Eczema
Eczema, also known as dermatitis, is a noncontagious inflammation of the skin characterized by symptoms such as red, dry, itchy skin, scaling, thickening, and cracking. It often occurs in various forms, with atopic dermatitis being the most common, typically beginning in infancy or childhood but potentially persisting into adulthood. The causes of eczema are multifaceted and may include genetic predispositions, environmental irritants such as soaps and rough fabrics, allergens like certain foods and pollen, and climate changes. Emotional factors can also exacerbate the symptoms.
While there is no cure for eczema, managing the condition primarily involves minimizing exposure to known irritants and allergens, along with symptomatic treatments. Dermatologists may recommend corticosteroid creams, antihistamines, and, in severe cases, systemic corticosteroids or phototherapy. Lifestyle modifications, including proper skin care, stress management, and avoiding scratching, play a crucial role in control. Additionally, some patients may benefit from alternative therapies such as oatmeal baths or wet dressing techniques. Eczema can lead to complications, including sleep disruption, infections, and behavioral issues, highlighting the importance of comprehensive care and management.
Subject Terms
Eczema
ALSO KNOWN AS: Dermatitis
ANATOMY OR SYSTEM AFFECTED: Skin
DEFINITION: An inflammation of the skin.
CAUSES: Genetic sensitivity to irritants (soaps, detergents, rough clothes), allergens (certain foods, pollen, animal dander), and climate or temperature changes
SYMPTOMS: Red, dry, and itchy skin; scaling, thickening, or cracking of skin
DURATION: Often chronic
TREATMENTS: Minimal exposure to irritants, drugs (corticosteroid creams and ointments, antihistamines, antibiotics); in severe cases, oral corticosteroids or phototherapy
Causes and Symptoms
The term eczema refers to a noncontagious inflammation of the skin. Several types of eczema exist, resulting in a range of symptoms that vary in appearance, duration, and severity. The common characteristic, however, is red, dry, and itchy skin. Other symptoms may include scaling, thickening, or cracking of the skin, leading to infections and severe discomfort.
Atopic dermatitis, the most common form of eczema, is characterized by itchy and cracked skin of the cheeks, arms, and legs. The onset of this chronic type of eczema occurs most often during infancy or childhood, although symptoms may continue into adulthood. The cause of atopic dermatitis unknown but is thought to be at least partly due to a hereditary predisposition to skin sensitivities to various environmental factors. These factors include irritants such as soaps, detergents, and rough clothes; allergens such as certain foods, pollen, or animal dander; and changes in climate or temperature. Other forms of eczema, such as contact dermatitis, have similar environmental causes. Seborrheic eczema, nummular eczema, and dishydrotic eczema may result from a combination of several possible causes.
Emotional factors, such as stress or frustration, may aggravate symptoms. Because most people with eczema are also found to have certain bacteria on the skin, notably Staphylococcus aureus, a bacterial connection is also hypothesized. Some studies have also linked eczema to immune system dysfunction. The condition is also often found in conjunction with hay fever and asthma, although the exact nature of the connection is not known.
If left untreated eczema can cause a variety of complications beyond the characteristic itchiness and dry skin. Repeated itching and scratching can become a habit and cause a condition known as neurodermatitis or lichen simplex chronicus, in which the scratched area of skin becomes thickened and discolored. Scratching may also break the skin and increase the risk of infection. If the eye area is affected by eczema the patient may be at risk of damaging the eyelid through scratching. Eczema can also cause behavioral issues, such as sleep disruption and depression. A link between atopic dermatitis and attention-deficit hyperactivity disorder (ADHD) has been suggested by some studies.
The diagnosis of eczema requires a careful and detailed observation of symptoms. Family and personal medical histories are often useful to determine the presence of allergies or exposure to allergens or irritants. Dermatologists may also use skin biopsies or blood tests to determine a tendency toward elevated allergic or immune response.
Treatment and Therapy
There is no known cure for eczema, as no single cause has been identified. The treatment of eczema involves minimizing exposure to possible causes while at the same time managing symptoms to maintain a high quality of life. Identifying known allergens and irritants specific to the individual is an important first step. Lifestyle changes aimed at avoiding exposure to these possible causes can lower the frequency and duration of symptoms dramatically. Proper skin care to avoid excessive drying of the skin, including the use of moisturizers or creams and minimizing exposure to water, may also help reduce skin irritation. Avoiding scratching of existing irritations and eliminating sources of emotional stress are other ways that patients can lessen the severity of their symptoms. Any scratched areas that have become infected should be referred to a doctor and may require antibiotics.
Dermatologists may prescribe additional treatments, such as corticosteroid creams and ointments, antihistamines (particularly diphenhydramine for serious itching), or antibiotics. In more severe cases, systemic injected or oral corticosteroid treatments, such as prednisone, or phototherapy—the use of ultraviolet (UV) light—may be tried. When other treatments do not work a doctor may prescribe calcineurin inhibitors such as tacrolimus (Protopic) and pimecrolimus (Elidel), which are applied in ointments to help reduce itching and flareups and protect the skin. However, these drugs affect the immune system and carry potentially strong side effects.
Other therapies have been shown to be effective in treating eczema to certain degrees. The practice of wet dressing, which uses topical corticosteroids together with wet bandages has been demonstrated to control symptoms, though it is not always practical outside of a hospital setting. The amount of potentially harmful skin bacteria can be reduced by taking a bath in a diluted bleach solution no more than three times a week. Oatmeal baths may also prove soothing to some individuals. Meditation, relaxation, and behavior modification programs can help deal with itching and scratching as well as stressors that may exacerbate the condition. Stress treatments can also be helpful to those dealing with embarrassment or other emotional complications from eczema.
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