What Is Eczema (Atopic Dermatitis)?
Eczema (atopic dermatitis) is a non-contagious chronic skin condition that produces an itchy rash. It is caused by a genetic condition that affects the skin's ability to protect itself from bacteria and allergens. The most susceptible are those with a family history of atopic dermatitis, asthma, or hay fever [1,2].
Infants will have a dry, scaly, itchy rash on the scalp, forehead, and cheeks. Older children will have the rash in the creases of elbows, knees, and buttocks.
Without treatment, a child may have trouble sleeping due to the intense itching. Constant scratching may cause skin infections.
Eczema cannot be cured, but it can be controlled through prescribed medications, skin care, stress management, and treatment of food allergies. People with eczema often have allergies to milk, nuts, and shellfish . Keeping the skin clean and moisturized helps prevent flares.
You should go to your local pharmacy or retail clinic to be treated. The usual treatment for atopic eczema involves avoiding irritants and other triggers, using moisturizers to prevent inflammation, as well as steroid creams and ointments when the inflammation flares up.
Eczema (Atopic Dermatitis) Symptoms
Eczema typically first occurs in children under the age of five. It may be constantly present or may relapse and recur. Eczema may resolve as they get older, or it may persist into adulthood. A diagnosis is made through physical examination, medical history, and allergen skin tests .
Symptoms of eczema vary from person to person and may include:
- Dry skin
- Sensitive skin: This may appear raw or swollen from repetitive scratching of itchy areas.
- Red to brown patches of skin: This may occur inside the bend of the elbows and knees, on the hands and feet, at the wrists and ankles, and on the neck and chest.
- Thickened skin that may be cracked and/or scaly
Symptoms of infected skin
Constant scratching predisposes people with eczema to infections with bacteria and viruses.
Signs of infected skin include:
- Red streaks
- Pus and fluid oozing from the skin
- Yellow scabs or crusting on the skin's surface
Other complications of eczema include:
- Asthma and allergies: These three conditions (asthma, allergies, and eczema — the atopic triad) frequently co-occur, but eczema often is experienced first.
- Neurodermatitis: Years of repetitive scratching of the skin can cause it to become discolored, thick, and leathery.
- Insomnia: The constant urge to scratch can impair sleep quality.
- Contact dermatitis: When the skin comes in proximity to certain materials, such as detergents and metals, this type of allergic skin reaction is especially common in people who have eczema.
- Irritant hand dermatitis: Skin can become especially irritated when wet or exposed to chemicals.
Eczema (Atopic Dermatitis) Causes
Eczema (atopic dermatitis) often occurs with asthma and seasonal allergies ("atopic" means sensitive to allergies and "dermatitis" refers to skin inflammation).
The exact cause of eczema is not completely understood. It likely stems from a combination of factors :
- Genetics: Eczema and other atopic conditions run in families. Genes linked to eczema also affect the skin and immune system.
- Skin (epidermal) barrier dysfunction: Because the skin cannot easily retain moisture, it may be more susceptible to irritation, allergens, and microbes.
- Immune system overactivity: This leads to inflammation.
Triggers of eczema vary from person to person and change throughout the lifespan. Some common triggers include :
- Environmental exposures: This includes pet dander, dust, pollen, mold, dry air, and smoke.
- Fragrant products: Soaps, detergents, and perfumes can cause this reaction.
- Body states: Eczema may flare during stress, hormonal changes (e.g., during a woman's period), or sweating.
- Food allergies: Cow's milk, eggs, peanuts, soy, or wheat can cause this reaction.
Eczema (Atopic Dermatitis) Symptom Checker
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Treatment Options and Prevention
Although eczema cannot be fully cured, there are many treatment options that can begin at home, starting with mild, responsible skincare described below. Other treatments can be given by your physician.
Moisturize to prevent eczema flares
Non-fragrant ointments and creams such as Eucerin cream or petroleum jelly help skin heal and reduce itch. Moisturizers should be used at least twice daily and more frequently if skin becomes dry in between applications. The American Academy of Dermatology (AAD) recommends selecting a moisturizer with the following qualities :
- Fragrance-free instead of unscented: Unscented moisturizers can contain masked fragrances that can still irritate eczema-prone skin.
- Cream or ointment: These are more effective than lotions.
- Fits your budget
- You or your child likes it enough to use it regularly
Avoid irritants and limit skin damage
Use a journal to identify new foods or products (such as a change in soap or detergent) that are associated with worsening eczema and try to reduce exposure to potential irritants. To prevent damage to the skin, you should try to reduce scratching as well as:
- Consider using mittens or bandages to prevent scratching
- Keep nails short
- Cover skin with light clothing
- Gently rub your skin with the fingertips instead of scratching with nails
Further skin maintenance
Beyond limiting scratching as much as possible, there are methods of skincare that can be practiced long-term for better maintenance .
- Use gentle soaps: Mild soaps are preferred. Additional antibacterial or deodorant chemicals can remove excess natural oils that protect your skin.
- Take short baths and showers: Baths and showers should be limited to five to 15 minutes and avoid hot water, which can dry the skin. Avoid directly washing any skin with eczema.
- Avoid bubble baths or bath oils: These can trigger eczema flares.
- Dry your skin gently: Avoid rigorous toweling after showers or bathing. Instead, gently pat your skin with the towel and moisturize promptly.
- Use a humidifier: This helps prevent dry indoor air that can worsen itchy skin.
- Use bleach baths to prevent infection and improve eczema: The bacterium Staph aureus is common on the skin of people with eczema. The AAD recommends bleach baths two to three times per week to control Staph and potentially suppress the inflammation associated with eczema . The AAD recommends adding a half cup of bleach to a full tub or water or one-quarter cup to a half tub. If the bleach is irritating, consider adding some baking soda or Epsom salts to the water to make it more soothing. Bleach baths are not a quick turnaround fix but have been shown in studies to help eczema improve over time.
Treatment of eczema during flare-ups
Treatments that may be used during eczema flare-ups include the following [8,9].
- Topical corticosteroids: Anti-inflammatory creams or ointments such as hydrocortisone or triamcinolone can reduce itching, redness, and swelling. These medicines should be applied as directed by your physician, usually 30 minutes or more aftermoisturizing — a very important step.
- Calcineurin inhibitors: Stronger creams, such as tacrolimus (Protopic) can also be used to reduce inflammation.
- Antibiotics: If the skin appears infected, your physician may temporarily prescribe topical or oral antibiotics.
- Light therapy (phototherapy): Regimens of controlled sunlight exposure have been found effective in some cases of eczema.
- Oral corticosteroids: In severe cases, your physician may prescribe oral steroids. These are typically only used for a short period of time (five to seven days) due to a variety of potential side effects.
- Dupilumab: A new antibody-based treatment can be given via injection to people with severe eczema that is not controlled by the more conventional treatments listed above.
Additional treatment for itching
Additional treatment options for cases of itching include the following.
- Mind-body exercises: Relaxation exercises and biofeedback can be helpful for people who scratch excessively.
- Antihistamines: Include diphenhydramine (Benadryl), which can help relieve itchiness. However, many antihistamines are sedating, so they may not be ideal for the school or workday.
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When to Seek Further Consultation
A variety of treatments are available to control eczema. If your eczema is not controlled on your current regimen and it is impairing your daily functioning at school/work or home, then see your physician to discuss the next level of treatment options.
If skin appears infected
If a patch of skin is warm, swollen, and painful or has evidence of pus or yellow crusting, contact your physician. Infected skin may require antibiotics to properly heal. If the skin appears infected and you or your child has a fever, seek immediate medical attention.
If you think that you need to change your or your child's diet to prevent eczema
Speak with your physician before making dietary changes to ensure that adequate nutrition is received.
Questions Your Doctor May Ask to Diagnose
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Any fever today or during the last week?
- Is your skin change constant or come-and-go?
- How long have your skin changes been going on?
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Does the rash have a clearly defined border?
If you've answered yes to one or more of these questions
Eczema (Atopic Dermatitis) Symptom Checker
Take a quiz to find out if you have Eczema (Atopic Dermatitis)
- Atopic dermatitis (eczema). Mayo Clinic. Published March 6, 2018. Mayo Clinic Link
- Eczema and atopic dermatitis. American Academy of Family Physicians: FamilyDoctor.org. Published June 8, 2017. FamilyDoctor.org Link
- Katta R, Schlichte M. Diet and dermatitis: Food triggers. The Journal of Clinical and Aesthetic Dermatology. 2014;7(3):30-6. NCBI Link
- Atopic dermatitis. National Institutes of Health: National Institute of Arthritis and Musculoskeletal and Skin Diseases. Published July 31, 2016. NIAMS Link
- Eczema causes and triggers. National Eczema Association. National Eczema Association Link
- Eczema friendly moisturizer: How to select. American Academy of Dermatology. AAD Link
- Eczema and bleach baths: Follow dermatologists' instructions to keep children safe. American Academy of Dermatology. Published January 8, 2014. AAD Link
- Eczema (atopic dermatitis) treatment. National Institutes of Health: National Institute of Allergy and Infectious Diseases. Published May 24, 2017. NIAID Link
- What to do when AD flares? National Eczema Association. National Eczema Association Link
- What is eczema? National Eczema Association. National Eczema Association Link
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