An Overview of Eczema (Atopic Dermatitis)

Tips For Prevention and Treatment

Young Woman Scratching her Itchy Arm

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Eczema is the common term used to describe atopic dermatitis, a skin condition that causes a scaly, inflamed, itchy rash. It is a very common skin problem that affects people of all ages, though it occurs more frequently in children than adults.

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.

Symptoms

Not all eczema rashes look the same. The appearance depends on the severity of the rash and where it occurs on the body.

However, eczema flare-ups have specific characteristics. Symptoms include:

  • A red, inflamed, itchy rash
  • Dry, scaly skin
  • Fluid-filled bumps called vesicles
  • Cracked skin (especially if the rash is scratched)
  • Oozing or weeping skin

The first symptom of an eczema flareup is often itching. The itching precedes the rash itself, which is a characteristic that sets atopic dermatitis apart from other skin rashes.

Severe eczema can cover large parts of the body. Eczema may become infected, especially if it is widespread, severe, or often scratched.

In infants and children: Eczema is incredibly common during childhood, affecting up to 20% of all children. It most often appears before age 5. In infants, the rash typically develops on the cheeks and trunk. As the child ages, the location of the rash changes, with flare-ups occurring less on the face and more on flexural areas (behind the knees, in the crook of the elbow).

In teens and adults: For teenagers and adults, eczema tends to develop behind the knees and in the front of the elbow. Eczema is also common on the face and on the hands. While some people deal with eczema off and on throughout childhood and beyond, it can develop for the very first time in adulthood.

Stages of Eczema

Eczema has three distinct stages: subacute, acute, and chronic.

In the subacute stage, the skin is likely to be dry, red, and scaly. The rash generally has indistinct borders at this stage. The skin is rough and bumpy.

When you have an eczema flareup, the condition moves into the acute stage. Acute eczema is intensely itchy and inflamed. It may also blister, crack, or ooze.

With chronic eczema (eczema that has lasted longer than three months) the skin takes on a thickened or leathery appearance. There may be darkening or deep cracking of the skin.

Eczema moves between these three stages. There will be periods of time where eczema is relatively clear, times where eczema flares significantly, and periods in-between.

Causes

As of yet, the exact cause of atopic dermatitis isn't completely clear. It's believed to be caused by an overactive response by your immune system.

However, many different factors coming together are what likely lead to an eczemic condition.

There appears to be a hereditary component. If you have a close relative with eczema, you're much more likely to develop it.

Factors that make it more likely that you will develop eczema also include a personal or family history of allergies (including food allergies or hay fever) and asthma.

Possible Genetic Causes

Scientists believe that people with eczema have a mutation of the protein filaggrin. Filaggrin is responsible for helping form a tight and healthy skin barrier.

When there is a mutation in this protein, the skin's barrier function is disrupted. The skin is not able to hold on to moisture properly, leading to dehydrated skin and dryness.

Also, the weak barrier allows other substances to easily pass through, increasing the risk of allergies and irritation. This helps explain why eczema-prone skin is so sensitive to many substances it comes in contact with.

Eczema Triggers

There are certain factors or health conditions that, while they don't cause eczema, may trigger it.

Health and environmental conditions that may be related to a flare-up of eczema include:

  • Xerosis (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 related to 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

Diagnosis

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

Some skin rashes can be difficult to identify, but your doctor will consider the appearance of your rash as well as your health and family history when working to diagnose you.

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

Blood testing and patch testing may be done to help diagnose specific allergens that may be contributing to eczema flares.

Differential Diagnoses

While the word eczema is often used interchangeably with atopic dermatitis, it is actually a broad term for number of skin conditions that cause a red, itchy, scaly rash.

Your doctor will consider these other forms of eczema in their diagnostic process:

There are also non-eczema-related skin conditions that can sometimes be confused with atopic dermatitis. These are:

Treatment

Eczema is a chronic condition with no known cure. When an eczema flare-up occurs, the treatment may depend on the severity of the rash.

Over-the-Counter Treatments

Mild eczema can often be effectively controlled with over-the-counter treatments and gentle skin care.

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. Choose products that are dye-free and fragrance-free.

Over-the-counter 1% hydrocortisone cream can help with inflammation and itching. Apply the hydrocortisone cream twice daily, before the moisturizer.

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.

Home remedies for eczema focus on keeping the skin well-moisturized. There is some indication that vitamin D supplementation or probiotics may be helpful in controlling eczema.

Dilute bleach baths are sometimes used in cases where eczema is not responding to traditional treatment. These should only be done under the advice and supervision of a physician.

Prescription Medications and Procedures

Prescription medications are needed in cases where eczema does not clear up with over-the-counter hydrocortisone. You often don't need to use prescription medications continuously, but rather only during an acute flare.

Prescription topical steroids (e.g., cortisone, prednisolone, or betamethasone) are often used and are a mainstay of eczema treatment. They are usually applied to the skin once or twice a day to the affected area. Topical medications should be used exactly as prescribed. When used properly, the risk of thinning skin or discoloration is small. Only low-strength topical steroids should be used on the face, and not around the eyes or on the eyelids.

Topical calcineurin inhibitors such as Protopic (tacrolimus) and Elidel (pimecrolimus) are non-steroid medications. They can be used on the face and around the eyes.

Dupixent (dupilumab) is an injectable medication that is used to treat moderate to severe eczema in adults. It's generally tried after other treatment options have failed.

Oral steroids or immunosuppressants have, in some cases, been prescribed to control an eczema flareup but these are typically reserved for severe cases.

Oral or topical antibiotics or antifungals may be necessary if your rash has become infected.

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.

Prevention

With conscientious care of your skin, you can greatly reduce your chance of an eczema flare-up by following some key strategies:

  • Use moisturizers liberally: Dry skin may trigger a flare-up. Use a moisturizer daily, ideally immediately after showering or bathing. Fragrance- and dye-free options are best.
  • 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.
  • 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 flareup.
  • Take steps to manage your stress: Strive to get adequate amounts of sleep and exercise, and consider meditation or other stress-reduction techniques. If necessary, do not hesitate to consult a mental healthcare professional for help.

A Word From Verywell

Gentle skin care and consistent application of moisturizing creams or ointments is the best step you can take to minimize flares and reduce itching and irritation. If home treatment isn't enough, prescription medications can help. Although eczema is a frustrating condition to manage, it can be done effectively. Ask your physician to help you devise the right treatment plan.

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