Eczema is a common skin condition marked itchy and inflamed patches of skin. It is also known as atopic dermatitis. It is more common in babies and young children. It occurs on the faces of infants, as well as inside the elbows and behind the knees of children, teenagers, and adults. It is caused by an overactive immune system. Up to 20 percent of children and one to three percent of adults develop atopic dermatitis, according to the American Academy of Dermatology. In rare cases, atopic dermatitis can first appear during puberty or adulthood. It affects males and females equally.
When people refer to eczema, they usually mean atopic dermatitis, which is the common and chronic type of eczema. Other types include:
- Contact dermatitis is caused by contact with irritants. Burning, itching, and redness occur. When the irritant is removed, the inflammation goes away.
- Dyshidrotic dermatitis affects fingers, palms of the hand, and soles of the feet. It causes itchy, scaly patches of skin that flake constantly or become red, cracked, and painful. The condition is more common in women.
- Nummular dermatitis causes dry, round patches of skin in the winter months. It usually affects the leg. It is more common in men.
- Seborrheic dermatitis causes itchy, red, scaly rashes, particularly on the scalp, on the eyebrows, on the eyelids, on the sides of the nose, and behind the ears.
An eczema flare-up is when one or more eczema symptoms appear on the skin. The cause of eczema is not fully understood.
It is thought to be triggered by an overactive immune system that responds aggressively to the presence of irritants.
Eczema is sometimes caused in part by an abnormal response to proteins that are part of the body. Normally, the immune system ignores proteins that are part of the human body and attacks only the proteins of invaders, such as bacteria or viruses. In eczema, the immune system loses the ability to distinguish between the two, which causes inflammation.
Common triggers of eczema flare-ups include:
- chemicals found in cleaners and detergents that dry out the skin
- rough scratchy material like wool
- synthetic fabrics
- raised body temperature
- temperature changes
- a sudden drop in humidity
Other triggers include stress, food allergies, animal dander, and upper respiratory infections.
Eczema is characterized by itchy, dry, rough, flakey, inflamed, and irritated skin. It can flare up, subside, and then flare up again. It can occur anywhere but usually affects the arm, inner elbow, back of the knee, or head (particularly the cheeks and the scalp). It is not contagious and becomes less severe with age.
Red or brownish-gray patches are common symptoms. Small, raised bumps that ooze fluid when scratched are another symptom. Scratching causes them to become crusty, which can signal infection. Thickened, scaly skin is another symptom.
Eczema can cause intense itching. Scratching further irritates and inflames the skin. This can cause infections that must be treated with antibiotics.
Several factors can increase the risk of developing eczema.
Eczema is more common in children who suffer from asthma and/or hay fever or who develop these conditions later, usually before the age of 30.
People with family members who have eczema are also at higher risk of developing the disease.
To diagnose eczema, a physician will order a complete physical exam and ask questions about symptoms.
While no specific test can diagnose eczema, a patch test can pinpoint certain allergens that trigger symptoms, such as skin allergies associated with contact dermatitis (a type of eczema). During a patch test, an allergen is applied to a patch that is placed on the skin. If you are allergic to that allergen, your skin will become inflamed and irritated.
A dermatologist, allergist, or primary care physician can help you identify the correct treatment for eczema.
Oral over-the-counter antihistamines may relieve itching. They work by blocking histamine, which triggers allergic reactions. Examples include:
- cetirizine (Zyrtec)
- diphenhydramine (Benadryl)
- fexofendaine (Allegra)
- loratidine (Claritin)
Several antihistamines can cause drowsiness and should be taken at night.
Cortisone (steroid) creams and ointments relieve itching and scaling. They should not be used long-term because of side effects including thinning of the skin, irritation, and discoloration.
Low-potency steroids like hydrocortisone are available over the counter. High-potency steroids may help patients who don’t respond to low-potency steroids. In severe cases, a doctor may prescribe oral corticosteroids. These can cause serious side effects including bone loss.
If there is an infection, a doctor may prescribe a topical or oral antibiotic.
Immunosuppressants are prescription medications that prevent the immune system from overreacting. This prevents flare-ups of eczema. Side effects include an increased risk of developing cancer, high blood pressure, and kidney disease.
Light therapy, or phototherapy, uses ultraviolet light or sunlamps to help prevent immune system responses that trigger eczema. It requires a series of treatments, and can help reduce or clear up eczema, as well as prevent bacterial skin infections.
Stress can trigger or exacerbate symptoms. Ways to reduce stress include deep breathing exercises, yoga, meditation, and listening to relaxing music. Prioritizing a good night’s sleep can help lower stress.
A cold compress can help alleviate itching, as can soaking for 15 to 20 minutes in a warm or lukewarm bath.
Alternative treatments may help calm the symptoms of eczema. Because of potential side effects, always check with your primary care physician before using an herbal supplement or beginning an exercise routine. Popular home remedies include:
- green, black, or oolong tea
- borage oil
- primrose oil
- relaxation techniques such as meditation, yoga, progressive muscle relaxation, or guided imagery
Lifestyle changes like stress reduction and improved sleep can reduce the likelihood of an eczema flare-up. Avoid irritants like rough fabrics, harsh soaps, and detergents. Cold weather can also dry out the skin and trigger flare-ups.
People with atopic dermatitis should avoid scratching. To prevent breaking the skin, it can help to rub rather than scratch the areas that are itchy.
Because dry skin can trigger an eczema flare up, a dermatologist can recommend an ointment- or cream-based moisturizer that will help soothe your skin.
There is no cure for eczema. In some cases, eczema can cause additional health complications.
Skin infections like impetigo are brought on by constant itching. When scratching breaks the skin, bacteria and viruses can enter. Signs of this include redness, pus-filled bumps, cold sores, or fever blisters. If these symptoms appear, immediately contact a physician.
Neurodermatitis is also caused frequent itching. It leaves skin thickened, red, raw, and darker in color. This is not a dangerous condition but may result in permanent discoloration and thickening of skin even when eczema is not active. Scratching can also cause scarring
Many people with eczema report feeling embarrassed and self-conscious about their skin. Receiving proper treatment and getting stress under control can help calm the skin condition. Support groups also help sufferers cope.
Vigorous exercise can be difficult for people with eczema because sweating can bring on a bout of itching. Dress in layers so you can cool down while exercising. You may want to avoid intense physical activity during an eczema flare-up.
Written by: the Healthline Editorial Staff
Published on Dec 12, 2013
Medically reviewed on Dec 12, 2013 by George Krucik, MD, MBA