching contribute to skin damage and inflammation.
While there is no cure for eczema, there are treatments that can reduce symptoms and prevent flare-ups.
You can take care of your eczema by protecting your skin barrier with moisturizers , avoiding skin irritants, triggers, and lastly, treating breakouts right away with medicated creams or ointments.
Eczema is particularly common in babies, and it is estimated that 10 to 20 percent of children have eczema. Eczema often gets better on its own with age.
Although most children outgrow eczema, for adults who continue to suffer, it is a serious condition.
Eczema in adults is a chronic condition consisting of itchy, red, and inflamed patches on the skin that can erupt in oozing outbreaks.
Different areas of the body can be affected by adults, such as the face, hands, and even the eyelids.
Itching in adults can be excruciating, as an outbreak can affect the skin all over the body.
There are treatments and medications that can help control the itching and pain caused by eczema.
It is not common to develop eczema after the age of 60. If it occurs, it usually has to do with a more serious underlying medical condition and you should see your doctor.
Causes
An eczema comes and goes over time.
It normally develops on very dry and sensitive skin and can be made worse by exposure to many different things, including allergens like pet dander or dust mites.
Other common triggers include strongly fragranced soaps, detergents, and lotions. Exposure to perfumes and cleaning products can also irritate eczema.
For some people, changes in the weather (especially dry winter air) make eczema worse. Eczema is not contagious and is often hereditary.
About 60 percent of people with eczema will experience symptoms before they are 1 year old, and another 30 percent will experience symptoms before age 5.
Children born to families with a history of allergic diseases such as asthma or hay fever are at increased risk of developing eczema. Eczema is considered part of the “atopic march.”
Atopic march involves the diagnosis of eczema, food allergy, allergic rhinitis, and asthma, usually in that sequential order.
Studies show that up to 80 percent of children with eczema develop asthma or allergic rhinitis later in childhood.
Eczema symptoms
Eczema symptoms include:
- A red rash or patches of skin, especially within the creases of the elbows and knees.
- Itch.
- Dry skin, which can crack and possibly bleed.
The location of the eczema can change with age.
In infants and young children, eczema is usually located on the cheeks, outside of the elbows, and on the knees.
In older children and adults, eczema is typically on the hands and feet, the arms, and the back of the knees.
Symptoms can be painful, cause skin color changes, and blisters.
The itching associated with eczema can be severe, often disrupting sleep.
Scratching the skin can lead to infection.
Babies with eczema can rub against bedding or other things to relieve itchiness.
Types
Itchy skin is a fairly common occurrence, which most of us have suffered from at some point.
One of the most prominent forms of this disorder is a condition characterized by skin that becomes red, itchy, dry, and flaky.
There are many different types of eczema that a person can suffer from. These include:
Atopic dermatitis
This type of Eczema is chronic and inflammatory.
While the exact cause of this disorder is unknown, atopic dermatitis occurs when the immune system goes into overdrive.
Some of the common symptoms of atopic dermatitis include:
- Dry and flaky skin
- Redness of the skin.
- Itch.
- Cracks behind the ears.
- Rashes on the cheeks, arms and legs.
- Open, crusted, or watery sores.
Contact dermatitis
This particular disorder occurs when the skin comes into contact with irritants or allergens .
These cause the skin to become inflamed and burned, itchy, and red.
There are two forms of contact dermatitis. These include:
- Irritant dermatitis.
- Allergic dermatitis.
The most common forms of irritants include solvents, detergents, fumes, tobacco smoke, paints, bleach, wool, acidic foods, alcohol-containing skin care products, and certain soaps and fragrances.
Symptoms of contact dermatitis include:
- Redness and rashes.
- Burning or swelling
- Blisters that may weep or crust over.
Eczema dishidrótico
This condition causes small, itchy blisters on the edges of the patient’s fingers, toes, palms, and soles of the feet.
This type of itching disorder can be caused by stress, allergies, wet hands and feet, exposure to metals such as nickel, cobalt, or chromium salts.
This type of Eczema is much more common in women.
Symptoms of dyshidrotic eczema include:
- Small fluid-filled blisters on the fingers, hands, or feet.
- Itch.
- Redness
- Peeling of the skin
- Flaky and cracked skin
- Pain.
Hand eczema
This form of eczema is very common and is a combination of internal and external factors, which will include genetics and also contact with allergens or irritants such as chemicals.
Some of the symptoms of hand eczema include:
- Redness
- Itch.
- Pain.
- Dryness to the point of flaking.
- Cracks in the skin.
- Blisters
Neurodermatitis
Also known as lichen simplex chronicus, this condition is an itchy skin disease that is similar to atopic dermatitis.
Patients suffering from this condition suffer from thick, scaly patches on the skin, which arise as a result of excessive rubbing and scratching of the area.
Symptoms of neurodermatitis include:
- Thick, scaly patches on the back of the neck, on the scalp, the back of the shoulders, on the bottom of the feet, as well as on the ankles, wrists, and the back of the hands.
- Itch.
- Hyperpigmentation (lichenification).
Diagnosis of eczema
The allergists are specially trained to treat skin conditions such as eczema, which are often associated with an allergic response.
They will likely ask you questions about the types of soap, detergent, and skin care products you use, and about any other exposures that may make your eczema worse.
Skin prick tests may be performed, which involve applying a diluted allergen with a prick to the surface of the skin.
The allergist watches the tested area for about 15 minutes to see if a lump (welt) or redness (flare) develops.
The test is usually done on the back or forearm in adults and on the back in children, with several allergens tested at once.
The findings help develop a treatment plan for your individual condition.
The goal will be to allow you to lead a life as normal and without symptoms as possible.
Possible allergic triggers for eczema can be determined and treatment suggestions offered to help relieve symptoms.
33 to 63 percent of young children with moderate to severe eczema also have food allergies.
It is recommended that children under 5 years of age with moderate to severe eczema be screened for allergies to milk, eggs, peanuts, wheat, and soy, if the child continues to have eczema even after treatment.
Testing is also recommended when the child has a history of reaction after eating a specific food.
An allergist can help you identify which foods, if any, to eliminate from your child’s diet.
Treatment and management
Children and adults diagnosed with eczema can manage the condition with the help of an allergist.
In cases of moderate or severe eczema, an allergist may recommend prescription medications, including topical steroids or antihistamines.
Milder cases can be treated with ointments like petroleum jelly and moisturizers.
Those should be applied daily, even when skin appears clear, to help prevent dryness.
People with eczema should avoid harsh cleansers, drink water frequently, wear gloves in cold weather, and avoid using materials such as wool, which could irritate the skin.
Eczema flare-ups can be caused by food, cosmetics, soaps, wool, dust mites, mold, pollen, cat or dog dander, dry weather, and other variables.
If you have a baby with eczema, your allergist may advise you to bathe him at least once a day and immediately apply moisturizer after the bath.
Limited use of pH balanced skin cleansers should also be part of a frequent bath, along with a gentle dry massage, and immediate application of a moisturizer to “lock in” moisture.
This technique is called “soak and spread” and it can provide relief from the itchiness that accompanies eczema.
Allergens
It is important to try to avoid anything that tends to aggravate your eczema.
Common environmental irritants include:
- Soaps
- Bubble bath.
- Shampoo.
- Solvents
- Lana.
- Nylon.
- Grass.
- Arena.
Common allergens (substances that can aggravate eczema if you are allergic to them) include:
- Poland.
- House dust mites .
- Animal dander (small scales from the skin and hair of animals).
- Certain foods
Overheating can also make your eczema worse and should be minimized. Always bathe in cool water, rather than hot.
In winter, turn down the heater and don’t use an electric blanket. Air conditioning and fans are useful during the summer.
Soaps
Regular soap is alkaline and can further dry out your skin.
Soap and detergent-based shampoos should be avoided, and soap and shampoo substitutes should be used instead.
Bath oils rich in emollients can also be helpful.
Bath oils can also be used by spraying the oil on damp skin immediately after showering and then lightly patting the skin dry with a towel.
Having shorter or less frequent baths or showers can also help treat dry skin.
Having long, hot showers can lead to eczema.
Hydration
Hydrating your skin is one of the easiest and most important measures to protect your skin barrier, prevent itching and scratching, as well as reduce eczema flare-ups.
Since eczema is a chronic disease, it is important to incorporate regular hydration into your daily skin care routine.
Emollient is just another word for a moisturizer, usually a cream or ointment that softens the skin and can soothe it.
You should use moisturizers frequently throughout the day to keep your skin soft and supple.
For very dry skin, moisten at least twice a day all over the skin.
Avoid moisturizers that contain perfumes and preservatives that can irritate the skin.
Moisturizers should be applied within 3 minutes of your bath and shower to lock in moisture.
Corticosteroid-containing creams or ointments are the most commonly used treatments for exacerbations (flare-ups or rashes) of eczema.
Steroid preparations relieve itching by reducing inflammation in the skin and are very effective and safe when used correctly.
During an eczema attack, corticosteroids should be applied to the entire area of the skin that is inflamed.
Daily applications are generally recommended until the inflammation has cleared up.
The strength of the corticosteroid cream or ointment will depend on the area of the skin that is affected (typically less forces are used for the face, armpits, and groin).
Wet dressings
Wet dressings, such as applying emollients or steroid cream to the skin and then covering them with bandages or clothing that have been soaked in warm water, can help relieve eczema symptoms, including itching, in some people.
Moist dressings are often used in severe eczema flare-ups, usually for a period of a few days.
They should be left on for about 15 minutes to an hour, and can be applied 3 to 4 times per day.
Medicines
Clinical trials show that dupilumab medication is effective in reducing inflammation and is well tolerated with long-term use.
Dupilumab is a drug that was made for those whose eczema cannot be well controlled with topical therapies such as ointments or creams.
Dupilumab can be used with or without topical corticosteroids.
Long-term use of heavy-duty steroid ointments or creams can be associated with local side effects (such as thinning of the skin, stretch marks, and dilated blood vessels).
However, short-term use of steroids to treat inflamed eczema is generally safe.
The risk of having untreated eczema outweighs the risk of side effects from the proper use of corticosteroids.
As a guide, a fingertip filled with cream or ointment (from the end of the finger to the first crease) is enough to cover an area the size of 2 adult hands.
Topical corticosteroids are anti-inflammatory treatments to control exacerbations.
Its effectiveness has been measured and its intermittent use has been shown to pose little risk.
Low-potency corticosteroids should be used on the face, areas with thinner skin, and in children.
Immunomodulators (also called calcineurin inhibitors) such as pimecrolimus cream can be used to treat eczema.
They control inflammation when applied to the skin and can be used to treat eczema symptoms and reduce flare-ups when a steroid cream cannot be used.
However, due to concerns about skin and lymphatic system cancers, pimecrolimus is not recommended for long-term continuous use and should not be used on skin that has precancerous changes, is exposed to a lot of sun, or has previously had a skin cancer removed.
One of the benefits is that these do not cause atrophy in the skin, therefore, they are recommended in delicate areas of the skin such as the face. It is recommended to apply emollients first, and after an hour to apply corticosteroids or calcineurin inhibitors.
After the stabilization of the disease, maintenance therapy based on emollients should be continued.
In the case of a severe presentation, phototherapy may be recommended. Phototherapy using ultraviolet light is another form of treatment for chronic and severe eczema.
Phototherapy involves controlled exposure to ultraviolet light for a few minutes 2 to 3 times a week.
This treatment is expensive and time consuming, and possible long-term side effects include premature aging of the skin and skin cancer.
Phototherapy should not be used in conjunction with calcineurin inhibitors or cyclosporine. Its use in children should be with great caution and should be indicated by the dermatologist.
In cases where topical treatment and phototherapy fail to control the disease, systemic immunosuppressive therapies are required.
The most commonly used agents are cyclosporine, azathioprine, methotrexate, and mycophenolate mofetil.
These drugs have some potentially serious side effects, and they are only available to adults with a prescription from a specialist.
They are usually used only when other treatments have failed. In patients suffering from atopic dermatitis, vitamin D may intervene in the expression of cathelicidins in the skin.
It is quite common for skin that is affected by eczema to be susceptible to infection.
If an infection occurs, antibiotic creams or tablets may be prescribed to treat the infection.
Adding a low-strength antiseptic solution to your bath water can prevent and treat skin infections.
Cold compresses, oatmeal bath additives, and coal tar, and pine tar preparations can help relieve itchy skin.
Nutritional supplements
Supplements such as evening primrose oil, fish oil, and borage seed oil have been touted as possible treatments for eczema symptoms.
However, there is a lack of good quality evidence to show that they are effective in treating eczema.
Prevention
There are many things you can do to prevent or reduce eczema flare-ups.
Avoid exposure to:
Extreme temperatures
- Dry air.
- Harsh soaps
- Scented products.
- Bubble bath.
Use blankets and clothing made of cotton. Avoid more irritating fabrics, such as wool. Avoid stiff synthetics, such as polyester.
After bathing or showering, pat dry rather than rub.
To leave a little moisture on the skin. Then apply a moisturizing cream or lotion to trap the moisture on the skin.
Use a humidifier to add moisture to the indoor air during the winter heating season.
To help prevent contact dermatitis, avoid skin contact with:
- Dish detergent, cleaning solutions, and other irritating chemicals.
- Floors.
- Jewelry.
- Substances that trigger skin allergies.
If you have swelling in your legs, you can help prevent stasis dermatitis by:
- Wearing compression stockings.
- Elevating your legs if you sit for long periods.
