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Eczema

Everything You Need to Know About Eczema

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Updated December 15, 2010

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Eczema

This person has eczema on the arms. Red, scaly plaques can be seen on the inside of the elbows. In adults, eczema usually involves the body creases, or flexural areas.

© ADAM

What is Eczema?

Eczema (also known as atopic dermatitis) is a chronic, recurrent skin disease that commonly occurs in early childhood but can continue or start in adulthood. Like other allergies and asthma, atopic dermatitis tends to run in families.

Read the definition of eczema.

What are the Symptoms of Eczema?

Eczema typically begins as an itch that when scratched, erupts into a rash. The rash may occur anywhere on the body, although certain areas of the body are more common depending on the age of the person. Eczema initially appears as small red bumps, or vesicles, which can ooze or flake with continued scratching. As the skin continues to be scratched, it will appear leathery, or lichenified.

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Where Does Eczema Occur on the Body?

The location of eczema on the body depends upon the age of the person. In infants and very young children, eczema most often involves the face, chest, and back of the scalp, since these are the areas where the child is able to scratch. Eczema doesn’t usually occur in the diaper region, unless the child is able to scratch there.

In older children and adults, the location of eczema often involves the skin in the bend of the elbows and behind the knees, since these flexural areas are the most easily scratched. Eczema can also involve the face, eyelids, and may be limited to the palms of the hands and soles of the feet, particularly in adults.

Do Skin Infections Occur More Frequently in People with Eczema?

In people with eczema, the immune system is more focused on allergies than fighting infections. This means that the skin has less infection-fighting chemicals, giving various bacteria, fungi and viruses a better chance of growing on or infecting the skin.

Colonization and infection of the skin by Staphylococcus aureus bacteria can worsen eczema, and treatment with antibiotics may help improve the eczema. Fungal infections, such as ringworm, are more common in people with eczema, especially if topical corticosteroid creams are used frequently. Viral infections are also more common in people with eczema, such as herpes infections and molluscum contagiosum.

People with recurrent bacterial skin colonization and/or infection can improve their eczema symptoms with the use of bleach baths.

How is Eczema Treated?

  • Eliminating the triggers: Avoiding the triggers of itching should be the first priority for people with eczema. Avoid wearing clothing that can irritate the skin, such as wool, nylon and other synthetic material. Cotton clothing should be worn, and washed with a mild detergent and a double-rinse cycle. The use of fabric softeners should be avoided.

    While cautious sun exposure can be helpful for eczema, over-exposure to the sun, resulting in sunburn, should be avoided. Therefore, sunscreen should be applied liberally to the skin before any prolonged sun exposure.

    People with significant eczema should be evaluated for allergic triggers with allergy testing. Pet dander and house dust mites are environmental allergens that frequently worsen eczema, and common food allergies can worsen eczema, particularly in children.


  • Maintaining good skin care: Good skin care starts with adequate moisturizing and hydration, which decreases itching and formation of eczema. Hydration of the skin is maintained with the daily application of skin moisturizing creams. Bathing can be helpful if done in the correct manner –- daily soaking in a warm water bath, followed by the immediate application of a moisturizing cream from head to toe while the skin is still moist.

Medications for Eczema

  • Oral Antihistamines: Itching may be at least partially controlled with the use of low-sedating antihistamines during the day, or with sedating antihistamines, such as Benadryl (diphenhydramine) at night. It is controversial whether antihistamines are helpful for the treatment of eczema.

  • Topical Steroids: These medications are the first-line therapy for atopic dermatitis, and are available in lotions, creams, ointments and foams or solutions (for the scalp). Topical steroids are available in over-the-counter and prescription strengths. In general, medications in ointment forms are stronger than cream forms, which are stronger than lotion forms. Side effects, such as thinning of the skin, bruising and blood vessel formation, can occur with the prolonged use of high-potency topical steroids.

  • Non-Steroid Creams: Topical calcineurin inhibitors, such as Elidel (pimecrolimus) and Protopic (tacrolimus), are non-steroid, topical medications approved for the treatment of eczema in adults and children over the age of 2 years. They do not cause thinning of or pigment changes in the skin, can be used safely on the face, and can help reduce the amount of topical steroids needed when used for mild symptoms. However, the FDA has given these medications a black box warning based on safety concerns.

  • Systemic (Oral or Injected) Steroids for Eczema: Rarely, short courses of systemic (oral or injected) steroids are required to achieve control of a severe flare of eczema. Extreme caution should be used, as while the eczema typically gets better on systemic steroids, a “rebound effect” can occur with worsening of the skin soon after the steroids are stopped. If oral steroids are required, the dose should be tapered slowly to minimize this risk.

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Learn all you’ve ever wanted to know about itching.

Source:

Leung DYM, Nicklas RA, Li JT, et al. Disease Management of Atopic Dermatitis: An Updated Practice Parameter. Ann Allergy Asthma Immunol. 2004;93:S1-21.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

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