What you need to know about eczema

Eczema is a disease in which skin patches are inflamed, itchy, swollen, broken and raw. Blisters will happen occasionally.

In the United States, 31.6 percent of people are affected by different stages and forms of eczema.

Also simply the term “eczema” is used to talk of atopic dermatitis, the most common type of eczema.

“Atopic” refers to a range of immune-system conditions, including atopic dermatitis, asthma, and hay fever. Dermatitis is a cutaneous inflammation.

Many people outgrow the disease while others go on with it throughout adulthood.

This article from the Nccmed Knowledge Center will explain what eczema is and will discuss the signs, causes, remedies and forms.

Fast facts on eczema

  • Certain foods can trigger symptoms, such as nuts and dairy.
  • Symptoms vary according to the age of the person with eczema, but they often include scaly, itchy patches of skin.
  • Eczema can also be triggered by environmental factors like smoke and pollen. However, eczema is not a curable condition.
  • Treatment focuses on healing damaged skin and alleviating symptoms. There is not yet a full cure for eczema, but symptoms can be managed.
  • Eczema is not a contagious condition.

Symptoms

Eczema symptoms
Eczema can cause dry and itchy rashes.
Image credit: G Steph Rocket, 2015.

Atopic dermatitis symptoms can vary depending on the person’s age with the disease.

Atopic dermatitis is common in children, and dry and scaly patches appear on the skin. Often these patches are heavily itchy.

By age 5 most people develop atopic dermatitis. Half of those who inherit the childhood condition continue to experience symptoms as an adult.

Those symptoms, however, are often different from those encountered by adolescents.

People with the condition will often experience periods of time where their symptoms either flare up or worsen, accompanied by periods of time when their symptoms will improve or become apparent.

Symptoms in infants under 2 years old

  • Rashes commonly appear on the scalp and cheeks.
  • Rashes usually bubble up before leaking fluid.
  • Rashes can cause extreme itchiness. This may interfere with sleeping. Continuous rubbing and scratching can lead to skin infections.

Symptoms in children aged 2 years until puberty

  • Rashes commonly appear behind the creases of elbows or knees.
  • They are also common on the neck, wrists, ankles, and the crease between buttock and legs.

Over time, the following symptoms can occur:

  • Rashes can become bumpy.
  • Rashes can lighten or darken in color.
  • Rashes can thicken in a process known as lichenification. The rashes can then develop knots and a permanent itch.

Symptoms in adults

  • Rashes commonly appear in creases of the elbows or knees or the nape of the neck.
  • Rashes cover much of the body.
  • Rashes can be especially prominent on the neck, face, and around the eyes.
  • Rashes can cause very dry skin.
  • Rashes can be permanently itchy.
  • Rashes in adults can be more scaly than those occurring in children.
  • Rashes can lead to skin infections.

Adults who have developed atopic dermatitis as a child but are no longer suffering the condition may still have dry or easily irritated skin, eczema in the hand and eye problems.

The skin appearance affected by atopic dermatitis may depend on how much a individual scratches and whether the skin gets infected. Scratching and scratching irritates the skin more, increases inflammation and makes itchiness worse.

Treatment

Eczema doesn’t get cured. The problem treatment aims at repairing the infected skin and avoiding symptom flare-ups. Doctors may prescribe a treatment plan based on the age, symptoms and present state of health of an patient.

Eczema goes away over time, for some people. It remains a condition for others for a lifetime.

Home care

There are many things people with eczema can do to improve skin health and relieve symptoms, like:

  • taking lukewarm baths
  • applying moisturizer within 3 minutes of bathing to “lock in” moisture
  • moisturizing every day
  • wearing cotton and soft fabrics, and avoiding rough, scratchy fibers and tight-fitting clothing
  • using a mild soap or a non-soap cleanser when washing
  • air drying or gently patting skin dry with a towel, rather than rubbing the skin dry after bathing
  • where possible, avoiding rapid changes of temperature and activities that make you sweat
  • learning and avoiding individual eczema triggers
  • using a humidifier in dry or cold weather
  • keeping fingernails short to prevent scratching from breaking the skin

Medications

There are several medicines that doctors can prescribe for treating eczema symptoms, including:

  • Topical corticosteroid creams and ointments: These are a type of anti-inflammatory medication and should relieve the main symptoms of eczema, such as skin inflammation and itchiness. They are applied directly to the skin.
  • Systemic corticosteroids: If topical treatments are not effective, systemic corticosteroids can be prescribed. These are either injected or taken by mouth, and they are only used for short periods of time.
  • Antibiotics: These are prescribed if eczema occurs alongside a bacterial skin infection.
  • Antiviral and antifungal medications: These can treat fungal and viral infections that occur.
  • Antihistamines: These reduce the risk of nighttime scratching as they can cause drowsiness.
  • Topical calcineurin inhibitors: This is a type of drug that suppresses the activities of the immune system. It decreases inflammation and helps prevent flare-ups.
  • Barrier repair moisturizers: These reduce water loss and work to repair the skin.
  • Phototherapy: This involves exposure to ultraviolet A or B waves, alone or combined. The skin will be monitored carefully. This method is normally used to treat moderate dermatitis.

Even though the condition itself is not yet curable, each person with different symptoms should have a particular treatment plan to match. Even after a skin area has healed it is important to continue to look after it, as it can easily get irritated again.

Causes

Pollen is one of the many potential triggers of eczema.

The specific cause of eczema remains unknown, but a combination of genetic and environmental factors is believed to cause it to develop.

No infectious eczema.

When a parent has the disorder or another atopic illness, children are more likely to develop eczema.

The risk is even greater if both parents have an atopic illness.

It is also understood that environmental factors bring out the signs of eczema, such as:

  • Irritants: These include soaps, detergents, shampoos, disinfectants, juices from fresh fruits, meats, or vegetables.
  • Allergens: Dust mites, pets, pollens, mold, and dandruff can lead to eczema.
  • Microbes: These include bacteria such as Staphylococcus aureus, viruses, and certain fungi.
  • Hot and cold temperatures: Very hot or cold weather, high and low humidity, and perspiration from exercise can bring out eczema.
  • Foods: Dairy products, eggs, nuts and seeds, soy products, and wheat can cause eczema flare-ups.
  • Stress: This is not a direct cause of eczema but can make symptoms worse.
  • Hormones: Women can experience increased symptoms of eczema at times when their hormone levels change, for example during pregnancy and at some points in the menstrual cycle.

Types

Numerous different forms of eczema exist. Although this article mainly focused on atopic dermatitis, other forms include:

  • Allergic contact dermatitis: This is a skin reaction following contact with a substance or allergen that the immune system recognizes as foreign.
  • Dyshidrotic eczema: This is an irritation of the skin on the palms of the hands and the soles of the feet. It is characterized by blisters.
  • Neurodermatitis: This forms scaly patches of skin on the head, forearms, wrists, and lower legs. It is caused by a localized itch, such as an insect bite.
  • Nummular eczema: These show as circular patches of irritated skin that can be crusted, scaly, and itchy.
  • Stasis dermatitis: This is a skin irritation of the lower leg usually related to circulatory problems.

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