What is eczema?
Eczema, or atopic dermatitis, is a common and chronic skin condition that can make the skin red and itchy. It commonly affects children, but it can occur at any age. It often begins before age 5 and it can persist into adolescence and adulthood. Eczema is a chronic condition, in that symptoms can flare from time to time.
Clinical Presentation of Eczema
Signs and symptoms vary from person to person and it may include:
- Dry skin
- Itching, which can be severe and occur at nighttime
- Red to brownish-gray patches
- Hands, feet, ankles, neck, upper chest, eyelids, area where elbows bend, area where knee bends
- Infants may also have patches on their face and scalp
- Small raised bumps
- If scratched, bumps may leak fluid, causing crust to form
- Thick, cracked scaly skin
- Sensitive and swollen skin, especially from over scratching
Causes/Risk Factors/Complications of Eczema
The most common cause of eczema is related to a gene variation that affects the skin’s ability to retain moisture and protect the body from bacteria, irritants, and allergens. Food allergies may also be a potential cause of eczema in some children.
Triggers of Eczema
- Soaps, detergents
- Dust, pollen
- Certain foods
Risk factors of Eczema
- Personal or family history of eczema, allergies, hay fever, or asthma
Complications of Eczema
Eczema can predispose people to other conditions and complications such as:
- Asthma and hay fever
- More than 50% of young children with eczema develop asthma and hay fever by age 13
- Skin infections
- Scratching repeatedly causes breaks in the skin. These breaks provide bacteria and viruses a point of entry into the body.
- Allergic contact dermatitis
- People with eczema are more likely to develop allergic contact dermatitis (allergic reaction due to contact with an allergen/skin irritant).
- Chronic itchy and scaly skin
- Eczema affected skin might be very itchy, prompting constant itching. However, some people may continue itching and scratching out of habit, which may cause the skin to become discolored, thick, and leather like.
Treatments of Eczema
The main goal of topical therapies is to control itching and reduce inflammation.
- Corticosteroids: Topical steroids are first line therapies for eczema. Potency of the steroids will depend on the affected area, as low potency corticosteroids should be used for mild eczema, especially on sensitive skin areas (face, neck, skin folds). Medium to high potency steroids should be used for moderate disease, and high potency steroids should be used for acute flares.
- Directions: Apply once to twice daily
- Side effects: thinning of skin
- Low potency: Desonide 0.05%, hydrocortisone 2.5%
- Medium potency: triamcinolone 0.1%, fluocinolone 0.025%
- High potency: fluocinonide 0.05%, triamcinolone 0.5%
- Calcineurin inhibitors: Topical calcineurin inhibitors reduce inflammation, and are often used as an alternative to corticosteroids, especially for application on the face and skin folds. Medications in this group are Tacrolimus 0.1% and Pimecrolimus 1%. These medications should not be used for long term due to possible risk of skin cancer.
- Directions: Applied twice daily
- Side effects: burning, stinging
- Oral therapies: Severe cases may require oral therapies, such as antibiotics and corticosteroids. Antibiotics are given if the skin develops a bacterial infection due to intense scratching and open skin. Oral corticosteroids, such as prednisone, may be given if topical therapies are not effective.
- Injectable biologics: Severe eczema that has not responded to other treatments may be controlled by newer injectable biologics. These medications work by altering the immune system.
It is important to prevent flares of eczema and try to maintain moisture in the skin.
- Apply moisturizer to the skin at least 2 times a day
- Identify and avoid triggers that worsen eczema
- Take shorter baths/showers and use warm water
- Use gentle soaps
- Dry the skin carefully to avoid further irritating the skin
- Atopic dermatitis (eczema). Mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/atopic-dermatitis-eczema/symptoms-causes/syc-20353273. Updated June 12 2020.
- Atopic dermatitis clinical guideline. Aad.org. https://www.aad.org/member/clinical-quality/guidelines/atopic-dermatitis. Accessed March 21 2021.