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Eczema

Definition

Atopic dermatitis, commonly referred to as eczema, is a chronic skin disorder categorized by scaly and itching rashes. People with eczema often have a family history of allergic conditions like asthma, hay fever, or eczema.

Causes, incidence, and risk factors

Eczema is most common in infants, and at least half of those cases clear by age 3. In adults, it is generally a chronic or recurring condition.

A hypersensitivity reaction (similar to an allergy) occurs in the skin, causing chronic inflammation. The inflammation causes the skin to become itchy and scaly. Chronic irritation and scratching can cause the skin to thicken and become leathery-textured.

Exposure to environmental irritants can worsen symptoms, as can dryness of the skin, exposure to water, temperature changes, and stress.

Symptoms

Intense itching
Blisters with oozing and crusting
Skin redness or inflammation around the blisters
Rash
- In children under 2 years old, skin lesions begin on the cheeks, elbows, or knees
- In adults, the rash more commonly involves the inside surfaces of the knees and elbows
Dry, leathery skin areas
- More or less pigment than their normal skin tone (see skin, abnormally dark or light)
- Located commonly in the inner elbow or behind the knee
- May spread to the neck, hands, feet, eyelids, or behind the knee
Raw areas of the skin -- from scratching
Ear discharges/bleeding

Signs and tests

Diagnosis is primarily based on the appearance of the skin and on personal and family history. The health care provider should examine the lesions to rule out other possible causes. A skin lesion biopsy may be performed, but is not always required to make the diagnosis.

Treatment

Consult your health care provider for a diagnosis of eczema because it can be difficult to differentiate from other skin disorders. Treatment should be guided by the health care provider.

Treatment may vary depending on the appearance (stage) of the lesions -- acute "weeping" lesions, dry scaly lesions, or chronic dry, thickened lesions are each treated differently.

Anything that aggravates the symptoms should be avoided whenever possible, including any food allergens and irritants such as wool and lanolin.

Dry skin often makes the condition worse. When washing or bathing, keep water contact as brief as possible and use less soap than usual. After bathing, it is important to trap the moisture in the skin by applying lubricating cream on the skin while it is damp. Temperature changes and stress may cause sweating and aggravate the condition.

Treatment of weeping lesions may include soothing moisturizers, mild soaps, or wet dressings.

Mild anti-itch lotions or topical corticosteroids (low potency) may soothe less severe or healing areas, or dry scaly lesions.

Chronic thickened areas may be treated with ointments or creams that contain tar compounds, corticosteroids (medium to very high potency), and ingredients that lubricate or soften the skin. Systemic corticosteroids may be prescribed to reduce inflammation in some severe cases.

The latest treatment for eczema is a class of skin medications called topical immunomodulators (TIMs). These medications are steroid-free. They include tacrolimus (Protopic) and pimecrolimus (Elidel). Studies have shown as high as an 80% success rate using these new medications.

Expectations (prognosis)

Eczema is a chronic condition, but it may be controlled with treatment and avoidance of irritants.

Complications

Secondary bacterial infections of the skin
Permanent scar formation

Calling your health care provider

Call for an appointment with your health care provider if eczema does not respond to moisturizers or avoiding allergens, if symptoms worsen or treatment is ineffective, or if signs of infection (such as fever, redness, pain) occur.

Prevention

Studies have shown that children who are breast-fed are less likely to get eczema. This is also true when the nursing mother has avoided cow's milk in her diet. Other dietary restrictions may include eggs, fish, peanuts, and soy.

Eczema tends to run in families. Control of stress, nervousness, anxiety, and depression can be beneficial in some cases.

References

Habif TP. Clinical Dermatology. 4th ed. St. Louis, Mo: Mosby, Inc. 2004:41.

Goldman L, Ausiello D. Cecil Textbook of Medicine, 22nd ed. Philadelphia, Pa: WB Saunders; 2004:2458-2460.