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Topic of the Month: January 2004: Eczema Exposed
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In this month's topic you will:
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Atopic dermatitis, also known as eczema is an allergic skin condition. It is hereditary and is often associated with food allergies, asthma and/or allergic rhinitis.
Eczema can affect all age groups, but is most often seen in young children. In young children, it looks like a red, itchy, scaly rash. It is patchy and starts out as flaky or scaly dry skin on top of reddened, inflamed skin. The rash will itch or burn. If it is scratched, it may ooze and become crusty, especially in young children. Painful cracks can develop over time.
The rash most often affects the face, wrists, inside of the elbows, on the backs of the knees and outer thighs. The severity of the disease can vary from person to person. In mild forms the skin is dry, hot and itchy, while in more severe forms the skin can become broken, raw and bleeding. Although it can sometimes look unpleasant, eczema is not contagious. With proper treatment the inflammation of eczema can be reduced, though the skin will always be sensitive to flare-ups and will need extra care.
Eczema or Atopic Dermatitis
Jonathan Spergel, MD, PhD, FAAAAI is a member of the AAAAI and an expert on the subject of eczema. Below Dr. Spergel provides answers to some of the most commonly asked questions.
What causes eczema?
The exact cause of eczema is unknown, but the disease seems to result from a combination of genetic (hereditary) and environmental factors. Basically, patients with eczema have extra-sensitive skin. Their skin reacts abnormally to irritants and allergens. This itching triggers inflammation, the red rash. Inflammation triggers more itching and leading to more inflammation in a vicious cycle. Many substances have been identified as "triggers," which are not the same for every person.
Will my child out grow eczema?
- 90% develop eczema before the age of 5
 - 40-50% of patients outgrow it by adolescence
- 2/3 of the patients with eczema develop allergic rhinitis or hayfever
- 1/2 of the patients with eczema develop asthma
What kinds of products are safe to use on my children?
Many products are safe to use on children, but, it depends on the age and severity of the symptoms. Some medications are approved to 6 months of age and other medications are approved to 2 years or 12 years of age. Moisturizers are safe to use on children of any age.
What types of signs should I look for?
The signs of atopic dermatitis are itchy red skin on the face, elbows, and knees. The rash can come and go.
What are the most common symptoms of eczema?
- An itchy red rash on the face
- The location of the rash varies by age
- Infants: very red, oozing rash typically on the face, scalp but can be anywhere.
- Children: the rash is less red and involves the wrist, knees, elbows and, less likely, the face.
- Teens and adults, the lesions occur on hands and feet.
- Common sites in all ages include: bends of the elbows, backs of the knees, ankles, wrists, face, neck and upper chest may also be affected.
What is the most effective eczema treatment?
Eczema outbreaks can usually be avoided with some simple precautions. One of the primary goals is to prevent itch and the inflammation. The following suggestions may help to reduce the severity and frequency of flare-ups:
- Moisturize frequently
- Control the inflammation with topical corticosteroids or topical creams
- Treat skin infections
- Avoid environmental factors that trigger allergies (e.g., pollens, molds, dust mites, and animal dander)
- Avoid sudden changes in temperature or humidity
- Avoid sweating or overheating
- Avoid irritants (tobacco smoke, pollution)
- Reduce stress
- Avoid scratchy materials (e.g., wool or other irritants)
- Avoid harsh soaps, detergents, and solvents
- Be aware of any foods that may cause an outbreak and avoid those foods
- A key component of treatment is partnership develops that includes the patient, family members and doctor.
Dry Skin vs. Eczema
The signs and symptoms of eczema are sometimes mistaken or confused with common dry skin. You may suffer from eczema and may not be aware you have it or realize you need to see a doctor. A physician looks for the following factors when diagnosing eczema;
- Very itchy skin
- Very dry skin
- Very sensitive skin
- A rash that first appeared during the infant stages
- A rash that tends to flare up, then go away for a while before coming back again
- Personal or family history of asthma, hay fever, or eczema
If you suffer from some or most of these symptoms please see your physician. Proper diagnosis and management of eczema requires a physician who recognizes the signs and symptoms. Once you are diagnosed, the physician and/or allergist/immunologist can work together to provide you with an effective management and treatment plan.
Treatment
There are many options available to treat eczema, either over the counter or as prescribed by a doctor. One of the most important goals of an eczema treatment routine is to prevent scratching. Applying cold compresses can be helpful. In addition, lubricating the dry skin with cream or ointment, especially during dry seasons, is essential. Your doctor can prescribe topical medications such as cortisone creams, ointments and lotions. In some cases oral medications such as antihistamines can help deal with the itch.
Steps to Manage Eczema
Eczema will leave many of us itching and scratching, especially in the winter months when the air is dry. According to the American Academy of Pediatrics here are some steps to manage your child's eczema.
| Take Steps to Manage your Eczema |
- Avoid certain foods that may trigger your eczema.
- Wear long-sleeved sleepwear to bed, this may help prevent nighttime scratching.
- Keep the skin well moisturized with creams and lotions.
- Avoid sudden changes in temperature or humidity.
- Choose soft clothing, such as cotton, rather than rough scratchy clothing, such as wool.
- Avoid soaps that contain harsh perfumes and deodorants.
- Use soaps and moisturizers that won't dry your skin -- look for ones that are hypo-allergenic and unscented, and avoid antibacterial products.
- Use laundry products that are free of dyes and perfumes.
- Take shorter showers and baths in warm (not hot) water.
- Gently pat, instead of rubbing yourself dry after the shower or bath to avoid irritating the skin.
- Always thoroughly wash new clothes before you wear them.
- In the winter, keep the air in your home moist by using a humidifier or vaporizer, or placing pans of water on the radiator.
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Additional Resources
Tips to Remember: Allergic Skin Conditions
Search Allergic Conditions: Eczema
The Allergy Report
The Physician Referral Directory
This topic was reviewed on 1-01-04 for medical accuracy by
Stuart A. Friedman, MD, FAAAAI, Patients and Consumers Center Editor.
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