Health Information

Eczema

Eczema

(Atopic Dermatitis)

Definition

Eczema, also known as atopic dermatitis, is a chronic inflammation of the outer layers of the skin.

Causes

The exact cause of eczema is not known. Factors that may contribute to eczema include:

Risk Factors

Eczema is more common in people of African or Asian descent.
Factors that increase your chance of eczema:
  • Asthma or hay fever
  • Urban areas or places with low humidity
  • A family history of eczema or allergic disorders
  • Exposure to certain fabrics, perfumes in soaps, dust mites (common), or foods
  • Stress, especially if it leads to scratching
  • Frequent washing of affected areas
  • Use of rubber gloves in persons sensitive to latex
  • Scratching or rubbing of skin
  • Immunosuppressant medications
Inflamed Lung and Asthma
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Symptoms

The symptoms vary from person to person. Scratching and rubbing can cause or worsen some of the symptoms. Symptoms include:
  • Dry, itchy skin
  • Cracks behind the ears or in other skin creases
  • Red rashes on the cheeks, arms, and legs
  • Red, scaly skin
  • Thick, leathery skin
  • Small, raised bumps on the skin
  • Crusting, oozing, or cracking of the skin
  • Symptoms that worsen in the winter when inside air is dry due to central heating

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. The diagnosis is made by the appearance and location of the rash. You may be referred to specialist. A dermatologist focuses on skin disorders. An allergist focuses on allergies.

Treatment

The main goals of eczema treatments are to:
  • Heal the skin and keep it healthy
  • Stop scratching or rubbing
  • Avoid skin infection
  • Prevent flare-ups
  • Identify and avoid triggers
Treatment options may vary. Your doctor may recommend more than one depending on your condition. They include:

Skin Care

Proper skin care may allow the skin to heal. Treatment may include the following:
  • Avoid hot or long baths or showers. Keep them less than 15 minutes.
  • Use mild, unscented bar soap or non-soap cleanser. Use it sparingly.
  • Air-dry or gently pat dry after bathing. Apply gentle moisturizer when you skin is still damp.
  • Treat skin infections right away.

Medications

In some cases, medication may also be needed and may include:
  • Prescription creams and ointments containing cortisone, tacrolimus, or pimecrolimus
  • Prescription or over-the-counter antihistamines to help prevent itching
  • Antibiotics applied directly to the skin or taken by mouth in order to treat infections
  • Oral medications, such as prednisone or cyclosporine for severe cases

Phototherapy

If skin care and medications are not effective, light therapy may be used. This may include:
  • Treatment with ultraviolet A light and 5-methoxypsoralen (PUVA)
  • Photopheresis—For severe cases

Prevention

It is difficult to prevent eczema. This is most true when there is a strong family history.

RESOURCES

American Academy of Allergy, Asthma, and Immunology http://www.aaaai.org

National Eczema Society http://www.eczema.org

CANADIAN RESOURCES

Canadian Dermatology Association http://www.dermatology.ca

Health Canada http://www.hc-sc.gc.ca

References

Atopic dermatitis. American Academy of Dermatology website. Available at: http://www.aad.org/skin-conditions/dermatology-a-to-z/atopic-dermatitis. Accessed November 6, 2014.

Atopic dermatitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Atopic%5FDermatitis/. Updated May 2013. Accessed November 6, 2014.

Barnetson RS, Rogers M. Childhood atopic eczema. BMJ. 2002;324:1376-1379.

Brehler R, Hildebrand A, Luger T. Recent developments in treatment of atopic eczema. J Am Acad Dermatol. 1997;36:983-994.

Holscher B, Frye C, Wichmann HE, Heinrich J. Exposure to pets and allergies in children. Pediatr Allergy Immunol. 2002;13:334-341.

Mohla G, Horvath N, Stevens S. Quality of life improvement in a patient with severe atopic dermatitis treated with photopheresis. J Am Acad Dermatol. 1999;40(5 Pt 1):780-782.

Saarinen UM, Kajosaari M. Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old. Lancet. 1995;346:1065-1069.

Skin allergy. American Academy of Allergy, Asthma, and Immunology website. Available at: http://www.aaaai.org/patients/allergic%5Fconditions/eczema.stm. Updated May 2013. Accessed November 6, 2014.

Wahn U, Bos JD, Goodfield M, et al. Efficacy and safety of pimecrolimus cream in the long-term management of atopic dermatitis in children. Pediatrics. 2002;110(1 Pt 1):e2.

7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Langan SM, Flohr C, Williams HC. The role of furry pets in eczema: a systematic review. Arch Dermatol. 2007;143:1570-1577.

6/4/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Alexander DD, Cabana MD. Partially hydrolyzed 100% whey protein infant formula and reduced risk of atopic dermatitis: a meta-analysis. J Pediatr Gastroenterol Nutr. 2010;50(4):422-430.

1/4/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Dotterud CK, Storr O, Johnsen R, Oien T. Probiotics in pregnant women to prevent allergic disease: a randomized, double-blind trial. Br J Dermatol. 2010;163:616-623.

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