Eczema

Eczema

What is Eczema?

Atopic dermatitis, also known as eczema, is a skin problem that causes dry, itchy, scaly, red skin. It can occur in infants, children, and adults, and seems more common in certain families. 

What Causes Eczema?

The cause of eczema are unkown, although hereditary factors appear to play a strong role. Atopic dermatitis is caused by dysfunction in the outermost layer of the skin (the epidermis). The epidermis is the first line of defense between the body and the environment. When the epidermis is intact, it keeps environmental irritants, allergens and microbes from entering the body.

In children, eczema is infrequently linked to food allergies. If a food allergy is suspected, the child should be evaluated by an allergy specialist. 

What are the Signs & Symptoms of Eczema?

Most people with eczema develop their first symptoms before age five. Intense itching of the skin, redness, small bumps, and skin flaking are common. Scratching can cause additional skin inflammation, which can further worsen the itching. The itchiness may be more noticeable at nighttime. 

Signs of eczema vary from one individual to another, and can change over time. It can include:

Dry scales

Plugged hair follicles causing small bumps to develop, usually on the face, upper arms, and thighs

Inflammation around the lips

Increased skin creasing on the palms and/or an extra fold of skin under the eye

Darkening of the skin around the eyes

Although eczema is usually confined to specific areas of the body, it may affect multiple areas in severe cases:

In infants, there may be red, scaly, and crusted areas on the front of the arms and legs, cheeks, or scalp. The diaper area is not usually affected.

In older children and adolescents, the skin may become thickened and darkened, or even scarred, from repeated scratching 

In adults, eczema commonly affects the back of the neck, the elbow creases, and the backs of the knees. Other affected areas include the face, wrists, and forearms.

The skin is often dry, increasing the risk of injuring the skin with scratching. The skin can become infected as a result of scratching. Signs of infection include painful red bumps that sometimes contain pus; a healthcare provider should be consulted if this occurs.

What can make eczema worse?

Flare-ups can be prompted by environmental elements or “triggers” such as certain

soaps, clothing fabrics, deodorants, carpet fibres, dust, and others. Sometimes a flare-

up will occur, however, with no discernable trigger. Overheating, excessive sweating,

low humidity, certain foods and stress can also contribute to flare-ups. When the skin becomes irritated by

any one of these irritants, it itches, causing the sufferer to scratch the affected area.

Scratching makes the condition worse and the skin becomes inflamed and reddened,

aggravating the itch. This is called the “itch-scratch cycle” and can become severe and

can cause pain.

How do we diagnose Eczema?

There is no specific test used to diagnose eczema. The diagnosis is usually based upon a person's medical history and physical examination.

Factors that strongly suggest eczema include long-standing and recurrent itching, a personal or family history of allergic conditions, and an early age when symptoms began. Other factors include worsened symptoms after exposure to certain triggers or any of the skin findings noted above.

WHAT ELSE MAY LOOK LIKE ECZEMA ?

  • Allergic Dermatitis
  • Contact Dermatitis
  • Hand Eczema - Hand Dermatitis
  • Lichen Simplex Chronicus
  • Nummular Dermatitis
  • Occupational Contact Dermatitis
  • Subtypes of Hand Dermatitis
  • Sunscreen Allergies

How do we treat Eczema?

Eczema is a chronic condition; it typically improves and then flares (worsens) periodically. Some people have no symptoms for several years. Eczema is not curable, although symptoms can be controlled with a variety of self-care measures and drug therapy.

Who treats eczema? — Many patients with atopic dermatitis can initially be treated by their primary care provider. However, a skin specialist (dermatologist) may be recommended in certain situations, such as if the condition does not improve with treatment, if certain areas of the body are affected (face or skin folds), and if another condition could be causing symptoms.

Eliminate aggravating factors — Eliminating factors that worsen eczema can help to control the symptoms. Aggravating factors may include:

Heat, perspiration, dry environments

Emotional stress or anxiety

Rapid temperature changes

Exposure to certain chemicals or cleaning solutions, including soaps and detergents, perfumes and cosmetics, wool or synthetic fibers, dust, sand, and cigarette smoke.

Keep the skin hydrated

Emollients — Emollients are creams and ointments that moisturize the skin and prevent it from drying out. The best emollients for people with atopic dermatitis are thick creams (such as Eucerin®, Cetaphil®, and Nutraderm®) or ointments (such as petroleum jelly, Aquaphor®, and Vaseline®), which contain little to no water. Emollients are most effective when applied immediately after bathing. Lotions contain more water than creams and ointments and should be avoided by people with eczema because they can worsen dry skin.

Bathing — It is not clear if showers or baths are better for keeping the skin hydrated. Lukewarm baths or showers can hydrate and cool the skin, temporarily relieving the itching of eczema. An unscented, mild soap or nonsoap cleanser (such as Cetaphil®) should be used sparingly. An emollient should be applied IMMEDIATELY after bathing or showering to prevent the skin from drying out as a result of water evaporation.

However, hot or long baths (greater than 10 to 15 minutes) and showers should be avoided since they can dry out the skin.

Treat skin irritation

Topical steroids — Prescription steroid (glucocorticoid) creams and ointments may be recommended to control mild to moderate atopic dermatitis. Steroid creams and ointments are available in a variety of strengths (potencies); the least potent are available without a prescription (eg, hydrocortisone 1 percent cream). More potent formulations require a prescription.

Steroid creams or ointments are usually applied to the skin once or twice per day. These help to reduce symptoms and moisturize the skin. As the skin improves, a non-medicated emollient can be resumed. Strong topical steroids may be needed to control severe flares of eczema; however, these should be used for only short periods of time to prevent thinning of the skin.

Other skin treatments — Newer skin treatments for eczema include tacrolimus (Protopic®) and pimecrolimus (Elidel®). These are effective in controlling eczema in people who have not improved with topical steroids, although do not work as quickly as topical glucocorticoids. They are useful in sensitive areas such as the face and groin, and can be used in children over age two. Due to safety concerns, these treatments should only be used as instructed by a healthcare provider.

Oral steroids — Oral steroids (eg, prednisone) occasionally are used to treat a severe flare of eczema, although this treatment is not usually recommended on a regular basis because of potential side effects.

Ultraviolet light therapy (phototherapy) — Ultraviolet light therapy (phototherapy) can effectively control atopic dermatitis. However, this therapy is expensive, may increase a person's risk for skin cancer, and is therefore recommended only for people with severe eczema who do not respond to other treatments.

Immunosuppressive drugs — Drugs that weaken the immune system may be recommended for people with severe eczema who do not improve with other treatments. Treatment with these drugs can cause serious side effects, including an increased risk for infection.

Control itching

Oral antihistamines — Oral antihistamines help relieve the itching of eczema and the accompanying eye irritation. The over-the-counter antihistamine diphenhydramine (Benadryl®), and prescription antihistamines, such as hydroxyzine (Atarax®) and cyproheptadine, are most effective for itching caused by eczema, although these drugs can cause drowsiness. Doxepin is an antidepressant that has antihistamine actions; it may be recommended if other antihistamines are not helpful, although it can cause drowsiness as well.

The nonsedating antihistamines such as cetirizine (Zyrtec®) and loratadine (Claritin®) may relieve symptoms, and both are available without a prescription in the United States and Canada

Wet dressings — Wet dressings help soothe the skin, reduce itching and redness, loosen crusted areas, and prevent skin injury from scratching. Dampened cotton garments may be worn over the affected area and covered with a dry garment. The person may wear these dressings overnight or change them every eight hours during the day.


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