Atopic dermatitis (eczema) is a condition that makes your skin red and itchy. It’s common in children but can occur at any age. Atopic dermatitis is long lasting (chronic) and tends to flare periodically. It may be accompanied by asthma or hay fever.
Eczema (eg-zuh-MUH) is the name for a group of conditions that cause the skin to become itchy, inflamed, or have a rash-like appearance. There are seven types of eczema: atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, seborrheic dermatitis, and stasis dermatitis.
Eczema, also known as atopic dermatitis, is a chronic, non-contagious, inflammatory skin condition characterized by severe itching, redness, oozing, and scaly rashes. Allergy plays a role in selected patients with eczema.
Eczema comes and goes over time. It results in very dry and sensitive skin, and can be made worse by exposure to many different things, including allergens such as pet dander or dust mites. Other common triggers include soaps, detergents and lotions with heavy fragrances. Exposure to perfumes and cleaning products can also irritate eczema. For some people, weather changes (especially dry winter air) make eczema worse.
Eczema is very common. In fact, over 31 million Americans have some form of eczema. Eczema can begin during childhood, adolescence, or adulthood and it can range from mild to severe.
Eczema is not contagious. You can’t “catch it” from someone else. While the exact cause of eczema is unknown, researchers do know that people who develop eczema do so because of a combination of genes and environmental triggers.
No cure has been found for atopic dermatitis. But treatments and self-care measures can relieve itching and prevent new outbreaks. For example, it helps to avoid harsh soaps, moisturize your skin regularly, and apply medicated creams or ointments.
In fact, the word “eczema” is often used interchangeably with “atopic dermatitis,” though clinically speaking, atopic dermatitis is the most common type of eczema.
Atopic dermatitis is the most severe and chronic (long-lasting) form of eczema. It’s characterized by inflamed skin that may crack and release a clear fluid when scratched (an effect known as weeping). People with atopic dermatitis often experience flares, during which symptoms worsen, and remissions, when symptoms improve or clear up, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases
What Is Eczema?
Eczema, also called atopic dermatitis, is a common skin condition marked by itchy and inflamed patches of skin.
It’s often seen in babies and young children, appearing on the faces of infants. But eczema can come in a variety of types in children, teens, and adults. Read on to learn what causes the skin condition and how to treat its symptoms.
Types Of Eczema
- Contact Eczema (Contact Dermatitis)
- Hand Eczema
There are at least 11 distinct types of skin conditions that produce eczema. In order to develop a rational treatment plan, it is important to distinguish them. This is often not easy.
- Atopic dermatitis: This health condition has a genetic basis and produces a common type of eczema. Atopic dermatitis tends to begin early in life in those with a predisposition to inhalant allergies, but it probably does not have an allergic basis. Characteristically, rashes occur on the cheeks, neck, elbow and knee creases, and ankles.
- Irritant dermatitis: This occurs when the skin is repeatedly exposed to excessive washing or toxic substances.
- Allergic contact dermatitis: After repeated exposures to the same substance, an allergen, the body’s immune recognition system becomes activated at the site of the next exposure and produces dermatitis. An example of this would be poison ivy allergy.
- Stasis dermatitis: It commonly occurs on the swollen lower legs of people who have poor circulation in the veins of the legs.
- Fungal infections: This can produce a pattern identical to many other types of eczema, but the fungus can be visualized with a scraping under the microscope or grown in culture.
- Scabies: It’s caused by an infestation by the human itch mite and may produce a rash very similar to other forms of eczema.
- Pompholyx (dyshidrotic eczema): This is a common but poorly understood health condition which classically affects the hands and occasionally the feet by producing an itchy rash composed of tiny blisters (vesicles) on the sides of the fingers or toes and palms or soles.
- Lichen simplex chronicus: It produces thickened plaques of skin commonly found on the shins and neck.
- Nummular eczema: This is a nonspecific term for coin-shaped plaques of scaling skin most often on the lower legs of older individuals.
- Xerotic (dry skin) eczema: The skin will crack and ooze if dryness becomes excessive.
- Seborrheic dermatitis: It produces a rash on the scalp, face, ears, and occasionally the mid-chest in adults. In infants, it can produce a weepy, oozy rash behind the ears and can be quite extensive, involving the entire body.
What Are The Symptoms Of Eczema?
The main symptom of eczema is itchy, dry, rough, flakey, inflamed, and irritated skin. It can flare up, subside, and then flare up again.
Eczema can occur anywhere but usually affects the arms, inner elbows, backs of the knees, or head (particularly the cheeks and the scalp). It’s not contagious, and, in some cases, becomes less severe with age.
Other symptoms include:
- intense itching
- red or brownish-gray patches
- small, raised bumps that ooze fluid when scratched
- crusty patches of dried yellowish ooze, which can signal infection
- thickened, scaly skin
Scratching eczema further irritates and inflames the skin. This can cause infections that must be treated with antibiotics.
Causes
The cause of eczema is not fully understood. But it’s believed to be triggered by an overactive immune system that responds aggressively when exposed to irritants.
Eczema is sometimes caused by an abnormal response to proteins that are part of the body. Normally, the immune system ignores proteins that are part of the human body and attacks only the proteins of invaders, such as bacteria or viruses.
In eczema, the immune system loses the ability to tell the difference between the two, which causes inflammation.
An eczema flare-up is when one or more eczema symptoms appear on the skin. Common triggers of eczema flare-ups include:
- chemicals found in cleaners and detergents that dry out the skin
- rough scratchy material, like wool
- synthetic fabrics
- raised body temperature
- sweating
- temperature changes
- sudden drop in humidity
- stress
- food allergies
- animal dander
- upper respiratory infections
Diagnosis
To diagnose eczema, your doctor will first conduct a physical examination to look at the state of your skin and see if you have the characteristic rash of the illness.
They may perform a skin biopsy (remove a skin sample for examination) to confirm the diagnosis and rule out other skin conditions.
Your healthcare provider will take a close look at your skin. They will look for classic signs of eczema such as a redness and dryness. They will ask about the symptoms you’re experiencing.
Usually your healthcare provider will be able to diagnose eczema based on examining your skin. However, when there is doubt, they may perform the following tests:
An allergy skin test.
Blood tests to check for causes of the rash that might be unrelated to dermatitis.
A skin biopsy to distinguish one type of dermatitis from another.
Treatment
The main goal of treatment is to eliminate itching, which is uncomfortable and causes or worsens the other symptoms. In some very mild cases eczema can be managed by:
- Avoiding likely sources of irritation (triggers)
- Using emollients such as special bath oils and moisturisers.
- Additional treatment options may be needed if the condition worsens. In some cases, a GP will refer the child to a skin specialist (dermatologist).
Home Care
There are several things that people with eczema can do to support skin health and alleviate symptoms.
They can try:
- taking lukewarm 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 a humidifier in dry or cold weather
- using a mild soap or a non-soap cleanser when washing
- taking extra precautions to prevent eczema flares in winter
- air drying or gently patting the skin dry with a towel, rather than rubbing the skin dry after bathing or taking a shower
- where possible, avoiding rapid changes of temperature and activities that cause sweating
- learning and avoiding individual eczema triggers
- keeping fingernails short to prevent scratching from breaking the skin
- People can also try various natural remedies for eczema, including aloe vera, coconut oil, and apple cider vinegar.
Medications
There are different strengths of corticosteroid creams and ointments available on prescription. that can reduce itchiness and redness. Care needs to be taken, especially if applying a strong corticosteroid as it can cause the skin to become thin. Only thin smears should be applied to the rash. The best time to do this is after a bath, as the skin is more absorbent.
It is not advisable to use a corticosteroid on the face unless prescribed by a doctor. Occasionally, corticosteroid medication may need to be given orally.
Pimecrolimus cream (Elidel) is a steroid-free medication used to treat eczema, and other inflammatory skin conditions. It is available on prescription and can be applied to affected skin on the face, head, and around the eyes where corticosteroid creams are not recommended.
Antihistamines may help the itching. The drowsiness they cause can also be useful at night to conquer sleeplessness caused by the irritation.
In severe cases of eczema, medications to suppress the immune system may be needed to treat the condition.
Skin that is broken and damaged is more likely to be infected by bacteria or fungi (yeasts). One common type of bacterium (Staphylococcus aureus) produces yellow crusts or pus-filled spots. Should bacterial infection occur, this can be treated with a course of antibiotics.
Antibiotics can be applied to the skin as a cream or taken orally in the form of syrup, capsules, or tablets. Fungal infections can be treated with antifungal medication in the form of creams or tablets.
Other therapies
Phototherapy, or ultraviolet (UV) light treatment, may be suggested for severe eczema. Phototherapy involves controlled exposure to UVA and/or UVB rays for a few minutes, two to three times each week. A course of treatment may continue for several months.
Special diets that exclude certain foods (elimination diets) have been effective in treating eczema in some children. However, not all children respond to diet therapy.
