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Eczema (atopic dermatitis) is a skin condition that causes your skin to become red and itchy. It is most common in children, but it can happen at any age. Atopic dermatitis is a chronic condition that flares up from time to time. Asthma or hay fever may accompany it.
There is no cure for atopic dermatitis. Treatments and self-care measures, on the other hand, can alleviate itching and prevent new outbreaks. Avoiding harsh soaps, moisturizing your skin on a regular basis, and applying medicated creams or ointments, for example, can all help.
WHAT ARE THE SYMPTOMS OF ECZEMA?
The signs and symptoms of atopic dermatitis (eczema) vary greatly from person to person and include:
- Parched skin
- Itching that can be severe, particularly at night
- Red to brownish-gray patches, particularly on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the elbow and knee bends, and, in infants, the face and scalp
- When scratched, small, raised bumps may leak fluid and crust over.
- Thickened, cracked, and scaly skin
- Scratched skin that is raw, sensitive, and swollen
Atopic dermatitis typically begins before the age of five and can last into adolescence and adulthood. It flares up for some people on a regular basis and then subsides for a period of time, even years.
WHAT ARE THE CAUSES OF ECZEMA?
Researchers do not know the exact cause of eczema, but many doctors believe it is caused by a combination of genetic and environmental factors.
Children are more likely to develop eczema or another atopic condition if one of their parents has it or another atopic condition. The risk is increased if both parents have an atopic condition.
Some environmental factors may aggravate eczema symptoms. These are some examples:
- Irritants: Soaps, detergents, shampoos, disinfectants, and juices from fresh fruits, meats, and vegetables are examples.
- Allergens: Eczema can be caused by dust mites, pets, pollens, and mold. This is referred to as allergic eczema.
- Microbes: Bacteria such as Staphylococcus aureus, viruses, and certain fungi are examples.
- Temperatures, both hot and cold: Eczema can be exacerbated by extreme heat and cold, high and low humidity, and perspiration from exercise.
- Foods: Eczema flare-ups can be triggered by dairy products, eggs, nuts and seeds, soy products, and wheat.
- Stress: This isn't a direct cause of eczema, but it can aggravate the symptoms.
- Hormones: Females may have more eczema symptoms when their hormone levels change, such as during pregnancy and at certain points in the menstrual cycle.
WHAT ARE THE RISK FACTORS FOR ECZEMA?
Eczema (atopic dermatitis) typically begins in childhood, but it can affect anyone at any age. If you have any of the following characteristics, you are at a high risk:
- Female.
- African-American
- You've been diagnosed with hay fever or asthma.
- A member of a family with dermatitis, hay fever, or asthma.
WHAT ARE THE COMPLICATIONS OF ECZEMA?
Complications
Atopic dermatitis (eczema) complications may include:
- Asthma and hay fever: These conditions are sometimes preceded by eczema. By the age of 13, more than half of young children with atopic dermatitis develop asthma and hay fever.
- Itchy, scaly skin that is chronic: Neurodermatitis (lichen simplex chronicus) is a skin condition that begins with an itchy patch of skin. You scratch the area, making it itch even more. You may eventually scratch simply out of habit. The affected skin may become discolored, thick, and leathery as a result of this condition.
- Infections of the skin: Scratching that breaks the skin repeatedly can result in open sores and cracks. These increase the risk of bacterial and viral infection, including the herpes simplex virus.
- Irritant hand dermatitis: This is especially true for people whose jobs require them to frequently wash their hands and expose them to harsh soaps, detergents, and disinfectants.
- Allergic contact dermatitis: This is a common condition in people who have atopic dermatitis.
- Sleep issues: The itch-scratch cycle can lead to a lack of sleep.
HOW IS ECZEMA DIAGNOSED?
A lab test is not required to diagnose atopic dermatitis (eczema). Your doctor will most likely make a diagnosis based on an examination of your skin and a review of your medical history. He or she may also use patch testing or other tests to rule out other skin diseases or identify conditions that occur in conjunction with your eczema.
Tell your doctor if you suspect a specific food caused your child's rash and inquire about identifying potential food allergies.
WHAT ARE THE TREATMENTS FOR ECZEMA?
Atopic dermatitis can be chronic. To control it, you may need to try several treatments over months or years. Even if treatment is effective, signs and symptoms may reappear (flare).
It is critical to recognize the condition as soon as possible so that treatment can begin. If regular moisturizing and other self-care measures are ineffective, your doctor may recommend one or more of the following treatments:
Medications
- Creams that relieve itching and aid in skin repair: A corticosteroid cream or ointment may be prescribed by your doctor. After moisturizing, apply it as directed. Overuse of this medication may result in side effects such as skin thinning.
Other creams that contain calcineurin inhibitors, such as tacrolimus (Protopic) and pimecrolimus (Elidel), have an effect on your immune system. They are used to help control the skin reaction in people over the age of two. After moisturizing, apply it as directed. When using these products, keep them out of direct sunlight.
These medications are labeled with a black box warning about the possibility of cancer. However, the American Academy of Allergy, Asthma, and Immunology concluded that the risk-to-benefit ratios of topical pimecrolimus and tacrolimus are comparable to those of most other conventional treatments for persistent eczema and that the data does not support the use of the black box warning.
- Infection-fighting medications: If you have a bacterial infection, an open sore, or cracks in your skin, your doctor may prescribe an antibiotic cream. To treat an infection, he or she may advise taking oral antibiotics for a short period of time.
- Anti-inflammatory medications taken orally: Your doctor may prescribe oral corticosteroids, such as prednisone, in more severe cases. These medications are effective, but they should not be used for an extended period of time due to the possibility of serious side effects.
- A newer treatment option for severe eczema: The Food and Drug Administration (FDA) recently approved dupilumab, an injectable biologic (monoclonal antibody) (Dupixent). It is used to treat patients with severe disease who have not responded well to other treatments. Because this is a newer medication, there isn't a long track record of how well it helps people. It has been shown in studies to be safe when used as directed. It is prohibitively expensive.
Therapies
Wet dressings: Wrapping the affected area with topical corticosteroids and wet bandages is an effective, intensive treatment for severe atopic dermatitis. Because it is labor intensive and necessitates nursing expertise, this is sometimes done in a hospital for people with widespread lesions. Alternatively, speak with your doctor about learning how to use this technique at home.
Counseling: People who are embarrassed or frustrated by their skin condition may benefit from speaking with a therapist or other counselor.
Biofeedback, relaxation, and behavior modification: These methods may be beneficial to people who scratch on a regular basis.
Light therapy: This treatment is used for people who either do not improve with topical treatments or relapse quickly after treatment. The most basic form of light therapy (phototherapy) consists of exposing the skin to controlled amounts of natural sunlight. Other types use artificial ultraviolet A (UVA) and narrow band ultraviolet B (UVB) alone or in combination with medications.
Long-term light therapy, while effective, has negative side effects such as premature skin aging and an increased risk of skin cancer. Phototherapy is less commonly used in young children and is not given to infants for these reasons. Discuss the benefits and drawbacks of light therapy with your doctor.
Eczema in infants
Eczema treatment for infants (infantile eczema) includes:
- Identifying and avoiding skin irritants
- Keeping extreme temperatures at bay
- Using bath oils, creams, or ointments to lubricate your baby's skin
Consult your baby's doctor if these measures do not alleviate the rash or if the rash appears to be infected. To control the rash or treat an infection, your baby may require prescription medication. Your doctor may also prescribe an antihistamine to relieve itching and cause drowsiness, which may be beneficial for nighttime itching and discomfort.
HOW CAN ECZEMA BE PREVENTED?
The following suggestions may aid in the prevention of dermatitis flare-ups and the reduction of the drying effects of bathing:
- At least twice a day, moisturize your skin: Creams, ointments, and lotions keep moisture in. Select a product or products that are effective for you. Using petroleum jelly on your baby's skin may aid in the prevention of atopic dermatitis.
- Try to identify and avoid triggers that aggravate the condition: Sweat, stress, obesity, soaps, detergents, dust, and pollen are all things that can aggravate the skin reaction. Reduce your contact with your triggers.
Certain foods, such as eggs, milk, soy, and wheat, can cause flares in infants and children. Consult your child's doctor about potential food allergies.
- Only use gentle soaps: Select gentle soaps. Deodorant and antibacterial soaps can strip your skin of its natural oils and dry it out.
- Reduce the length of your baths or showers: Bathe and shower for 10 to 15 minutes at a time. Also, use warm water rather than hot water.
- Take a bleach bath: To help prevent flare-ups, the American Academy of Dermatology suggests taking a bleach bath. A diluted-bleach bath reduces bacteria on the skin and infections associated with them. Fill a 40-gallon (151-liter) bathtub halfway with warm water and add 1/2 cup (118 milliliters) of household bleach, not concentrated bleach. The measurements are for a standard-sized tub in the United States, filled to the overflow drainage holes.
Soak for about 10 minutes from the neck down or just the affected areas of skin. Submerge the head but do not immerse it. Bathe in bleach no more than twice a week.
- Dry yourself thoroughly: After bathing, pat your skin dry gently with a soft towel and apply moisturizer while it is still damp.
CONCLUSION
Eczema (atopic dermatitis) is completely normal, extremely common, and excruciatingly painful. It can have an impact on your quality of life. Worse, it can keep you awake, distract you, and make you feel self-conscious in public. Consult your dermatologist or other healthcare provider as soon as you notice symptoms. Investigate both at-home and prescribed treatments.
You're not by yourself! Eczema or another type of dermatitis affects 15% to 20% of the population at some point in their lives.