Eczema is a skin condition and a general term for a range of skin irritations that cause the skin to become itchy and/or inflamed. The most common of these is atopic dermatitis, which is also known as atopic eczema. It involves dry, red, itchy skin that sometimes develops blisters and scaly patches. Most people develop eczema in their childhood and continue to experience flare-ups into adulthood. However, your can have clear, healthy skin; preventing eczema, and eczema treatment, are possible.
Itching often precedes an eczema rash. For people with lighter skin, the affected skin turns red or brown, while people with darker skin will experience either darker or lighter colored skin because eczema manipulates skin pigmentation.
Eczema can appear as a rash on the face, wrists, hands, feet, back of the knees, and several other places. Symptoms vary with age but with many similarities.
- Rash appears on knees and creases inside elbows
- Can also appear on the legs, ankles, wrists, neck, and in creases of the buttocks
- Rashes will become thicker over time with a more permanent itch
- Rashes may either become lighter or darker in color over time
- Over time, rashes may look similar to goose bumps
- Rashes can cover most of the body
- Rashes may cause skin to be very dry
- They can lead to skin infection
- Rashes may be perpetually itchy
- Most usually appear on the nape of the neck, knees, and elbows
- Affected skin may be very scaly
- Oozing and crusting of skin can occur
Who is Affected
Researchers and scientists are not exactly sure what causes eczema, and therefore it is difficult to pinpoint who is affected. Generally, the people who develop eczema do so because of a variety of reasons including their own genes and different environmental triggers. It is most common in infants and children (affecting 10-20%), with most growing out of it by adulthood. People who live in drier climates and those who live in cities are also more likely to develop eczema. It is not contagious.
One of the biggest factors that determine if an individual will develop eczema is that it tends to run in families. If you have a close relative with the condition, you are more likely to develop it. However, the genetic link extends beyond eczema. If your relative has asthma or seasonal allergies you are also more likely to develop the skin condition eczema. It is also important to note that eczema is not an allergic reaction.
Another factor is the age of the mother at the time of birth. While the reasoning behind this isn’t clear, babies born to younger women are not as likely to develop eczema as those who are born to older women.
The environment in which a child is born is also a major cause. Those who live in cities with higher pollution levels, those who live in colder climates, and those who are born in higher social classes all run a higher risk of developing eczema.
While these are causes for the initial development of the condition, there are other causes for flare-ups which include:
- Exposure to various allergens such as mold, pollen, dust mites, pets, dandruff
- Hot and cold temperatures such as perspiration during exercise, etc.
- Stress (which tends to worsen the symptoms of eczema)
- Irritants such as disinfectants, shampoos, soaps, detergents, etc.
- Foods can cause a flare-up if the person is allergic (and a person can become allergic to something even if they weren’t allergic to it in the past) such as wheat products, nuts, seeds, eggs, dairy and soy products, meats, and vegetables
- High histamine-containing and histamine-producing foods
- Microbes such as viruses, fungi, and various bacteria
- Hormones can cause women to experience eczema flare-ups. This includes flare-ups during pregnancy and various points in the menstrual cycle.
- Abnormal immune system functioning
How to Diagnose Eczema
Diagnosing eczema is not done with one quick test. The individual may have to visit with their doctor many times before an accurate diagnosis can be made. This is due to the fact that most people experience a medley of symptoms that fluctuate in intensity over time.
While a diagnosis is made based on the patient’s current symptoms, the doctor will also ask about their medical history, taking special note of the existence of any other atopic conditions like asthma and hay fever. The doctor will also likely discuss previous flare-ups that can be pinpointed to exposure to medications, steroids, sleep disturbances, irritants, and different foods.
Various tests can be performed on the individual to rule out other conditions. These include:
- Skin prick test: If the doctor believes that the patient may be allergic to something such as food or pollen, a small amount of the suspected allergen will be inserted into the skin via a needle to examine any possible reaction.
- Food challenges: Food allergies can also be determined by eliminating and then introducing various foods. This is done under supervised conditions.
- Patch testing: Various allergens are placed on the surface level of the skin to determine any possible skin allergies.
The patient may be referred to a dermatologist or allergist for additional treatment or evaluation if the doctor is unable to come to any definitive conclusion.
How to Treat Eczema
Eczema is a skin condition that cannot be cured, only treated. But it can often be prevented. The goal of Eczema treatment is to heal the affected skin and to prevent future flare-ups. The doctor can recommend a treatment plan based on the patient’s age, current health status, and symptoms. Some people are lucky in that their eczema goes away with the passage of time, while others endure it for a lifetime.
What you can do at home:
- Wear loose fitting clothes that are made of soft fabrics like cotton. Avoid scratchy, rough fibers that could irritate your skin.
- After showering or bathing, pat your skin dry instead of rubbing it dry.
- Use a humidifier during the cooler months.
- Take lukewarm or cold baths/showers instead of using steaming hot water
- Use only mild soap that is fragrance free, or just use a washcloth and avoid using soap or body wash (reserve mild soap for hair and pubic hair regions)
- Apply moisturizer to your skin immediately after bathing/showering and drying off, before skin dries out
- Use moisturizer every day; it can be applied as needed throughout the day
- Trim fingernails so itching doesn’t break the skin (which can lead to infection).
- Learn what your own triggers are and how you can avoid them.
- Test eliminating from your diet foods that could be triggers, especially histamine-containing and histamine-producing foods.
Medications and other therapies:
- Anti-inflammatory medications that are used to treat itchiness and inflammation. These are generally topical corticosteroid ointments and creams.
- If the topical corticosteroids are ineffective then systemic corticosteroids may be prescribed. These are taken orally or injected and used for a short period of time.
- UV light exposure or phototherapy. This is used to treat mild to moderate eczema. The individual is exposed to UVA or UVB light waves, or both in combination.
- Antihistamines are sometimes recommended to keep the patient from itching and scratching at night. Some types can make people drowsy and should only be used as a nighttime treatment.
- If the individual has developed a viral or fungal condition due to scratching, medications that treat these conditions will be prescribed.
- Antibiotics may also be prescribed to treat bacterial skin infections, if present.
How to Prevent Eczema
Even though eczema can’t be cured, there are things a person can do to help prevent a flare-up. The first step is figuring out what causes flare-ups and avoiding those issues. Common prevention tips are similar to treatment tips including:
- Only use laundry detergent, dish soap, and body soap that are made for sensitive skin.
- Apply moisturizer daily to help prevent dryness and cracking.
- Petroleum jelly is often a great choice as it is fragrance free and inexpensive.
- Keep fingernails trimmed. Infants and children (and adults!) with eczema can wear cotton gloves or mittens at night to avoid scratching and breaking through the skin.
- Take cooler or cold baths and showers – avoid hot temperatures.
- Pat dry wet skin instead of rubbing it dry.
- Avoid excessive perspiring under clothing, if possible, as it can lead to a flare-up.
- Wear loose fitting, soft clothing to keep skin from getting irritated.
- In dry, arid environments, keep a humidifier working in your home, especially the bedroom
- Extremely hot and humid conditions can also cause flare-ups, so take appropriate action to avoid it if this applies to you.
- Manage stress levels by taking part in healthy practices such as hobbies, regular exercise, laughing, socializing, etc.
- Avoid any foods or other allergens that you notice cause flare-ups, and especially avoid histamine-containing and histamine-producing foods.
The outlook for patients with eczema is relatively good. While 10-20% of infants are born with eczema, only 3% of adults suffer from it, meaning that many infants grow out of it as time goes on. Although eczema can cause serious irritation and sometimes with excessive itching may cause bacterial or fungal skin infections, there are methods of prevention that can be practiced both medically and at home. Several treatments are available including OTC and prescription medications, as well as phototherapy.
Eczema is an umbrella term for a number of skin conditions, the most common of which is atopic dermatitis or atopic eczema. 10-20% of infants are born with the skin condition, but many outgrow it by adulthood.
Symptoms of the condition vary from person to person but generally include itchy, dry, swollen skin that develops on the backs of the knees, feet, wrists, elbows, face, etc. Eczema creates a lightening of the skin in lighter-skinned people, and in darker-skinned people can present as either darkening or lightening of the skin. Sometimes blisters and scaly patches may also develop.
While anyone anywhere can have eczema, people who are born in cooler climates and in families with a history of eczema are more likely to develop it.
Causes of eczema include exposure to various allergens including dust, mold, food allergies, bleaches, fragrances, stress, extreme temperatures, perspiration, hormones, and an abnormally functioning immune system.
Diagnosing eczema is often not done in one visit to the doctor. The doctor takes information about the patient’s current symptoms and medical history and monitors symptoms over time. The individual can also be referred to a dermatologist or allergist who may then perform various tests such as the patch test, skin prick test, and suspected food allergen challenges.
Prescription medications, OTC medications, and various home remedies can be used to help treat the symptoms of eczema. Topical corticosteroids may be used and if those are not effective, then systemic (oral or injectable) steroids may be used. Home remedies include wearing loose fitting clothing, taking cooler showers, and trimming nails to avoid infections and exacerbations of the condition via scratching. UV light therapy may also be used.
Preventing eczema, and treating eczema, can be accomplished by keeping moderate humidity levels in the home with a humidifier, managing stress levels, taking only luke-warm or cool baths/showers, using moisturizer, avoiding food allergens, and eliminating known irritants.
For healthy skin (and eyes) you may also consider using a daily antioxidant supplement that protects your skin.