Eczema (Atopic Dermatitis)

Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition that causes dry, itchy, and inflamed skin. It's one of the most common skin conditions, affecting millions of people worldwide. Eczema often begins in childhood and may improve or persist into adulthood.

While there's no cure for eczema, it can be effectively managed with proper skin care, avoiding triggers, and medications when needed. The condition tends to flare up periodically and then improve, so understanding triggers and having a management plan is important.

Eczema symptoms can vary and may include:

• Dry, Sensitive Skin: Skin feels rough and dry
• Intense Itching: Often worse at night
• Red to Brownish-Gray Patches: Especially on hands, feet, ankles, wrists, neck, upper chest, eyelids, inside bend of elbows and knees
• Small, Raised Bumps: That may leak fluid when scratched
• Thickened, Cracked, Scaly Skin: From chronic scratching
• Raw, Sensitive, Swollen Skin: From scratching

Common Locations:

• Infants: Face and scalp
• Children: Elbows, knees, wrists, ankles
• Adults: Hands, neck, face, around eyes

Severity Varies:

• Mild: Occasional itching, minor patches
• Moderate: More frequent flares, larger affected areas
• Severe: Constant symptoms, significant impact on life

Skin Care Routine:

1. Moisturize Regularly:

   • Apply moisturizer at least twice daily
   • Immediately after bathing (within 3 minutes)
   • Use thick creams or ointments
   • Avoid lotions with alcohol

2. Gentle Bathing:

   • Use lukewarm (not hot) water
   • Limit baths to 10-15 minutes
   • Use mild, fragrance-free cleansers
   • Pat dry (don't rub)
   • Apply moisturizer while skin still damp

3. Avoid Triggers:

   • Irritants: Soaps, detergents, fragrances
   • Allergens: Dust mites, pet dander, pollen
   • Foods: If known to trigger (varies by person)
   • Stress: Can worsen symptoms
   • Temperature: Extreme heat or cold
   • Sweat: Can irritate skin

4. Prevent Scratching:

   • Keep nails short
   • Cover affected areas
   • Use cold compresses for itching
   • Distraction techniques
   • Anti-itch medications

5. Clothing:

   • Wear soft, breathable fabrics (cotton)
   • Avoid wool and synthetic materials
   • Loose-fitting clothing
   • Wash new clothes before wearing

• Symptoms not improving with self-care
• Signs of infection (pus, yellow crusts, increased redness)
• Severe itching interfering with sleep or daily activities
• Eczema covering large areas
• Need for prescription treatments
• Symptoms affecting quality of life

• Signs of skin infection (fever, spreading redness, pus)
• Severe flare not responding to treatment
• Eczema herpeticum (rare but serious complication)

• Mild symptoms well-controlled
• Following treatment plan
• Occasional flares manageable

Diagnosis is typically clinical:

1. Medical History:

   • Family history of eczema, asthma, or allergies
   • Pattern of symptoms
   • Triggers and timing

2. Physical Examination:

   • Appearance and location of rash
   • Signs of scratching
   • Other signs of atopy

3. Patch Testing (if contact allergy suspected):

   • Identifies contact allergens
   • Small amounts of allergens applied to skin

4. Blood Tests (rarely needed):

   • Allergy testing if food allergies suspected
   • Usually not necessary for diagnosis

Topical Treatments:

1. Moisturizers:

   • Foundation of treatment
   • Apply frequently
   • Choose appropriate type for your skin

2. Topical Corticosteroids:

   • Reduce inflammation and itching
   • Various strengths
   • Use as directed
   • Don't overuse (can thin skin)

3. Topical Calcineurin Inhibitors:

   • Non-steroid option
   • For sensitive areas (face, genitals)
   • Prescription required

4. Other Topicals:

   • Coal tar preparations
   • Topical antibiotics (if infected)

Systemic Treatments (for severe cases):

• Oral corticosteroids (short-term)
• Immunosuppressants
• Biologics (newer option)
• Phototherapy (light therapy)

Antihistamines:

• May help with itching
• Especially at night
• Don't treat underlying condition

Prevent Flares:

• Maintain Skin Barrier: Regular moisturizing
• Avoid Known Triggers: Identify and avoid
• Manage Stress: Stress can trigger flares
• Control Environment:
  • Use humidifier in dry climates
  • Avoid extreme temperatures
  • Reduce allergens in home
• Gentle Skin Care: Avoid harsh products
• Stay Hydrated: Drink plenty of water

Eczema involves:

1. Skin Barrier Dysfunction:

   • Skin doesn't retain moisture well
   • More susceptible to irritants and allergens

2. Immune System Response:

   • Overactive immune response
   • Inflammation in skin

3. Genetic Factors:

   • Often runs in families
   • Associated with asthma and allergies

4. Environmental Triggers:

   • Interact with genetic predisposition
   • Cause flare-ups

The combination leads to dry, inflamed, itchy skin that's prone to infection.

• Often begins in first 6 months
• May improve with age
• Food allergies more common trigger
• Important to establish good skin care habits
• Can affect sleep and quality of life

• May persist from childhood or start in adulthood
• Often affects hands
• Stress and work factors important
• May have other atopic conditions

• Less common but can occur
• May be confused with other conditions
• Skin more fragile
• Medications may interact

No. Eczema is not contagious. You cannot catch it from or spread it to others.

Many children improve significantly or completely outgrow eczema, especially by school age. However, some continue to have symptoms into adulthood.

For some people, certain foods can trigger flares. Common triggers include dairy, eggs, nuts, and soy. However, food allergies are not the cause of eczema for most people. Elimination diets should be done under medical supervision.

No. Regular bathing is important, but do it correctly: lukewarm water, short duration, mild cleansers, and immediate moisturizing afterward.

Stress doesn't cause eczema but can trigger or worsen flares. Stress management is an important part of eczema management.