Eczema

What is eczema?

Eczema, also known as atopic dermatitis, is a skin condition that causes dry and itchy patches of skin. It is common in young children but can occur at any age. Eczema is not contagious. It can cover large areas of the body or be limited to a few spots, causing red, inflamed, and itchy skin.

Some key points about eczema include:

  • Symptoms: Dry skin, severe itching, red to brownish-gray patches, small raised bumps that may leak fluid when scratched, and thickened or cracked skin. Itching is often worse at night.
  • Causes: A combination of genetic and environmental factors. Common in families with allergies or asthma. Triggers include stress, irritants, allergens, and weather changes.
  • Types: Includes atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, and seborrheic dermatitis.
  • Treatment: No cure, but treatments include moisturizers, prescription topicals to reduce inflammation, and avoiding triggers.

What are the types of eczema?

  • Atopic dermatitis: the most common form, causing inflammation, dryness, and itchy skin.
  • Contact dermatitis: triggered by environmental allergens or irritants.
  • Dyshidrotic eczema: causes burning sensation, rashes, and blisters.
  • Neurodermatitis: also called discoid eczema, causes scaly, itchy patches.
  • Nummular eczema: also called nummular dermatitis, creates round lesions typically on arms and legs.
  • Seborrheic dermatitis: affects the scalp with inflamed patches.
  • Stasis dermatitis: causes skin discoloration on legs resembling varicose veins.

What causes eczema?

The exact cause is unknown, but risk factors include:

  • Genetic factors: family history of eczema, asthma, or hay fever.
  • Skin barrier dysfunction: weakened barrier that loses moisture and is more sensitive to irritants.
  • Immune system overactivity: inappropriate immune response causing inflammation.
  • Environmental triggers:
    • Irritants: soaps, detergents, shampoos, disinfectants, and juices from fruits or meats.
    • Allergens: pollen, dust mites, pet dander, mold.
    • Microbes: bacteria (Staphylococcus aureus), viruses, fungi.
    • Hot and cold temperatures: extreme temperatures, humidity, and sweating.
    • Foods: certain foods may trigger symptoms in some individuals.
    • Stress: emotional stress can cause flares.

What are the symptoms of eczema?

  • Itching, often severe and worse at night.
  • Redness or pigment changes, varying by skin tone.
  • Dry, scaly, or flaky skin.
  • Inflammation with warmth and swelling.
  • Itchy rash on face, behind knees, wrists, hands, or feet.
  • Oozing and crusting from blisters.
  • Thickened, leathery patches (lichenification) from chronic scratching.
  • Secondary infections marked by redness, warmth, swelling, or pus.

Symptoms can vary by type and may flare up or subside. Management includes skin hydration and treatments to control inflammation and itching.

How is eczema diagnosed?

  • Medical history: symptom duration, family history, known triggers.
  • Physical exam: observation of characteristic lesions in typical locations.
  • Allergy tests: patch or prick tests for suspected contact dermatitis.
  • Other tests: skin biopsy or blood tests to rule out other conditions.
  • Infection tests: swabs or cultures if infection is suspected.

Referral to a dermatologist may be needed for complex cases.

How is eczema treated?

  • Moisturizers: regular creams and ointments to lock in moisture.
  • Topical corticosteroids: reduce inflammation and itching, used under guidance.
  • Topical calcineurin inhibitors: tacrolimus and pimecrolimus for sensitive areas.
  • Topical PDE4 inhibitors: crisaborole to reduce inflammation in mild to moderate cases.
  • JAK inhibitors: ruxolitinib for patients aged 12 and older.
  • Systemic treatments: oral or injectable corticosteroids, immunosuppressants, biologics for severe cases.
  • Antihistamines: reduce itching and improve sleep.
  • Phototherapy: controlled UV light to reduce symptoms.
  • Wet wraps: enhance medication absorption and skin healing.
  • Infection treatment: antibiotics, antivirals, or antifungals if needed.
  • Lifestyle and home remedies: avoid triggers, stress management, healthy diet.

Can diet affect eczema symptoms?

There is no evidence that specific foods cause eczema, but some individuals report symptom worsening after certain foods. Elimination diets may help those with known food allergies. Consult your healthcare provider before making major dietary changes. A balanced diet with fruits, vegetables, nondairy alternatives, and whole grains supports overall health.

Sources

  • What is Eczema? American Academy of Dermatology. Accessed Apr. 17, 2024.
  • What Is Eczema? National Eczema Association. Accessed Apr. 17, 2024.
  • American Academy of Dermatology Guidelines: Awareness of comorbidities associated with atopic dermatitis in adults. Journal of the American Academy of Dermatology. 2022; doi:10.1016/j.jaad.2022.01.009. Accessed Apr. 17, 2024.
  • Atopic Dermatitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Accessed Apr. 17, 2024.