Eczema, also known as atopic dermatitis, is an umbrella term that describes a number of conditions that causes the skin to become red, inflamed, and itchy. Eczema is not contagious, and can occur at any age. Eczema is very common with over 30 million Americans having some form of the condition.
What Is Eczema?
Eczema, also called dermatitis, describes different types of allergic skin conditions that can appear on the body. It usually appears as a rash on the face, hands, feet, inside of elbows, and behind the knees, but can occur anywhere on the body.
Eczema rashes are often red, dry, and very itchy. People with eczema are more likely to develop asthma, though doctors are only beginning to understand the connection between the two. The severity of eczema may change over time, but it is typically a chronic condition.
Types of Eczema
Different types of eczema include:
- Atopic dermatitis: Atopic dermatitis is the most common form of eczema. It is most often seen in children, but can occur in adults as well. Its known causes include stress, allergens, infection, and dry skin. Symptoms include dry, itchy, and cracked skin, and it often occurs in individuals who also experience allergies or asthma. Currently, there isn’t a cure, through certain treatments can help alleviate symptoms.
- Contact dermatitis: Contact dermatitis is usually due to an allergic reaction after direct contact with an irritant, such as poison ivy, or the chemicals found in soaps, creams, and detergents. It can appear as blisters, swelling, bumps, itchy skin, or a red rash.
- Dyshidrotic eczema: Dyshidrotic eczema is typically caused by direct contact with allergens, and presents with itchy blisters, most commonly on the feet or hands.
- Nummular eczema: Nummular eczema is a chronic condition related to extremely dry skin or direct contact to allergens. It appears as circular spots which can ooze fluid, and is especially common in more senior adults.
- Seborrheic dermatitis: Seborrheic dermatitis causes yellow or white scaly patches, with greasy skin around the area. It is most commonly seen on the scalp, but can also affect the back, face, and chest. Though research is limited, it’s believed that Malassezia, a fungus, and oils from overproducing glands, are the main culprits.
- Stasis dermatitis: Stasis dermatitis occurs when the legs have poor blood circulation, causing veins to swell. This causes generalized inflammation in the skin of the lower legs, which can become red, itchy, and uncomfortable. It is most common in older adults with chronic medical conditions, including heart problems and diabetes.
Symptoms can vary depending on the type of eczema you have, however there are some characteristics that are common to all of them. Symptoms of eczema can also vary depending on the age that you contract it. For example, eczema in children may present differently than eczema in adults.
Symptoms in those under two years old:
- Rashes that bubble up and ooze fluid
- Rashes that show up on the cheeks/scalp
- Extreme itchiness
Symptoms in those two years to puberty:
- Rashes behind the knees, legs, or elbows, or on the ankles, neck, wrists, and buttocks
- Rashes that are thick or bumpy
- Chronic itchiness
- Overlying skin infections
Symptoms in adults:
- Rashes around the knees, elbows, or neck
- Extremely dry skin
- Chronic itchiness
Causes of Eczema
The causes of eczema are unclear and are not singular. It is believed that eczema can be caused by a variety of factors, which can include:
- Abnormalities in the immune system
- Genetic predisposition
- Endocrine system disorders
- Skin barrier issues that allow germs to enter and moisture to leave
While not the primary causes of eczema, there are also things that can trigger flare ups and make symptoms worse if you are predisposed to developing eczema. These factors include:
- Skin irritants like itchy clothes, perfumes, fragrant soaps, etc.
- Cold and/or dry weather
- Prolonged exposure to moisture such as being in a pool too long or excessive sweating
- Allergic reactions
- Cigarette smoke
How Is Eczema Diagnosed?
To get an accurate diagnosis, doctors first complete a thorough exam to check your skin and perform a thorough medical history. They’ll look closely at the location and physical appearance of the rash and ask questions about rash patterns, possible triggers, and the severity of your symptoms. They will also ask about your family history of eczema.
It is important to note that eczema can sometimes be mistaken for other conditions, such as psoriasis or lupus, so your doctor may use additional tests to confirm a diagnosis.
- Patch test: If your doctor suspects allergic dermatitis, they might administer a patch test to determine the specific causative allergen. During a patch test, they’ll apply small dots of different allergens to your back. After 48 hours, they’ll note which allergens caused a skin reaction.
- Skin biopsy: If a physical exam or patch test were not sufficient to provide an accurate diagnosis, doctors may order a skin biopsy. They’ll remove a small piece of your skin to send it to a pathology lab for testing. Biopsy results typically take between 3-7 days.
Eczema Treatment Options
Unfortunately, there is no cure for eczema, but many treatments are effective at preventing and relieving symptoms during flare-ups. These treatments include:
- Eczema creams: Eczema creams can aid in hydrating your skin and reducing itchiness and inflammation. These can range from over-the-counter (OTC) options or prescription creams containing higher concentrations of corticosteroids.
- Antibiotics: Doctors might order antibiotics for you if your rash develops a secondary bacterial infection.
- Phototherapy: Phototherapy, also known as light therapy, can help reduce inflammation and itchiness, in addition to helping the skin fight bacterial infections. The most common form is with narrowband ultraviolet B (UVB) light.
- Antihistamines: Doctors may prescribe antihistamines for severe itching. These can be in the form of pills or creams.
- Topical immunomodulators: Protopic and Elidel are two skin creams that are FDA approved for eczema treatment. They change the response of the immune system to prevent eczema symptoms from worsening. There is a possible risk of cancer associated with their use, so doctors should prescribe them with extreme caution. Use them for short-term treatment only, and never in children under two years of age.
To help clear up eczema and prevent symptoms from getting worse, try these at-home guidelines:
- Apply fragrance-free and dye-free moisturizer daily, especially immediately after bathing
- Use a mild cleanser or soap when bathing
- Use a humidifier
- Avoid rubbing your skin with a towel after bathing; pat gently or air dry instead
Many people have found that avoiding certain foods can help prevent flare ups of eczema. Do not eat the following when following an eczema diet to see if it makes a difference for you:
Who Is at Risk for Eczema?
Individuals at a greater risk for eczema are:
- Babies and children: More than half of people who go on to develop atopic dermatitis experience symptoms by age one, with almost all experiencing symptoms by five years old.
- Those prone to allergies: Allergens connected to eczema include mold, animal dander, pollen, and some foods.
- Individuals with a genetic history: If you have a family history of eczema, asthma, or other atopic conditions, you will be at a higher risk for it yourself.
- Exposure to environmental factors: Eczema symptoms can worsen with exposure to extreme temperatures, skin irritants (i.e. cosmetics, chlorine, detergents), dry air, and by not moisturizing after bathing.
Eczema Complications and Related Conditions
Complications of eczema and related conditions can include the following:
- Fungal and bacterial skin infections
- Herpes simplex virus
- Eye problems
- Asthma/other allergies
- Sleep issues
- Erythroderma (a chronic inflammatory skin condition)
When to See a Doctor
You should make sure to see a doctor if you have any of the following symptoms:
- Blisters, crusting, or thick discharge: If this develops over an existing eczema rash, it might be indicative of a superimposed bacterial infection that requires antibiotics.
- Persistent inflammation: If your inflammation isn’t responding to OTC creams, your doctor may need to give you a prescription for something stronger.
- Exposure to a skin disease: If you are exposed to someone who currently has a viral skin disease (i.e. genital herpes), eczema could increase your chance of contracting it. If you develop small blisters that are painful and filled with fluid near your eczema, you could have eczema herpeticum, a rare but serious complication.
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