Eczema Flare-Up

Tips For Prevention and Treatment

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Young Woman Scratching her Itchy Arm

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Eczema, also called atopic dermatitis, is a very common skin condition that can affect people of all ages, though it occurs more frequently in children than adults. Eczema flare-ups often first appear in kids under 5 years old. It causes an itchy, inflamed, skin rash.

Although the exact cause of eczema is unknown it is associated with hay fever, food allergies, and a defective skin barrier. It may also have a genetic component. Some individuals with eczema may not be able to produce a protein called filaggrin which helps to keep a healthy amount of moisture in the top layer of your skin.

What Does Eczema Look Like?

Not all eczema rashes look the same. The appearance depends on the severity of the rash and where it is on the body. However, most eczema flare-ups have some specific characteristics.

  • The rash may be dry or scaly, or even cracked (especially if scratched).
  • It's usually red and swollen.
  • There are often fluid-filled bumps called vesicles.
  • It may weep or ooze a yellowish watery substance.
  • Severe eczema may become infected.
  • The first symptom of an eczema flare-up may be itching.

Eczema commonly appears on the neck, behind the ears, insides of the elbow, and behind the knees as well as the palms of the hands and soles of the feet. Infants may develop eczema on the torso or face. Severe eczema can cover large parts of the body.

Eczema Triggers

Certain substances or health conditions may trigger an eczema flare-up. Health and environmental conditions that may be related to a flare-up of your eczema include:

  • Dry skin
  • Stress, anxiety or other mental health problems
  • High humidity or very cold, dry air (extreme climates)
  • Spending long periods of time in water (baths or swimming pools, for example)
  • Hormone fluctuations including pregnancy or other health conditions

Chemicals or other substances that may trigger an eczema flare-up include:

  • Allergens like foods, pollen, pet dander, molds or dust mites
  • Cigarette smoke
  • Perfumes in skin products or hygiene products (such as soap)
  • Metals, including nickel
  • Some types of fabric, especially wool and polyester
  • Chemicals found in beauty products including isothiazolinones, cocamidopropyl betaine, and paraphenylenediamine

How Is an Eczema Flare-Up Diagnosed?

Uncomplicated cases of eczema are often diagnosed by a family doctor or other general practitioner. Severe cases or cases that are not easily diagnosed may require the assessment of a dermatologist.

Some skin rashes can be difficult to diagnose but your doctor will consider the appearance of your rash as well as your health history (including any family history of hay fever, etc.) when diagnosing an eczema flare-up.

Sometimes scrapings of the rash can be viewed under a microscope. In very difficult cases to diagnose or cases that don't respond to treatment, a skin biopsy may be necessary to make a definitive diagnosis of eczema.

Treating an Eczema Flare-Up

Eczema is a chronic condition with no known cure. A person with eczema will likely experience periods of no symptoms alternated with occasional flare-ups. When an eczema flare-up does occur the treatment may depend on the severity of the rash.

Over-the-counter 1 percent hydrocortisone cream, coupled with a dye-free, fragrance-free moisturizer, can often control mild eczema. Apply the hydrocortisone cream twice daily, before the moisturizer.

If over-the-counter treatments are insufficient to control your eczema symptoms you should see a doctor.

Prescription medications are needed in cases where eczema does not clear up with over-the-counter hydrocortisone, prescription topical steroids (e.g., cortisone, prednisolone, or betamethasone) are often used. Other topical medications that may be used include PDE4 inhibitors, topical calcineurin inhibitors (pimecrolimus). Topical medications should be used exactly as prescribed. They are usually applied to the skin once or twice a day to the affected area.

Oral steroids or immunosuppressants have, in some cases, been prescribed to control an eczema flare up but these are typically reserved for severe cases. Oral or topical antibiotics or antifungals may be necessary if your rash has become infected.

Skin barrier creams contain lipids and ceramides which work to form a protective barrier on the top layer of skin protecting it from moisture and germs while it heals.

Phototherapy is another treatment that can be used to control eczema. This involves exposing the skin to ultraviolet B (UVB) light. Phototherapy may increase your vitamin D production, help to control bacteria and reduce itching and redness.

Wet wrap therapy may work to hydrate and calm irritated skin. Clean fabric strips or gauze are soaked in warm water and applied to the rash. A clean dry piece of gauze or fabric is placed over the top of the wet one to hold it in place for a couple of hours. Try wet wrap therapy under the direction of your doctor.

Preventing an Eczema Flare-Up

With conscientious care of your skin, you can greatly reduce your chance of an eczema flare-up.

Use moisturizers liberally. Dry skin may trigger a flare-up in individuals prone to eczema so you should use a daily moisturizer after showering or bathing. It may be better for people with eczema to choose a moisturizer free of fragrances or dye. Moisturizer should be applied within minutes of exiting the bath or shower for best results.

Prevent your skin from drying out. It may also be helpful to avoid spending long periods of time in the water, and to use a humidifier in your home with your climate is very dry.

Avoid your triggers, when possible. If you can identify triggers such as specific allergens or chemicals and avoid contact with those substances this can also be helpful in preventing an eczema flare-up.

Take steps to manage your stress, or other mental health problems, as this can also help prevent flare-ups. If necessary do not hesitate to consult a mental health care professional for help. You should strive to get adequate amounts of sleep and exercise and may consider meditation or other stress reduction techniques. It is also important to reach out to friends and family members when you are feeling stressed.

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