About Eczema

Eczema, also known as atopic dermatitis, is an itchy inflammation of your skin. It’s a chronic condition and may affect any area of the skin, but it typically appears on the arms, hands and feet, especially elbows, ankles, wrists and behind the knees. It can also appear on the neck, face and upper chest. It tends to flare periodically and then subside. The cause is unknown, but it may result from a combination of inherited tendencies and malfunction in the body’s immune system.

See a dermatologist to get diagnosed, but common symptoms include:

  • Red to brownish-gray colored patches
  • Itching, which may be severe, and worse at night
  • Small, raised bumps, which may leak fluid and crust over when scratched
  • Thickened, cracked or scaly skin
  • Raw, sensitive skin from scratching

It’s important to see a doctor if:

  • You’re so uncomfortable that you feel you cannot function normally or sleep
  • Your skin is painful
  • You think your skin is infected
  • You’ve tried self-care steps without success

Eczema most often begins in childhood before age 5 and may persist into adulthood. For some, it flares periodically and then subsides for a time, even up to several years. Itching may be severe, and scratching the rash can make it even itchier and cause more inflammation. Once the skin barrier is broken, the skin can become infected by bacteria, especially Staphylococcus aureus, which commonly live on the skin. Breaking this cycle can be challenging. Early, effective treatment helps keep eczema from worsening. The more severe it becomes, the more difficult it is to control.

Eczema can be worsened by:

  • Generally dry skin
  • Long, hot baths or showers
  • Stress
  • Sweating
  • Rapid temperature changes
  • Low humidity (using a humidifier in the house in the winter often helps)
  • Solvents, cleaners, soaps or detergents
  • Chemicals such as parabens in lotions
  • Wool or man-made fabrics or clothing
  • Dust or sand
  • Cigarette smoke
  • Living in cities where pollution is high
  • Certain foods, such as eggs, milk, fish, soy or wheat

Treatments aim to reduce inflammation, relieve itching and prevent future flare-ups. Over-the-counter (nonprescription) anti-itch creams and other self-care measures may help control mild eczema.

Self care is important for treatment of eczema in order to relieve itching and minimize flareups. Follow our blogs for latest news and articles on self care for eczema.

Self-care:

  • Try to identify and avoid triggers that worsen the inflammation based on the above list.
  • Avoid scratching whenever possible. If you scratch at night, consider wearing gloves. Or cover the area so you cannot get to it.
  • Apply cool, wet compresses. Covering the affected area with bandages and dressings can help protect the skin and prevent scratching. You can use natural ingredients such oatmeal on the compress.
  • Take a warm bath. Sprinkle the bath water with baking soda, uncooked oatmeal or colloidal oatmeal — a finely ground oatmeal that is made for the bathtub (Aveeno, others). Note that too frequent baths and showers can actually make the condition worse.
  • Moisturize your skin. Use an oil or cream to seal in moisture while your skin is still damp from a bath or shower. Pay special attention to your legs, arms, back and the sides of your body.
  • Use a humidifier, especially in the winter.
  • Wear cool, smooth-textured cotton clothing. Avoid clothing that’s rough, tight, scratchy or made from wool. Wear appropriate clothing to prevent excessive sweating during exercise or if it is hot.

Medications:

  • Corticosteroid creams or ointments. Always talk to your doctor before using any topical corticosteroid. Side effects of long-term or repeated use can include skin irritation or discoloration, thinning of the skin, infections, and stretch marks on the skin.
  • Antibiotics. You may need antibiotics if you have a bacterial skin infection or an open sore or fissure caused by scratching. Your doctor may recommend taking antibiotics for a short time to treat an infection or for longer periods of time to reduce bacteria on your skin and to prevent recurrent infections.
  • Oral antihistamines. If itching is severe, oral antihistamines may help. Diphenhydramine (Benadryl, others) can make you sleepy and may be helpful at bedtime. If your skin cracks open, your doctor may prescribe mildly astringent wet dressings to prevent infection.
  • Oral or injected corticosteroids. For more severe cases, your doctor may prescribe oral corticosteroids, such as prednisone, or an intramuscular injection of corticosteroids to reduce inflammation and to control symptoms. These medications are effective, but can’t be used long term because of potential serious side effects, which include cataracts, loss of bone mineral (osteoporosis), muscle weakness, decreased resistance to infection, high blood pressure and thinning of the skin.
  • Immunomodulators. A class of medications called immunomodulators, such as tacrolimus (Protopic) and pimecrolimus (Elidel), affect the immune system and may help maintain normal skin texture and reduce flares of atopic dermatitis. This prescription-only medication is approved for children older than 2 and for adults. Due to possible concerns about the effect of these medications on the immune system when used for prolonged periods, the Food and Drug Administration recommends that Elidel and Protopic be used only when other treatments have failed or if someone can’t tolerate other treatments. Some patients do not tolerate these medications well either.
  • Light therapy (phototherapy). As the name suggests, this treatment uses natural or artificial light. The simplest and easiest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight. Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light including the more recently available narrow band ultraviolet B (NBUVB) either alone or with medications. Though effective, long-term light therapy has many harmful effects, including premature skin aging and an increased risk of skin cancer. For these reasons, it’s important to consult your doctor before using light exposure as treatment for atopic dermatitis. Your doctor can advise you of possible advantages and disadvantages of light exposure in your specific situation