Eczema is a medical term used for a group of medical conditions which cause inflammation and irritation of the skin. Atopic dermatitis (also called atopic eczema) is the most common type of eczema. Eczema affects between 10 to 20% of infants and approximately 3% of children and adults in the United States. Most infants with the condition outgrow it before their 10th birthday, but others continue to suffer from the symptoms periodically for the rest of their lives. The disease is controllable but only with proper treatment.
Signs and Symptoms
The signs and symptoms of eczema (atopic dermatitis) differ widely from one person to another and may include any of the following:
- Itching which usually worsens at night or during extreme temperatures
- Red to dark brownish spots especially on the hands, wrists, feet, ankles, neck, upper chest, inside the bend of the knees and elbows and in infants the scalp and facial area.
- Small to medium raised bumps with may release fluid and crust over when scratched.
- Dry, thickened, cracked, scaly skin.
- Raw, swollen, sensitive skin when scratched.
Atopic dermatitis usually begins before a child reaches his/her 5th birthday and may persist into adolescence and adulthood. For many affected individuals, it flares periodically then clears up for a certain time period.
There are factors that can worsen atopic dermatitis (eczema) which are:
- Dry skin from hot, long showers or baths.
- Bacteria and viruses
- Heat and humidity changes
- Chemicals like solvents, soaps, cleaners, etc.
- Wool in beddings and clothing
- Dust and pollen
- Air pollution including tobacco smoke
- Allergens like eggs, milk, soybean, wheat, etc.
Causes and Risk Factors
The exact cause of eczema is still a mystery. The most common type, atopic dermatitis is similar to an allergy. However, the skin irritation which occurs is not an allergic reaction. Experts believe that eczema is caused by a combination of the following factors:
- Abnormal immune system function
- Activities that can irritate the skin
- Defects in the barrier of the skin
A proven fact about eczema is that it is not contagious so you can’t get it through contact with someone who has it. Eczema runs in families, so there is a genetic role in its development. A major risk factor is having relatives who have or had eczema, asthma or seasonal allergies.
Types of Eczema
- Atopic Dermatitis – This is the most common form of eczema which often affects people with asthma, hay fever, family history of eczema, asthma or hay fever. It usually begins during infancy or childhood but can strike anyone regardless of age. It usually affects the skin on the face, hands, feet, inner elbows and back of the knees.
- Contact Dermatitis – There are two types of contact dermatitis which are irritant contact dermatitis and allergic contact dermatitis. These types of eczema develop after a substance damages the skin. Some examples are chemicals and strong soap used for frequent hand washing.
- Dyshidrotic Dermatitis – This is a particular type of eczema that affects the hands and feet. The cause is still unknown, and the symptoms are severe itching, blistering and deep cracks on the skin. It may become chronic and painful, but there are several treatment options available.
- Nummular Dermatitis – This is a type of eczema that often affects males. It usually starts after a man’s mid-50s, but women can get it during their teen years or early adulthood. It causes coin-shaped red marks on the legs, back of the hands, forearms, lower back, and hips. Its cause is still unknown but cold and dry air, chemicals and metals can trigger an episode.
- Neurodermatitis – This type of eczema develops in spots that are frequently scratched because of habit. It often affects the back, sides/back of the neck, genitals and scalp.
- Seborrheic Dermatitis – This is more commonly known as dandruff. It causes skin to fall off in flakes. In some cases, it can be due to an overgrowth of a specific type of yeast. It is harder to treat* in people with weakened immune systems.
- Statis Dermatitis – This type of eczema develops in people when the veins in the lower part of the legs are not able to return blood properly to the heart. It can arise quickly which causes crusting and weeping of the skin. Over time, it can lead to brown stains on the skin.
Tests and Diagnosis
Diagnosing eczema involves mostly talking to a doctor about the signs and symptoms along with the medical history of the patient. There is no single test to diagnose eczema, but an accurate medical history and examination of the skin are usually enough for diagnosis.
Treatments and Medications
The treatments used for eczema depend on the particular type. Non-drug treatments include mild soap and moisturizer, short and warm showers and stress reduction*. Medications used for treating eczema include hydrocortisone, antihistamines, corticosteroids, ultraviolet light therapy, immunosuppressants, immunomodulators and prescription-strength moisturizers.
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Precautions and Self Care
Home remedies for eczema are simple which may include using mild soap and skin products, changing your laundry detergent and moving to a new climate. It mostly depends on the particular type of eczema and the “triggers” which can differ from one case to another. It is crucial to prevent dry skin which can worsen the problem. Avoiding rough and scratchy clothing can also prevent flare ups and control symptoms. Sweating can irritate any rash so avoid strenuous exercise during a flare.
If the cause of inflammation is unidentifiable or cannot be removed, the best thing to do is to lessen the allergic inflammatory response. This can be done by applying a non-prescripted steroid cream (hydrocortisone). Anti-itching lotion can also be used but in extreme cases diphenhydramine can be used to reduce* itching quickly. Use a hypoallergenic soap and other skin care products to prevent flare-ups. Keeping affected areas moisturized can also help control symptoms and prevent flare ups.
- Bershad, SV (1 November 2011). “In the clinic. Atopic dermatitis (eczema)”. Annals of internal medicine 155 (9): ITC51–15; quiz ITC516. doi:10.1059/0003-4819-155-9-201111010-01005 (inactive 2015-01-12). PMID 22041966
- McAleer, MA; Flohr, C; Irvine, AD (23 July 2012). “Management of difficult and severe eczema in childhood”. BMJ (Clinical research ed.) 345: e4770. doi:10.1136/bmj.e4770. PMID 22826585.
- Hay, RJ; Johns, NE; Williams, HC; Bolliger, IW; Dellavalle, RP; Margolis, DJ; Marks, R; Naldi, L; Weinstock, MA; Wulf, SK; Michaud, C; J L Murray, C; Naghavi, M (28 October 2013). “The Global Burden of Skin Disease in 2010: An Analysis of the Prevalence and Impact of Skin Conditions.”. The Journal of investigative dermatology 134 (6): 1527–34. doi:10.1038/jid.2013.446. PMID 24166134.