Eczema (Dermatitis): Causes, Symptoms, &Treatment

What is eczema?

Eczema is a general term for many types of skin inflammation, also known as dermatitis.
The most common form of eczema is atopic dermatitis (some people use these two
terms interchangeably). However, there are many different forms of eczema.

Eczema can affect people of any age, although the condition is most common in infants.
Eczema will permanently resolve by age 3 in about half of affected infants. In others, the
condition tends to recur throughout life. People with eczema often have a family history
of the condition or a family history of other allergic conditions, such as asthma or hay
fever. Up to 20% of children and 1%-2% of adults are believed to have eczema.

What are the causes of eczema?

Doctors do not know the exact cause of eczema, but an abnormal function of the
immune system is believed to be a factor. Some forms of eczema can be triggered by
substances that come in contact with the skin, such as soaps, cosmetics, clothing,
detergents, jewelry, or sweat. Environmental allergens (substances that cause allergic
reactions) may also cause outbreaks of eczema. Changes in temperature or humidity, or
even psychological stress, for some people lead to outbreaks of eczema.

What are the symptoms of eczema?

Eczema most commonly causes dry, reddened skin that itches or burns, although the
appearance of eczema varies from person to person and varies according to the specific
type of eczema. Intense itching is generally the first symptom in most people with
eczema. Sometimes, eczema may lead to blisters and oozing lesions, but eczema can
also result in dry and scaly skin. Repeated scratching may lead to thickened, crusty skin.

While any region of the body may be affected by eczema, in children and adults, eczema
typically occurs on the face, neck, and the insides of the elbows, knees, and ankles. In
infants, eczema typically occurs on the forehead, cheeks, forearms, legs, scalp, and
neck.

Eczema can sometimes occur as a brief reaction that only leads to symptoms for a few
hours or days, but in other cases, the symptoms persist over a longer time and are
referred to as chronic dermatitis.

What are the different types of eczema?

Atopic dermatitis is the most common of the many types of eczema, and sometimes
people use the two terms interchangeably. But there are many terms used to describe
specific forms of eczema that may have very similar symptoms to atopic dermatitis.
These are listed and briefly described below.

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Atopic dermatitis

Atopic dermatitis is a chronic skin disease characterized by itchy, inflamed skin. Atopic
dermatitis is believed to be caused by an abnormal function of the body's immune
system. The condition tends to come and go, depending upon exposures to triggers or
causative factors. The most common form of eczema, atopic dermatitis, affects about
10% of infants and 3% of adults in the U.S. Around two-thirds of those who develop the
condition do so prior to age 1. When the disease starts in infancy, it is sometimes termed
infantile eczema. Atopic dermatitis tends to run in families, and people who develop the
condition often have a family history of allergic conditions such as asthma or hay fever.

Contact eczema

Contact eczema (contact dermatitis) is a localized reaction that includes redness,

itching, and burning where the skin has come into contact with an allergen (an allergy-
causing substance to which an individual is sensitized) or with a general irritant such as
an acid, a cleaning agent, or other chemical. Other examples of contact eczema include
reactions to laundry detergents, nickel (present in jewelry), cosmetics, fabrics, clothing,
and perfume. Due to the vast number of substances with which individuals have contact,
it can be difficult to determine the trigger for contact dermatitis. The condition is
sometimes referred to as allergic contact eczema (allergic contact dermatitis) if the
trigger is an allergen and irritant contact eczema (irritant contact dermatitis) if the trigger
is an irritant. Skin reactions to poison ivy and poison sumac are examples of allergic
contact eczema. People who have a history of allergies have an increased risk for
developing contact eczema.

Seborrheic eczema

Seborrheic eczema (seborrheic dermatitis) is a form of skin inflammation of unknown

cause. The signs and symptoms of seborrheic eczema include yellowish, oily, scaly
patches of skin on the scalp, face, and occasionally other parts of the body. Dandruff
and "cradle cap" in infants are examples of seborrheic eczema. It is commonplace for
seborrheic dermatitis to inflame the face at the creases of the cheeks and/or the nasal
folds. Seborrheic dermatitis is not necessarily associated with itching. This condition
tends to run in families. Emotional stress, oily skin, infrequent shampooing, and weather
conditions may all increase a person's risk of developing seborrheic eczema. One type
of seborrheic eczema is also common in people with AIDS.

Nummular eczema

Nummular eczema (nummular dermatitis) is characterized by coin-shaped patches of

irritated skin—most commonly located on the arms, back, buttocks, and lower legs—that
may be crusted, scaling, and extremely itchy. This form of eczema is relatively
uncommon and occurs most frequently in elderly men. Nummular eczema is usually a
chronic condition. A personal or family history of atopic dermatitis, asthma, or allergies
increases the risk of developing the condition.

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Neurodermatitis

Neurodermatitis, also known as lichen simplex chronicus, is a chronic skin inflammation

caused by a scratch-itch cycle that begins with a localized itch (such as an insect bite)
that becomes intensely irritated when scratched. Women are more commonly affected
by neurodermatitis than men, and the condition is most frequent in people aged 20-50.
This form of eczema results in scaly patches of skin on the head, lower legs, wrists, or
forearms. Over time, the skin can become thickened and leathery. Stress can
exacerbate the symptoms of neurodermatitis.

Stasis dermatitis

Stasis dermatitis is a skin irritation on the lower legs, generally related to the circulatory
problem known as venous insufficiency, in which the function of the valves within the
veins has been compromised. Stasis dermatitis occurs almost exclusively in middle-
aged and elderly people, with approximately 6%-7% of the population over age 50 being
affected by the condition. The risk of developing stasis dermatitis increases with
advancing age. Symptoms include itching and/or reddish-brown discoloration of the skin
on one or both legs. Progression of the condition can lead to the blistering, oozing skin
lesions seen with other forms of eczema, and ulcers may develop in affected areas. The
chronic circulatory problems lead to an increase in fluid buildup (edema) in the legs.
Stasis dermatitis has also been referred to as varicose eczema.

Dyshidrotic eczema

Dyshidrotic eczema (dyshidrotic dermatitis) is an irritation of the skin on the palms of

hands and soles of the feet characterized by clear, deep blisters that itch and burn. The
cause of dyshidrotic eczema is unknown. Dyshidrotic eczema is also known as vesicular
palmoplantar dermatitis, dyshidrosis, or pompholyx. This form of eczema occurs in up to
20% of people with hand eczema and is more common during the spring and summer
months and in warmer climates. Males and females are equally affected, and the
condition can occur in people of any age.

How is eczema diagnosed?

To diagnose eczema, doctors rely on a thorough physical examination of the skin as well
as the patient's account of the history of the condition. In particular, the doctor will ask
when the condition appeared, if the condition is associated with any changes in
environment or contact with certain materials, and whether it is aggravated in any
specific situations. Eczema may have a similar appearance to other diseases of the skin,
so the diagnosis is not always simple. In some cases, a biopsy of the skin may be taken
in order to rule out other skin diseases that may be producing signs and symptoms
similar to eczema. If a doctor suspects that a patient has allergic contact dermatitis,
allergy tests, possibly including a skin "patch test," may be carried out in an attempt to
identify the specific trigger of the condition.

There are no laboratory or blood tests that can be used to establish the diagnosis of
eczema.

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What is the treatment for eczema?

The goals for the treatment of eczema are to prevent itching, inflammation, and
worsening of the condition. Treatment of eczema may involve both lifestyle changes and
the use of medications. Treatment is always based upon an individual's age, overall
health status, and the type and severity of the condition.

Keeping the skin well hydrated through the application of creams or ointments (with a
low water and high oil content) as well as avoiding over-bathing is an important step in
treatment. Lifestyle modifications to avoid triggers for the condition are also
recommended.

Corticosteroid creams are sometimes prescribed to decrease the inflammatory reaction

in the skin. These may be mild-, medium-, or high-potency corticosteroid creams
depending upon the severity of the symptoms. If itching is severe, oral antihistamines
may be prescribed. To control itching, the sedative type antihistamine drugs (for
example, diphenhydramine [Benadryl], hydroxyzine [Atarax, Vistaril], and
cyproheptadine) appear to be most effective.

In some cases, a short course of oral corticosteroids (such as prednisone) is prescribed

to control an acute outbreak of eczema, although their long-term use is discouraged in
the treatment of this non life-threatening condition because of unpleasant and potentially
harmful side effects. The oral immunosuppressant drug cyclosporine has also been used
to treat some cases of eczema. Ultraviolet light therapy (phototherapy) is another
treatment option for some people with eczema.

Finally, two topical (cream) medications have been approved by the U.S. FDA for the
treatment of eczema: tacrolimus (Protopic) and pimecrolimus (Elidel). These drugs
belong to a class of immune suppressant drugs known as calcineurin inhibitors. In 2005,
the FDA issued a warning about the use of these drugs, citing studies in animals that
showed a possible association between use of these drugs and the development of
certain types of cancer. It is recommended that these drugs only be used as second-line
therapy for cases that are unresponsive to other forms of treatment, and that their use
be limited to short time periods, and the minimum time periods needed to control
symptoms. Use of these drugs should also be limited in people who have compromised
immune systems.

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 Eczema
•

Eczema Overview

Eczema is an allergic condition that affects the skin. Another name for eczema is
dermatitis. Dermatitis is inflammation of the skin. There are several different types of
dermatitis, but the one people usually mean when they say eczema is atopic dermatitis.
Atopic refers to a lifelong tendency to allergic conditions such as asthma and allergic
rhinitis (hay fever).

Eczema can be triggered by just about anything coming in contact with the skin. It
occurs in atopic people, who are extra sensitive to skin irritation. Dry, flaky skin appears
over red, inflamed areas, causing intense itching and burning.

Eczema is a very common condition, and it affects all races and ages, including young
infants. About 1-2 percent of adults have eczema, and as many as 20 percent of children
are affected. It usually begins early in life, even before asthma or hay fever. Most
affected individuals have their first episode before age 5 years.

For some, the disease will improve with time. For others, however, eczema is a chronic
or recurrent disorder. Although it can occur just once, it usually occurs on and off
throughout life, or lasts the entire lifetime.

Eczema can be a difficult, frustrating condition. The natural human desire to scratch or
rub an itchy rash just makes the condition worse, and treatments can be slow and are
not always completely effective.

Eczema Causes

The exact cause of eczema is not known. Although it is activated by the immune system
and is related to allergic reactions, it is not the same as other allergic reactions. People
with eczema do have the IgE antibodies (immunoglobulin E) produced by the immune
system as part of allergic reactions.

• Contact with the external trigger (allergen) causes the skin to become inflamed. The
duration of the contact is not important. Eczema can develop on first contact (in days to
weeks) or over time with repeated contact (in months to years).

• Common triggers of eczema include the following:

o Soaps
o Detergents
o Weather (hot, cold, humid, or dry)
o Environmental allergens
o Jewelry
o Creams
o Food handling

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 o Clothing
o Sweating
o Gloves
o Rubbing
o Bacteria
o Emotional or mental stress

• Severe forms of eczema are caused by powerful allergic responses to external agents that
cannot be eliminated from the environment.

• Risk factors for eczema include the following:

o People with severe eczema usually also have hay fever and asthma.
o Eczema is probably hereditary and often is found in other family members.
o Eczema is not contagious.

• Risk factors for an eczema flare include the following:

o Illness
o Physical or mental stress
o Exposure to skin irritants

Eczema Symptoms

Medical professionals sometimes refer to eczema as "the itch that rashes."

• Usually the first symptom of eczema is intense itching.

• The rash appears later. It is patchy and starts out as flaky or scaly dry skin on top of
reddened, inflamed skin.

• The rash itches or burns.

• If it is scratched, it may ooze and become crusty, especially in young children.

• In adults, the patches are more likely to be brownish, scaly, and thickened.

• Some people develop red bumps or clear fluid-filled bumps that look "bubbly" and, when
scratched, add wetness to the overall appearance.

• Painful cracks can develop over time.

• The rash can be located anywhere on the body but is most often found on the face and on
the arms and legs, particularly in creases and on hands and feet. This pattern makes sense
because the face and extremities are in contact with external agents more than any other
part of the body.

• The itching may be so intense that it interferes with sleep.

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When to Seek Medical Care

If eczema is worsening (spreading, increasing redness, painful, hot) despite multiple

daily applications of steroid cream over several days, call your heath care provider

If you are so uncomfortable that your sleep, work, or other daily activities are disrupted,
you need a more effective treatment and should see your health care provider.

Generally eczema is not an emergency and should not be handled in a hospital

emergency department. Exceptions include the following:

• When the skin becomes so irritated that it breaks down and becomes infected; if the rash
has become red, hot, and painful; if red streaks are coming from the rash; or if you have a
fever, an emergency department visit may be necessary if you cannot see your regular
health care provider within 24 hours.
• Any person with a weakened immune system or certain medical conditions (such as
diabetes, on chemotherapy, alcoholism, AIDS, older than 70 years) and symptoms of
infection should go immediately to a hospital emergency department.

Exams and Tests

A medical professional can usually identify eczema by looking at the rash and asking
questions about how it appeared. He or she may scrape some scales off the rash and
look at them under the microscope to make sure the rash is not caused by fungus. Other
types of infection also must be ruled out.

The three key elements in identifying eczema are:

• Characteristic scaly rash

• Severe itching
• Atopy, or a personal or family tendency toward asthma, hay fever, and other allergies

Eczema Treatment
Self-Care at Home

Removing whatever is causing the allergic reaction is the easiest and most effective
treatment. This may be as simple as changing your laundry detergent or as difficult as
moving to a new climate or changing jobs.

Prevent dry skin by taking warm (not hot) showers rather than baths. Use a mild soap or
body cleanser. Dry yourself very carefully and apply moisturizing skin lotions all over
your body. Avoid lotions with fragrances or other irritating substances.

Avoid wearing tight-fitting, rough, or scratchy clothing.

Avoid scratching the rash. If you can't stop yourself from scratching, cover the area with
a dressing. Wear gloves at night to minimize skin damage from scratching.

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Anything that causes sweating can irritate the rash. Avoid strenuous exercise during a
flare.

If the allergy-causing agent cannot be removed or identified, the next step is to lessen
the allergic inflammatory response.

• Apply an nonprescription steroid cream (hydrocortisone) along with anti-itching lotion

(menthol/camphor, such as calamine). The cream must be applied as often as possible
without skipping days until the rash is gone.
• Diphenhydramine (Benadryl) in pill form may be taken for the itching. Caution - this
medication may make you too drowsy to drive a car or operate machinery safely.
• Clean the area with a hypoallergenic soap every day. Apply lubricating cream or lotion
after washing.

Avoid physical and mental stress. Eating right, light activity, and adequate sleep will help
you stay healthy, which can help prevent flares.

Do not expect a quick response. Eczema is easier to control than cure.

Medical Treatment
Once your health care provider is sure you have eczema, the mainstays of therapy are
anti-inflammatory medication and relief from the itching.

Prescription-strength steroid cream and antihistamine medication are the usual

treatments.

Diet restrictions and chemical skin-drying agents may also be offered, but their success
is controversial.

For severe cases not responding to high-potency steroid cream, alternate treatments
may be tried. These include coal tar, PUVA (psoralen + ultraviolet A light), and
chemotherapy agents.

Medications

• Antihistamines - Prescription strength antihistamines relieve symptoms without

drowsiness, allowing you to carry on with your normal activities.
• Corticosteroids - A short course of an oral steroid is sometimes given if the rash is severe.
A long course is rarely prescribed because of the many side effects.
• Antibiotic pills or an antifungal cream may be prescribed if your health care provider is
concerned about infection.

Other Therapy

Allergy shots (immunotherapy) usually do not work in eczema.

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Next Steps
Follow-up

• Take all your medicines as prescribed and expect slow improvement.

• Keep the affected area as clean, dry, and protected as possible to avoid further breakdown
of the skin and prevent infection.

• Apply steroid cream until the rash has completely gone away.

• If prescription medications are not controlling the eczema or your prescription

medications are running out, make an appointment with your health care provider.

• Watch the area carefully for signs of infection: increased redness, warmth, or pain, or a
discharge from the area. See your health care provider if you suspect infection.

Prevention
Avoid, when possible, whatever triggers your allergic reaction.

An allergist may use skin patch testing to find out what is triggering your reactions.

• If you know the trigger, you may be able to avoid it.

• In many cases, it is impossible to determine exactly what the trigger is.

See Self-care at home for other ideas on preventing eczema flares.

Outlook

Eczema may go away completely if the allergy-causing trigger is identified and removed.
More often, the allergy-causing agent cannot be removed or identified, and the eczema
becomes chronic. Chronic eczema means you will have occasional flares of the
symptoms, often at times of increased stress.

Repeated scratching of the rash can cause toughening of the skin. Small patches of the
skin can become thickened and like leather. This condition is called lichen simplex
chronicus.

Eczema causes skin sores and cracks that are susceptible to infection. These infections
are usually very minor, but they do require treatment with antibiotics or they may
become very severe. See your health care provider if you suspect that your skin has
become infected.

Eczema may fade in adulthood, but people who have eczema tend to have lifelong
problems with skin irritation and related problems.

• Dry, sensitive skin

• Contact dermatitis

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 • Skin infections and cold sores
• Eye irritations

People who have eczema also tend to have more problems with family and social
relationships and work difficulties.

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