Eczema (Atopic Dermatitis)
Eczema is a condition where skin becomes dry and irritated. If severe, eczema can also cause the skin to crack and sometimes bleed.
While doctors are unsure of the exact cause of eczema, it is thought to be a combination of several factors: genetics, immune dysfunction, and environmental exposures, including irritating soaps or changes in the weather.
While children are more likely to have eczema, people can develop eczema at any age. Some children will grow out of it, but it may return again in later years. Those with asthma, hay fever, and certain allergies are more prone to eczema than others. Additionally, a family history of eczema, or asthma and hay fever, can increase the risk of developing eczema. Everyone has bacteria on the skin, but sometimes the balance of this bacteria can be upset, and this can cause eczema to flare.
Eczema presents with dry, itching skin that can be red and cracked, or can occasionally be bumpy. Severe forms of eczema can cause fluid to come out from the cracks left in the skin. If left untreated, these cracks can allow bacteria and viruses to penetrate the skin and lead to a more serious infection.
Eczema can be diagnosed by physical exam of the skin. If there is concern that a patient’s eczema is related to allergies, a referral to an allergist may be necessary.
Eczema cannot be cured, but needs to be managed chronically. Occasionally, changes to a patient’s skin care routine are all that is needed to maintain clear skin. Flares and poorly controlled eczema can be treated with medicated ointments or creams. Antibiotics may necessary if there is concern for infection. Similarly, bleach baths or vinegar water soaks may be used to prevent infections.
As fragrances, dyes, and other chemicals can exacerbate eczema, it is important to use fragrance free and sensitive skin self-care and laundry products. Avoid alcohol based products, including aerosol sprays and waterless hand sanitizers, as alcohol is very drying for the skin. Antihistamines taken routinely can decrease the itch associated with eczema and are particularly helpful in patients with associated hay fever and seasonal allergies.
Because eczema cannot be cured, a patient will always have the tendency for flares of the skin. And while hereditary eczema cannot be prevented, the frequency and severity of the flares can be managed with good skin care and avoidance of irritants.
Is there a cure for eczema?
Unfortunately there is no cure for eczema, but it can be well managed with proper skin care.
What are common treatments for managing eczema?
There are a number of ways to manage eczema, all of which begin with an effective skin care routine. The following are common treatments used to help manage eczema.
Emollient is the medical term for a non-cosmetic moisturizer. Emollients are required to reduce water loss from skin, and prevent the dryness that is typically associated with eczema. By providing a seal or barrier, the skin is less dry and itchy, and more comfortable.
Emollients are safe to use as often as is necessary and are available as lotions, creams, gels and ointments. Ointments are preferable for very dry, cracked skin. Creams and lotions are lighter and suitable for mild to moderate eczema.
When eczema is under control, the continued use of emollients is all that is needed. However, when the eczema flares up and the skin becomes inflamed, a steroid cream or ointment may be required.
Topical steroids act by reducing inflammation and are used in most types of eczema. Topical steroids should not be confused with the steroids used by body-builders.
Topical steroids are available in different strengths. The strength and potency of steroid cream/ointment that a healthcare provider prescribes depends on the age of the patient, the severity of the condition, the part of the body being treated and the size of the area of eczema.
Your doctor will also take into account any other medications being taken. Topical steroids should be applied to the affected area, as directed by the prescribing doctor.
How can I reduce the itching?
Itching is one of the worst symptoms of eczema. There are many methods to reduce the itchiness of the skin and minimize the damage of scratching. Cotton clothing and bedding keep the skin cool and allow it to breathe, whereas synthetic fabrics and wool can irritate the skin.
The use of a free & clear detergent and avoidance of fabric softener can also help to reduce the itchiness of the skin. Nails should be kept short to prevent injury to the skin from scratching. Frequent application of fragrance free emollients, especially after bathing, help repair the skin barrier and minimize the itch. At nighttime, a cool bedroom temperature can be helpful as heat can trigger itching.
For children in particular, the itchiness of eczema can be very distressing. Distraction is often the best way of reducing scratching. Cotton mittens or all-in-one sleep suits can be helpful in reducing the damage to the skin occurring during sleep.
How can I tell if my eczema is infected? What are the signs?
If you think that an infection is present, you should see your doctor as early as possible so that it can be treated accordingly. Infection may be suspected if:
- The skin has blisters, pustules or dry crust.
- The skin is weeping a clear or yellow fluid.
- There is reddening, itching, soreness and sudden worsening of the eczema.
- Yellow pus spots appear.
- There are small, red spots around the body hairs.
- You have a raised temperature, and flu-like symptoms.
- You have swollen glands in the neck, underarms or groin.
The possibility of infection should always be considered in eczema that is getting worse or not responding to emollient and topical steroid treatment.
I find that winter makes my eczema worse. What can I do to keep it under better control?
Many people find that the cold winter months can exacerbate their eczema. Here are some measures you can take to reduce the impact.
- If you want to wear wool clothing or gloves, wear cotton or silk clothing underneath and avoid direct contact of wool with the skin.
- Wear loose, thin layers of clothing so that items can be added or removed according to temperature.
- Apply emollient ointment or Vaseline to lips to stop them from drying out.
- Apply your preferred emollient, especially to exposed areas such as your face, neck and hands, before going outside. Apply routinely twice a day.
- If you find that your skin is drier in winter, switch to a heavier emollient ointment during this season.
- Avoid fast changes of temperature extremes, such as getting out of a hot bath and going into a cold room.
- Do not have your central heating on too high, as sweating can aggravate eczema.
- Central heat can also dry out the air in a home, making regular use of an emollient that much more important. Consider using a humidifier during the winter months.
- Resist the temptation to take very hot, long showers in the winter, as this can dry out skin more. Instead, use warm water and limit baths or showers to 5-10 minutes.
Is there a mosquito repellent suitable for people with eczema?
Unfortunately, all mosquito repellents applied to the skin can cause some irritation. This is especially true of liquid repellents, which are alcohol-based and can sting. Test any repellent on your own forearm first and wait 24 hours to see if you have a reaction.
Some people have found that ankle and wrist bands, which are impregnated with DEET, cause fewer problems. However, long-sleeved cotton tops, trousers and socks, especially at night, will provide the most protection and the least irritation.
Will my child grow out of her/his eczema?
Unfortunately, there are no guarantees that a child will grow out of eczema. However, research has shown that 65% of children will be free of eczema by the time they are 7 years old, and 74% by the time they reach 16 years of age.
My child is starting school - have you any advice?
School or nursery should not present problems for a child with eczema if time is taken to ensure that the teachers and nursery staff are aware of the child’s diagnosis and skin care needs. Several steps can be taken to provide teachers information and tools to help maintain control of a child’s eczema:
- Tell the school if the child has to take antihistamines, as they can make a child a little drowsy first thing in the morning.
- Provide the school or nursery with a pump dispenser of an emollient to be used frequently throughout the day.
- Also provide soap for sensitive skin to use for hand-washing. Avoidance of hand sanitizer and wipes is important for avoiding flares.
- In the classroom, ask the teacher if your child can have a desk away from direct sunlight or a radiator as this will help prevent the child from getting too hot and itchy.
Can changing mine or my child’s diet help?
Dietary changes can be quite helpful in babies and young children, where the emollients and topical steroids have failed to control the eczema. Children under 5 are at the greatest risk of having their symptoms worsened by food allergies.
It is thought that in about 30% of children with eczema, food may be one of the causes, but a much smaller group than this (about 10%) will have food as their main or only trigger. This means that only a small number of children will be helped by changes in their diet. In other words, it is rarely diet alone that triggers eczema.
The evidence for changing diet in older children and adults is inconclusive and only a small number of adults are helped by diet changes. Also, finding the trigger can be difficult because of the wider variety of foods typically eaten by adults.
In children, dietary changes should not be made without the advice of a healthcare professional.
Eczema: Tips to help your child feel betterThese skin care tips from dermatologists can help reduce eczema flare-ups. Learn more: https://www.aad.org/public/diseases/eczema/eczema-resource-center
Eczema: Bleach bath therapyIf your child's dermatologist recommends bleach baths, follow these important steps for giving a bleach bath. Learn more: https://www.aad.org/public/diseases/eczema/eczema-resource-center
Eczema: Consejos para que sus hijos se sientan mejorEstos consejos de cuidado de piel de dermatólogos pueden ayudar a reducir los brotes de eccema.
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