Eczema is a condition where patches of skin become inflamed, itchy, red, cracked, and rough. Blisters can also occur. It affects a large section of the American population to a lesser or greater degree.
The word eczema is also used specifically to refer to atopic dermatitis, the most common type of eczema.
In this article, we will explain what eczema is and discuss the causes, symptoms, and treatments.
Fast facts on eczema
Here are some key points about eczema. More detail and supporting information is in the main article.
- Eczema is likely related to conditions that adversely affect the skin's barrier function (including genetic factors, nutrient deficiencies, bacterial infection, and dry, irritated skin)
- Certain foods such as nuts and dairy can trigger symptoms
- Eczema can also be triggered by environmental factors such as smoke and pollen
- Treatment focuses on healing damaged skin and alleviating the symptoms
- For some, their eczema will eventually disappear completely, but for others, it remains a lifelong condition
What is eczema?
Common symptoms of eczema include areas of thickened, red, itchy skin.
The term 'eczema' is used in two different ways. It can be used widely to describe any rash-like skin conditions.
Or it can be used to describe atopic dermatitis, a chronic skin condition that commonly starts during infancy and continues through into childhood.
Some people outgrow the condition while some people will continue to have it into adulthood.
Causes of eczema
The specific cause of eczema remains unknown, but it is believed to develop due to a combination of hereditary (genetic) and environmental factors.
Children are more likely to develop eczema if a parent has had it or another atopic disease. If both parents have an atopic disease, the chances increase further.
Environmental factors are also known to bring out the symptoms of eczema. These include:
- Irritants - soaps, detergents, shampoos, disinfectants, juices from fresh fruits, meats, or vegetables
- Allergens - dust mites, pets, pollens, mold, dandruff
- Microbes - bacteria such as Staphylococcus aureus, viruses, certain fungi
- Hot and cold temperatures - hot weather, high and low humidity, perspiration from exercise
- Foods - dairy products, eggs, nuts and seeds, soy products, wheat
- Stress - it is not a cause of eczema but can make symptoms worse
- Hormones - women can experience worsening of eczema symptoms at times when their hormone levels are changing, for example during pregnancy and at certain points in their menstrual cycle
Symptoms of eczema
Atopic dermatitis commonly manifests itself in infants with dry and scaly patches appearing on the skin. These patches are often intensely itchy. The symptoms of atopic dermatitis can vary, depending on the age of the person with the condition.
Most people develop atopic dermatitis before the age of 5. Half of those who develop the condition in childhood continue to have symptoms as an adult, though these symptoms are often different to those experienced by children.
People with the condition will often experience periods of time where their symptoms will flare up or worsen, followed by periods of time where their symptoms will improve or clear up.
- Rashes commonly appear on scalp and cheeks.
- Rashes usually bubble up before weeping fluid.
- Rashes can cause extreme itchiness, which may lead to trouble sleeping. Continuous rubbing and scratching can lead to skin infections.
Children, from 2 years old to puberty:
- Rashes commonly appear behind the creases of elbows or knees
- Also common on neck, wrists, ankles, crease between buttock and legs
Over time, the following symptoms can manifest:
- Rashes can become bumpy, like goosebumps
- Rashes can lighten or darken in color
- Rashes can thicken (also known as lichenification) and then develop knots and a permanent itch
- Rashes commonly appear in creases of elbows or knees or nape of neck
- Rashes cover much of the body
- Rashes can be especially prominent on neck, face, and around the eyes
- Rashes can cause very dry skin
- Rashes can be permanently itchy
- Rashes can cause scaly skin (more scaly than in children)
- Rashes can lead to skin infections
Adults who developed atopic dermatitis as a child but no longer experience the condition may still have dry or easily irritated skin, hand eczema, and eye problems.
The appearance of skin affected by atopic dermatitis will depend on how much a person scratches and whether the skin is infected. Scratching and rubbing irritates the skin further, increases inflammation and makes itchiness worse.
Types of eczema
There are many different types of eczema. This article will predominantly focus on atopic dermatitis. Other variants include:
- Allergic contact eczema (dermatitis) - a skin reaction following contact with a substance that the immune system recognizes as foreign
- Contact eczema - a localized reaction where the skin has come into contact with an allergen
- Dyshidrotic eczema - irritation of skin on palms of hands and soles of feet characterized by blisters
- Neurodermatitis - scaly patches of skin on head, forearms, wrists, and lower legs caused by a localized itch such as an insect bite
- Nummular eczema - circular patches of irritated skin that can be crusted, scaling, and itchy
- Seborrheic eczema - oily, scaly yellowish patches of skin, usually on scalp and face
- Stasis dermatitis - skin irritation on lower legs, usually related to circulatory problems
Tests and diagnosis of eczema
Skin allergy testing is useful for investigating potential eczema cases.
There is no single test that is used to diagnose eczema.
The doctor may need to see a patient multiple times to make an accurate diagnosis. This is because people with eczema experience individual combinations of symptoms, which tend to fluctuate in severity over time.
Diagnosis is based primarily on the patient's symptoms, but medical history is also important.
A doctor will often ask about a patient's family history, other atopic diseases such as asthma and hay fever, possible exposure to irritants, whether any foods are related to flare-ups, sleep disturbances, past treatment for skin symptoms, and the use of steroids or other medications.
A doctor may refer a patient to either an allergist or dermatologist for further evaluation.
They may also attempt to rule out other conditions that can cause skin irritations. This can involve the following tests:
- Patch testing - substances are placed onto the surface of the skin to test for skin allergies
- Skin prick testing - a needle containing a small amount of a suspected allergen pricks the skin to test for allergies that do not necessarily occur on the skin, such as pollen or food
- Supervised food challenges - foods are eliminated and then introduced into the diet to determine whether a food allergy is present
Treatments for eczema
There is no cure for eczema. Treatment for the condition aims to heal the affected skin and prevent flaring of the symptoms. Doctors will suggest a plan of treatment based around a patient's age, symptoms, and current state of health.
For some people, eczema goes away over time, and for others, it remains a lifelong condition.
There are numerous things that people with eczema can do to support skin health and alleviate symptoms, such as:
Regular warm baths can help alleviate eczema symptoms.
- Taking regular warm baths
- Applying moisturizer within 3 minutes of bathing to "lock in" moisture
- Moisturizing every day
- Wearing cotton and soft fabrics, avoiding rough, scratchy fibers, and tight-fitting clothing
- Using mild soap or a non-soap cleanser when washing
- Air drying or gently patting skin dry with a towel, rather than rubbing skin dry after bathing
- Avoiding rapid changes of temperature and activities that make you sweat (where possible)
- Learning individual eczema triggers and avoiding them
- Using a humidifier in dry or cold weather
- Keeping fingernails short to prevent scratching from breaking skin
There are several medications that can be prescribed by doctors to treat the symptoms of eczema:
- 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.
- If ineffective, systemic corticosteroids can be prescribed. These are either injected or taken by mouth; they are only used for short periods of time.
- Antibiotics if there is an overlying bacterial skin infection.
- Medications to treat fungal and viral infections.
- Antihistamines that cause drowsiness are often recommended as these can help to reduce the risk of night-time scratching.
- Topical calcineurin inhibitors - 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 can be prescribed to treat mild to moderate dermatitis. It involves exposure to ultraviolet A or B waves, alone or combined. The skin will be monitored carefully.
Even though the condition itself is not presently curable, there should be a particular treatment plan to suit each case. Even after an area of skin has healed, it is important to keep looking after it, as it may easily become irritated again.