Definition

Eczema is a chronic inflammation of the outer layers of the skin. It is most common in infants and children. It can occur in adults. This condition is not contagious. Eczema is also known as atopic dermatitis.

Eczema

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Causes

The exact cause of eczema is unknown. Factors that may contribute to eczema include:

  • Genetics
  • Environment
  • Allergies —may include allergies to things that touch the skin (such as wool or perfumes in soaps), allergies to dust mites (very common), or allergies to foods
  • Stress, especially if it leads to scratching
  • Frequent washing of affected areas
  • Use of rubber gloves in persons sensitive to latex
  • Scratching or rubbing of skin

Risk Factors

Factors that increase your chance of eczema:

  • Age: five years old or younger (eczema becomes less common after the ages of 5-10)
  • Asthma or hay fever
  • Urban areas or places with low humidity
  • Relatives who have eczema or allergic disorders
  • Race: Black or Asian

Symptoms

The symptoms vary from person to person. Scratching and rubbing can cause or worsen some of the symptoms. Symptoms include:

  • Dry, itchy skin
  • Cracks behind the ears or in other skin creases
  • Rashes on the cheeks, arms, and legs
  • Red, scaly skin
  • Thick, leathery skin
  • Small, raised bumps on the skin
  • Crusting, oozing, cracking, or scaling of the skin
  • Worsening in the winter, when inside air is dry due to central heating

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may be referred to specialist. A dermatologist focuses on skin disorders. An allergist focuses on allergies.

Treatment

The main goals of eczema treatment are to:

  • Heal the skin and keep it healthy
  • Stop scratching or rubbing
  • Avoid skin infection
  • Prevent flare-ups
  • Recognize and avoid precipitating allergens, if there are any
  • Learn to avoid scratching

Treatment options may vary. Your doctor may recommend more than one depending on your condition. They include:

Skin Care

  • Avoid hot or long baths or showers. Keep them less than 15 minutes.
  • Use mild, unscented bar soap or nonsoap cleanser. Use it sparingly.
  • Air-dry or gently pat dry after bathing. Apply gentle moisturizer right after.
  • Treat skin infections right away.

Medications

  • Prescription creams and ointments containing cortisone, tacrolimus, or pimecrolimus
  • Oral medications (eg, prednisone or cyclosporine )—for severe cases
  • Antibiotics applied directly to the skin or taken by mouth (only for treating infections)
  • Prescription or over-the-counter antihistamines to help prevent itching

Phototherapy

  • Treatment with ultraviolet light (by a doctor)
  • Photopheresis—for severe cases

Prevention

It is difficult to prevent eczema. This is most true when there is a strong family history.

You may be able to reduce your child's risk of eczema by:

  • Breastfeeding
  • For bottlefed infants, using a certain kind of formula—Ask the doctor if your baby should have 100% whey protein formula (eg, Nestle Good Start)
  • Exposing your child to pets at an early age

If you already have eczema, there are several things you can do to try to control it:

  • Follow guidelines to limit house dust mites in bedding.
  • Avoid direct contact with wool to the skin.
  • Talk to your doctor about any natural or herbal treatments. Some of these may make eczema worse.
  • Avoid scratching or rubbing when possible.
  • Follow your treatment plan. Improvement may take several weeks or even months after a new medicine is started.
  • Maintain a cool stable environment. Keep consistent humidity levels.
  • Recognize and limit emotional stress.