DefinitionEczema, also known as atopic dermatitis, is a chronic inflammation of the outer layers of the skin.
CausesThe exact cause of eczema is not known. Factors that may contribute to eczema include:
Risk FactorsEczema is more common in people of African or Asian descent. Factors that increase your chance of eczema include:
- 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
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SymptomsThe 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
DiagnosisYou will be asked 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.
TreatmentThe 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
Skin CareProper 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 your skin is still damp.
- Treat skin infections right away.
MedicationsIn 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
PhototherapyIf 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
PreventionIt is difficult to prevent eczema. This is most true when there is a strong family history.
American Academy of Allergy, Asthma, and Immunology
National Eczema Society
Canadian Dermatology Association
Atopic dermatitis. American Academy of Dermatology website. Available at: http://www.aad.org/skin-conditions/dermatology-a-to-z/atopic-dermatitis. Accessed January 22, 2015.
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 January 22, 2015.
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. Accessed January 22, 2015.
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.
- Reviewer: Michael Woods, MD
- Review Date: 01/2015
- Update Date: 11/06/2014
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