Eczema

Eczema is a diagnosis that encompasses several inflamed skin conditions, the most common of which is atopic dermatitis or atopic eczema. It is most common during childhood. It is a chronic, very itchy rash, and it often clears and even disappears with age.

The cause is not  fully understood, but eczema appears to be an abnormal response of the body’s immune system. In people with eczema, the inflammatory response to irritating substances overacts, causing itching and scratching. It is not contagious and currently cannot be cured. However, for most patients the condition may be managed well with treatment and avoidance of triggers.

What does eczema look and feel like?

It can vary from person to person, but eczema typically is characterized by dry, red, extremely itchy patches on the skin. It is sometimes referred to as “the itch that rashes,” since the itch, when scratched, results in the appearance of the rash.

Eczema can occur on just about any part of the body. In infants, eczema typically occurs on the forehead, cheeks, forearms, legs, scalp and neck. In children and adults, eczema typically occurs on the face, neck and the insides of the elbows, knees and ankles. In some people, eczema may “bubble up” and ooze. In others, the condition may appear more scaly, dry and red. Chronic scratching causes the skin to take on a leathery texture because the skin thickens (lichenification).

What makes patients with eczema itch?

Triggers, too, can vary widely from person to person and it can be difficult to identify what they are. Some people develop eczema from contact with rough fabric, while for others, feeling too hot and/or sweating will cause an outbreak. Certain soaps, detergents, disinfectants, contact with juices from fresh fruits and meats, dust mites, and animal saliva and danders may trigger itching. Upper respiratory infections (caused by viruses) may also be triggers. Stress can also sometimes aggravate an existing flare-up.

Who gets eczema?

Eczema occurs in both children and adults, but usually appears during infancy. It often affects people with a family history of allergies. Those who are genetically predisposed and then exposed to environmental triggers may develop eczema. Many people who have eczema also suffer from allergic rhinitis or asthma, or have family members who do.

How common is eczema?

The National Institutes of Health estimates that 15 million people in the United States have some form of eczema. About 10 percent to 20 percent of all infants have eczema; however, in nearly half of these children, the disease will improve greatly by the time they are between five and 15 years of age.

How can eczema be prevented?

Eczema outbreaks can usually be avoided with some simple precautions. The following suggestions may help to reduce the severity and frequency of flare-ups:

• Moisturize frequently
• Avoid sudden changes in temperature or humidity
• Avoid sweating or overheating
• Reduce stress
• Avoid scratchy materials (e.g., wool)
• Avoid harsh soaps, detergents and solvents
• Avoid environmental factors that trigger allergies (e.g., pollens, molds, mites and animal dander)
• Be aware of any foods that may cause an outbreak and avoid those foods

How can eczema be treated?

One of the most important things you can do to prevent eczema is to avoid scratching. Because eczema is usually dry and itchy, the most common treatment is the application of lotions or creams to keep the skin as moist as possible. These treatments are generally most effective when applied directly after bathing (within three minutes is a common recommendation) so that the moisture from the bath is “locked in.” Cold compresses applied directly to itchy skin can also help relieve itching. If the condition persists, worsens or does not improve satisfactorily, another effective treatment is the application of nonprescription corticosteroid creams and ointments to reduce inflammation.

Other Alternatives

Alternatives to nonprescription lotions include more potent prescription corticosteroid creams and ointments, which are effective, but may have some side effects, such as skin thinning. Therefore the length of treatment may be limited. Oral corticosteroids may be prescribed for severe flare-ups.

Skin infection at the site of an eczema flare-up is a common problem. In this case, topical or oral antibiotics may be prescribed to eradicate the infection. Antihistamines are sometimes used for severe itching. They are available in both prescription and over-the-counter varieties. Drowsiness is a common side effect so people taking these medications should not drive. Phototherapy, which uses special lighting equipment can also be helpful.

In severe cases, medications to modify the immune response may also be used. Two topical medications, tacrolimus and pimecrolimus, have been approval by the U.S. Food and Drug Administration (FDA) to treat atopic dermatitis. These medications belong to a class of drugs called calcineurin inhibitors.

What can be done for children with eczema?

Eczema in children presents special challenges, since it may be difficult for them to resist scratching and they end up making the condition worse. Fortunately, for mild to moderate cases, the application of moisturizer on a regular basis can be very helpful. After bathing, apply moisturizer within three minutes to retain the moisture in the skin. Avoid sudden temperature changes. Keep your child’s bedroom and play areas free of dust mites (a common trigger). Use mild soaps, both on your child’s skin and on your child’s clothing. Dress your child in breathable cotton clothing. Sometimes an over-the-counter cream, a prescription cream, ointment, antihistamines or antibiotics may be necessary. Regardless, most children will see improvement as time goes by.