Eczema

Eczema is a chronic skin disorder that involves scaly and itchy rashes.

Infantile eczema; Atopic dermatitis; Dermatitis - atopic

Eczema is due to a hypersensitivity reaction (similar to an allergy) in the skin, which leads to long-term inflammation. The inflammation causes the skin to become itchy and scaly. Long-term irritation and scratching can cause the skin to thicken and have a leather-like texture.

Eczema is most common in infants. The condition tends to run in families.

People with eczema often have a family history of allergic conditions such as asthma, hay fever, or eczema.

The following can make eczema symptoms worse:

• Dry skin
• Exposure to environmental irritants
• Exposure to water
• Stress
• Temperature changes

• Blisters with oozing and crusting
• Dry, leathery skin areas
• Ear discharge or bleeding
• Intense itching
• Rash
  • In children younger than age 2, skin lesions begin on the cheeks, elbows, or knees
  • In adults, the rash is more commonly seen on the inside of the knees and elbows
• Raw areas of the skin from scratching
• Skin coloring changes -- more or less coloring than the normal skin tone (See: Skin abnormally dark or light)
• Skin redness or inflammation around the blisters

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 can vary depending on the appearance (stage) of the lesions. "Weeping" lesions, dry scaly lesions, or chronic dry, thickened lesions are each treated differently.

• Avoid anything that makes your symptoms worse. This may include food allergens and irritants such as wool and lanolin.
• 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. Dry skin often makes the condition worse. Temperature changes and stress may cause sweating and aggravate the condition.
• Treat weeping lesions with soothing moisturizers, mild soaps, or wet dressings.
• Use mild anti-itch lotions or topical corticosteroids to soothe less severe or healing areas, or dry scaly lesions.
• You can treat chronic thickened areas with ointments or creams that contain tar compounds, powerful anti-inflammatory medicines, and ingredients that lubricate or soften the skin.
• Your health care provider may prescribe oral corticosteroids to reduce inflammation if the condition is severe.
• Medicines called topical immunomodulators (TIMs) may be prescribed in some cases. TIMs include tacrolimus (Protopic) and pimecrolimus (Elidel). These medications do not contain corticosteroids.

Eczema is a chronic condition, but you can control it with treatment and by avoiding irritants. In children, it often clears up by early adulthood. In adults, it is generally a long-term or recurring condition.

• Bacterial infections of the skin
• Permanent scars

Call for an appointment with your health care provider if:

• Eczema does not respond to moisturizers or avoiding allergens
• Symptoms worsen or treatment is ineffective
• You have signs of infection (such as fever, redness, pain)

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. Controlling stress, nervousness, anxiety, and depression can help in some cases.

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

Lewis-Jones S, Mugglestone MA; Guideline Development Group. Management of atopic eczema in children aged up to 12 years: summary of NICE guidance. BMJ. 2007;335:1263-1264.

Ascroft DM, Chen LC, Garside R, Stein K, Williams HC. Topical pimecrolimus for eczema. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005500.