Atopic dermatitis, commonly referred to as eczema, is a chronic skin disorder categorized by scaly and itching rashes. People with eczema often have a family history of allergic conditions like asthma, hayfever or eczema.
What causes eczema and who is at risk?
Eczema is most common in infants (where it is known as infantile eczema) and at least half of those cases clear by age 3. In adults, it is generally a chronic or recurring condition.
A hypersensitivity reaction (similar to an allergy) occurs in the skin, causing chronic inflammation. The inflammation causes the skin to become itchy and scaly. Chronic irritation and scratching can cause the skin to thicken and have a texture like leather. Exposure to environmental irritants can worsen symptoms, as can dryness of the skin, exposure to water, temperature changes, and stress.
Studies have shown that children who are breast-fed are less likely to get eczema. This is also true when the nursing mother has avoided cow's milk in her diet. Other dietary restrictions may include eggs, fish, peanuts, and soy.
- Intense itching
- Blisters with oozing and crusting
- Skin redness or inflammation around the blisters
- In children under 2 years old, skin lesions begin on the cheeks, elbows, or knees
- In adults, the rash more commonly involves the inside surfaces of the knees and elbows
- Dry, leathery skin areas
- More or less pigment than their normal skin tone (see skin, abnormally dark or light)
- Located commonly in the inner elbow or behind the knee
- May spread to the neck, hands, feet, eyelids, or behind the knee
- Raw areas of the skin -- from scratching
- Ear discharges/bleeding
Diagnosis is primarily based on the appearance of the skin and on personal and family history. The health care provider should examine the lesions to rule out other possible causes. A skin lesion biopsy may be performed, but is not always required to make the diagnosis.
Contact your doctor if:
Call and make an appointment with your health care provider if your eczema does not respond to moisturizers or avoiding known allergens, if your symptoms worsen, if treatment is ineffective, or if signs of infection (such as fever, redness, pain) occur.
Consult your health care provider for a diagnosis of eczema because it can be difficult to differentiate from other skin disorders. Treatment should be guided by the health care provider.
Treatment may vary depending on the appearance (stage) of the lesions -- acute "weeping" lesions, dry scaly lesions, or chronic dry, thickened lesions are each treated differently.
Anything that aggravates the symptoms should be avoided whenever possible, including any food allergens and irritants such as wool and lanolin.
Dry skin often makes the condition worse. When washing or bathing, keep water contact as brief as possible and use less soap than usual. After bathing, it is important to trap the moisture in the skin by applying lubricating cream on the skin while it is damp. Temperature changes and stress may cause sweating and aggravate the condition.
Treatment of weeping lesions may include soothing moisturizers, mild soaps, or wet dressings.
Mild anti-itch lotions or topical corticosteroids (low potency) may soothe less severe or healing areas or dry scaly lesions.
Chronic thickened areas may be treated with ointments or creams that contain tar compounds, corticosteroids (medium to very high potency), and ingredients that lubricate or soften the skin. Systemic corticosteroids may be prescribed to reduce inflammation in some severe cases.
The latest treatment for eczema is a class of skin medications called topical immunomodulators (TIMs). These medications are steroid-free. They include tacrolimus (Protopic) and pimecrolimus (Elidel). Studies have shown a success rate as high as 80% among patients using these new medications.