Eczema Information

Reviewed By: Kimberly Bazar, M.D., AAD

About eczema Eczema is an inflammation of the skin. It is not life-threatening or contagious. However, it typically causes itchiness, discomfort and a dry, scaly rash. The terms “eczema” and “dermatitis” are usually used interchangeably. There are several types of eczema, but most people use the term to refer to the most common variety known as atopic dermatitis. Eczema is a common condition that affects people of all ages and races. It usually begins early in life, typically before the age of 5, and often appears periodically throughout a person’s lifetime. In some cases, the condition will improve over time. In other cases, it will remain chronic (ongoing). Although some children outgrow the condition, they usually are plagued with dry skin that is easily irritated for the rest of their lives. Because the disease is intensely itchy, patients often have the urge to rub or scratch the affected area. However, this only makes the condition worse. Several different triggers for eczema have been identified. They include: Bacteria Abrasive clothing (e.g., wool) Consuming and handling certain foods Illness Jewelry Physical or mental stress Rubbing the skin Soaps, detergents, lotions Perfume Sweating Weather (hot, cold, humid or dry) Exposure to skin irritants (e.g., solvents such as gasoline) or allergens (e.g., dust mites, pollen, mold, pet dander) Eczema is often hereditary and may be found in other family members. People who suffer from severe eczema often also have hay fever or asthma, or have family members who do. Types and differences of eczema There are several different types of eczema. They include: Atopic dermatitis. The most common form of eczema. It may occur in association with allergies and frequently runs in families with a history of asthma or hay fever. It typically begins in infancy (where it is often related to food allergies) and varies in severity during childhood and adolescence before becoming less troublesome in adulthood. However, exposure to certain allergens or irritants can trigger an outbreak later in life. Stress can exacerbate atopic dermatitis. Some people use the term “atopic dermatitis” interchangeably with “eczema.” Contact dermatitis. Results from direct skin contact with various irritants (irritant contact dermatitis) or allergens (allergic contact dermatitis). Irritants include laundry soap, skin soaps and cleaning products. Allergens include rubber, metals such as nickel, jewelry, perfume, cosmetics, hair dye, weeds such as poison ivy, and neomycin, an ingredient often found in topical antibiotic creams. A brief exposure to a small amount of allergen can cause contact dermatitis. However, it takes a more significant amount of an irritant – and a longer period of exposure – to trigger irritant contact dermatitis. Neurodermatitis. Occurs when a tight garment or insect bite irritates the skin, leading to chronic scratching or rubbing and a subsequent rash that is dull red to brown, thickened and slightly scaly. Common locations include ankles, wrists, outer forearms or arms, and the back of the neck. Seborrheic dermatitis. Common in people with oily skin or hair, it involves an overproduction of skin cells and the skin’s natural oil (sebum). It may reoccur depending on the season of the year or whether the patient is under stress. People who have neurologic conditions such as Parkinson's disease or who are immunocompromised such as in HIV patients also are at risk for this form of eczema. Seborrheic dermatitis is often an inherited condition. Stasis dermatitis. Occurs on the lower legs when fluid builds up in tissues just beneath the skin, thinning out the skin and interfering with the blood's ability to nourish the skin. Stasis dermatitis is associated with varicose veins and other chronic conditions in the legs. Perioral dermatitis. Often associated with conditions such as rosacea, adult acne or seborrheic dermatitis of the skin around the mouth or nose. The precise cause is unknown, but exposure to makeup, moisturizers and dental products may be involved. Latex dermatitis. Occurs when the skin comes into contact with latex, a fluid produced by rubber trees and found in gloves, balloons, condoms and other products. Dyshidrotic dermatitis. An intensely itchy, chronic form of eczema that typically appears on the palms, fingers and soles of the feet. The cause of dyshidrotic dermatitis is unknown but may include allergies, exposure to irritants and stress. It often progresses to small, fluid-filled bumps, which peel off after one or two weeks. This leaves cracks in the skin that resolve slowly over time. Signs and symptoms of eczema The signs and symptoms of eczema vary from person to person and may range from mild to severe. In most cases, eczema begins as intense itching, followed by a patchy rash that is red, inflamed, dry and scaly. The rash most often appears on the face, arms and legs, and particularly affects the creases of the hands and feet. The rash often itches or burns and may ooze or become crusty when scratched. Rashes in children under age 2 tend to begin on the cheeks, elbows and knees. In adults, rashes are more likely to begin on the inside surfaces of knees and elbows. Adults are more likely than children to have patches that appear brownish, scaly and thickened. Some people with eczema develop red or clear fluid-filled bumps that look bubbly. Painful cracking also may occur. In some cases, eczema may cause other associated conditions. These may include: Infection. Affects the body through open sores and cracks associated with eczema. Infections associated with eczema include: Impetigo. A form of infection caused by staphylococci bacteria. It is often associated with atopic dermatitis. Cellulitis. Bacterial infection of tissues beneath the skin. Cellulitis manifests as red streaks of skin that are swollen, tender and warm to the touch. It often spreads and has indistinct margins. Cellulitis occurs when a patient’s immune system has been compromised, making it a potentially life-threatening condition that demands prompt medical attention. Lichen simplex chronicus. A toughening of the skin that manifests as small skin patches that become thickened and leathery with a dull red to brown color. It is caused by repeated scratching of the skin. Patients should consult a physician if they experience any of the following in relation to their eczema: Discomfort that causes the patient to lose sleep or become distracted from daily routines Extremely painful skin Indications that the skin may be infected Presence of a fever Failure to see improvement in eczema despite self-care measures Diagnosis methods for eczema To diagnose eczema, a physician will perform a complete physical examination and compile a thorough medical history. Other tests may also be performed. For example, a physician may conduct patch testing that exposes a patient’s skin to various substances to determine if any of the substances inflame the skin, which would be characteristic of contact dermatitis. Allergy testing may occasionally be necessary to identify allergens that may trigger atopic dermatitis. A physician may also take a scraping of the rash and examine it under a microscope to make sure it is not caused by a fungus. Eczema is usually diagnosed if three conditions are present: Characteristic scaly rash Intense itching Personal or family history of asthma, hay fever or other allergies Treatment options for eczema Treatment options for eczema may depend on the type of eczema being treated, and whether it manifests as dry and scaly lesions, dry and thickened lesions or weeping lesions. In general, the goal is to reduce skin inflammation, dryness and itchiness. Medications such as over-the-counter or prescription antihistamines, corticosteroids, antibiotics and antifungal topical creams or ointments may be used. The kinds of treatment are often similar for the different types of eczema. Therefore, in some cases distinguishing between the types is not necessary. Some patients with severe or chronic (ongoing) eczema may wish to consult a dermatologist for treatment. Other treatments, according to type of eczema, include: Atopic dermatitis. Corticosteroid creams and lotions are used to ease symptoms. Recently, topical medications called immunomodulators have been used to treat atopic dermatitis. They affect the immune system and help maintain normal skin texture while reducing flare-ups. Patients whose skin cracks open may use wet dressings with a mild astringent to help contract the skin, reduce secretions and prevent infection. Contact dermatitis. Avoidance of the source of irritation or allergy is the best treatment. Corticosteroid creams or wet dressings provide moisture to the skin that may relieve redness and itching. It may take up to four weeks for this type of dermatitis to clear. Neurodermatitis. Treatment is focused on getting the patient to avoid scratching or further aggravating the skin. Dressings, corticosteroid lotions and creams, and wet compresses may help soothe skin by reducing inflammation and relieving itch. Sedatives and tranquilizers are also sometimes used to prevent patients from scratching. Seborrheic dermatitis. Patients are instructed to frequently shampoo while also carefully rinsing the scalp. A specific shampoo may be suggested that contains ingredients such as tar, zinc pyrithione and salicylic acid. Corticosteroid creams and lotions may soothe the skin and relieve itching. Stasis dermatitis. Treatment focuses on preventing fluid from accumulating in the ankles and lower legs for extended periods. Patients may have to wear elastic support hose or require varicose vein surgery. Wet dressings can also soften the thickened skin and control infection. Perioral dermatitis. Several months of treatment with oral antibiotics is typically recommended. A mild corticosteroid cream may also be prescribed. Latex dermatitis. Avoidance is the best treatment for latex dermatitis. This entails ensuring that the patient does not use or come into contact with latex-based products. Dyshidrotic dermatitis. Topical corticosteroids are usually used to control mild breakouts. More substantial breakouts can be controlled with oral steroids or treatments of PUVA phototherapy (ultraviolet light). Patients with eczema may also need antibiotics or other treatments if they are diagnosed with an associated secondary infection. Prevention methods for eczema Patients with the form of eczema known as contact dermatitis are encouraged to avoid coming into contact with irritating substances – such as poison ivy or harsh soaps – that may trigger the condition. Many other forms of eczema can be partially or fully prevented by avoiding dry skin. Tips for helping to achieve this goal include: Bathe less frequently. When possible, people may opt to bathe just two or three times a week, limiting themselves to 15 minutes of bathing in warm – rather than hot – water. Use mild soaps or synthetic detergents. Mild soaps clean without excessively removing natural oils. Soap substitutes (synthetic detergents) in bar, gel and liquid forms dry the skin less than deodorant and antibacterial soaps. Soap should be used on the face, underarms, genital areas, hands and feet. Clear water can be used elsewhere. Patients should avoid the use of body sponges and washcloths, which can irritate the skin. The hands should be used instead to gently apply soap to the body. Dry skin carefully. Brush the skin rapidly with the palms of the hands, or gently pat skin dry with a soft towel after bathing. Moisturize skin. A moisturizer should be applied whenever the skin appears dry. Lotions should be avoided because they often contain fragrances, alcohol and other irritants which can aggravate the skin. Creams, which contain oil and water, and ointments, which contain only oil, are better choices. It is particularly important to apply moisturizers after a bath, especially on the legs, arms, back and the sides of the body. Applying these products to the skin within three minutes of bathing, while the skin is still damp, helps seal in moisture. Wear gloves in the winter. Exposing skin to cold air with little humidity can dry out skin. Other tips for preventing eczema or for reducing symptoms associated with the disease include avoiding: Substances that provoke allergies (allergens), which may trigger atopic dermatitis. Tight-fitting, rough or scratchy clothing. This can irritate the skin. Wool, linen and some synthetics are especially likely to irritate the skin. Cotton and cotton blends are better choices. Scratching the rash. Patients who find it difficult to control this urge should cover the area with a dressing or even wear gloves at night to minimize damage to the skin caused by scratching. Keeping short fingernails can help decrease the damage scratching causes the skin. Strenuous exercise during a flare-up. Sweating can irritate the rash. Mental and physical stress. Stress can trigger flare-ups. Stress management techniques, such as deep breathing, yoga and meditation can help patients reduce their stress levels. Patients may also benefit from joining an eczema support group. Contact with solvents and soaking in water. People who use solvents or who use water to clean should wear gloves to protect the skin on their hands. Sudden changes in temperature and humidity. An increase in temperature can lead to sweating and a decrease in humidity can dry the skin. In addition, patients with eczema should choose facial cleansers and makeup with care. Products labeled as “hypoallergenic”, “noncomedogenic” and “nonacnegenic” are least likely to irritate the skin. When using a product for the first time, patients should test the product on a small patch of skin that is clear and not irritated.