Eczema (Atopic Dermatitis)

Cause

Things that trigger a flare-up of eczema

The itching and rash of eczema can be triggered by:

• Allergens, such as dust mites, pollen, molds, or animal dander. Rarely, certain foods trigger a rash and itching.
• Harsh soaps or detergents, rubbing the skin, and wearing wool.
• Workplace irritants, such as fumes and chemicals.
• Weather changes, especially dry and cold.
• Temperature changes, such as a suddenly higher temperature. This may bring on sweating, which can cause itching.
• Stress. Stress may lead to more itching and scratching.
• Washing without moisturizing afterward. This can lead to drier skin and more itching.

What Increases Your Risk

The major risk factor for eczema is having a family history of the condition. You are also at risk if family members have asthma, allergic rhinitis, or other allergies.

Symptoms

Eczema starts with dry skin that is often very itchy. Scratching causes the dry skin to become irritated. Tiny bumps that look like little blisters may appear and ooze fluid or crust over. This can happen when the skin is rubbed or scratched or if a skin infection is present.

These symptoms may come and go. Over time, a recurring rash can become tough and thick from constant scratching.

Eczema may be mild, moderate, or severe. How much your symptoms affect you will depend on how much of your skin has a rash and how itchy it is. It also depends on how much the eczema affects your daily activities, sleep, and well-being.

The areas most often affected are the face, scalp, neck, arms, and legs. The rash is also common in areas that bend, such as the back of the knees and the inside of the elbows.

What Happens

Eczema is most common in babies and children. It tends to come and go over months to years. It is common for the rash to get infected at times. Most children outgrow it. But some teens and adults continue to have problems with it, though usually not as bad as when they were children.

Health problems caused by eczema

There are some other health problems that can happen when you have eczema.

Eczema can cause problems with sleep. The itching caused by it, especially during flares, can make it hard to fall asleep or to get good sleep.

Skin infections can happen more often in people who have it. The skin may become reddish and warm, and a fever may develop. Most skin infections are treated with antibiotics.

People with eczema often have allergies and asthma. Depression and anxiety have also been linked with eczema.

When to Call a Doctor

Call your doctor if you or your child has eczema and:

• Itching makes you or your child irritable.
• Itching is interfering with daily activities, mood, or sleep.
• There are crusting or oozing sores, severe scratch marks, widespread rash, severe discoloration of the skin, or a fever that is accompanied by a rash.
• Painful cracks form on the hands or fingers.
• Eczema on the hands interferes with daily school, work, or home activities.
• Signs of an infection develop. These may include:
  • Increased pain, swelling, warmth, or redness.
  • Red streaks leading from the area.
  • Pus draining from the area.
  • A fever.

Exams and Tests

A doctor can usually tell if you have eczema by doing an exam and asking questions about your health. You may also be asked about your family health history. Sometimes a skin biopsy or allergy testing is recommended.

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Treatment Overview

Treatment for eczema depends on how severe your rash is. It's usually treated with medicines that are put on your skin (topical medicines) and with moisturizers.

Getting medical treatment early may keep your symptoms from getting worse.

• Topical medicines are usually creams, gels, or ointments. They include medicines such as corticosteroids, calcineurin inhibitors, and crisaborole. These reduce itching and help the rash heal.
• Moisturizers—including skin barrier repair moisturizers—can help. They can reduce the itching, keep your rash from getting worse, and help your rash heal.

If topical medicines don't help, your doctor may prescribe other treatments. These may include pills, phototherapy, or injections. Your doctor may also talk to you about bleach baths and wet wraps.

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Self-Care

• Use moisturizer at least twice a day.
• If your doctor prescribes a cream, use it as directed. If your doctor prescribes other medicine, take it exactly as directed.
• Wash the affected area with warm (not hot) water only. Soap can make dryness and itching worse. Pat dry.
• Apply a moisturizer after washing your hands or after bathing. Use petroleum jelly or a cream such as Cetaphil, Lubriderm, or Moisturel that does not irritate the skin or cause a rash. Apply the cream while your skin is still damp after lightly drying with a towel.
• Use cold, wet cloths to reduce itching.
• Keep cool, and stay out of the sun.
• If itching affects your sleep, ask your doctor if you can take an antihistamine that might reduce itching and make you sleepy, such as diphenhydramine (Benadryl). Be safe with medicines. Read and follow all instructions on the label.
• Control scratching. Keep your fingernails trimmed and smooth to prevent damage to the skin when you scratch it. Wearing cotton mittens or gloves can help you stop scratching.
• Try to avoid things that trigger your rash. These may include things like allergens, such as pollen or animal dander. Harsh soaps, scratchy clothes, and stress are other examples.

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Medicines

Medicines are used to help control itching and heal the rash caused by eczema. Topical medicines are applied directly to the skin. Options include:

• Corticosteroids. They are a commonly used topical treatment. These medicines come in different strengths. Oral corticosteroids are sometimes used to treat severe eczema.
• Calcineurin inhibitors. These include tacrolimus ointment and pimecrolimus cream. They can be used to treat mild-to-moderate atopic dermatitis.
• Crisaborole. This ointment is used to treat mild-to-moderate atopic dermatitis.

Carefully follow your doctor's directions. Corticosteroids and calcineurin inhibitors are strong medicines. They shouldn't be used for long periods of time.

Other medicines that may be prescribed include:

• Antibiotic, antiviral, or antifungal medicines, if the rash gets infected.
• Antihistamines, to treat the itch.
• Medicines that affect the immune system. Examples include cyclosporine, dupilumab, or methotrexate. They're used for adults, and sometimes children, if other treatment doesn't help.