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.
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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.
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.
- 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.
- 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.
Read more about:
- Which Over-the-Counter Anti-itch Creams Should be Avoided?
- Why Steroid Creams Should Be Used with Caution on the Face
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.