Eczema and Atopic Dermatitis
What Is Eczema?
Eczema is a condition that causes red, dry, intensely itchy patches of skin that may crack, crust and weep fluid. Atopic dermatitis is the most common type of eczema. Often, the itch develops before the rash, which is why eczema is sometimes described as “the itch that rashes.”
Atopic dermatitis can be mild, causing just a few patches of affected skin, or more widespread. In some people it comes and goes, but for other people it’s constant. There’s no cure, but self-care measures and medication can help relieve symptoms and minimize flares.
What Causes Eczema?
There’s no one thing that causes eczema. It’s a complex disease caused by a combination of environmental factors and genetics, including a genetic tendency for the immune system to overreact to common allergens. (This tendency is called atopy, thus the term “atopic dermatitis.”) The immune system overreaction causes inflammation, which in turn causes red, itchy skin.
Mutations in a certain gene may also compromise cells in the protective top layer of skin, known as the skin barrier. As a result, moisture quickly evaporates and skin becomes more sensitive. When cells in the skin barrier dry out they shrink, leaving more room for irritants to enter.
Who Gets Eczema?
Eczema affects up to 20% of children and up to 3% of adults. It usually begins early in life, often in infants and in most cases before age 5. For some children, it resolves completely by age 2. For others, especially those with more severe cases, eczema can be a lifelong condition. For kids who don’t outgrow it, the good news is that it tends to become less severe with age.
Adults can also develop eczema. The 50s are a peak decade for adult-onset symptoms to develop.
People who have a personal or family history of hay fever, asthma, environmental allergies and/or food allergies are more prone to eczema. The condition is equally common in males and females and slightly more common in African-Americans than Caucasians. It’s less common in Asians.
What Are the Symptoms of Eczema?
Some of the signs and symptoms of eczema are:
- Red rash
- Scaly, leathery patches
- Crusting or thickening of the skin
- Swelling of the skin
- “Weeping” of clear fluid
Itching is the hallmark of eczema. More than 85% of people with eczema experience itching on a daily basis, and it’s widely considered to be the worst aspect of the condition.
The itching is often worse at night. That’s partly because skin loses moisture at night, and dryness can feel itchy. Also, people often inadvertently scratch their skin at night, and scratching causes more itching.
Where Does Eczema Occur?
Eczema can occur anywhere on the skin, but it tends to move around with age.
Infantile eczema, baby eczema and child eczema
In infants, itchy patches tend to develop on the face, neck and groin. During the childhood phase, they usually form in the folds of the skin, especially the back of the knee and the inside of the elbow.
Teen and adult eczema
During the teenage and young-adult years, eczema often develops on the elbows and knees. Other common sites are the hands, feet, ankles, wrists, face, neck and upper chest. Patches are not limited to these areas; they can appear anywhere on the body, including around the eyes and on the eyelids.
Eczema on the hands is very common in adulthood. Some people who see their eczema clear during adolescence develop hand eczema as adults. Hand eczema may be triggered by irritants such as cleaning products, by allergens such as rubber and nickel, by frequent exposure to water, such as from frequent hand washing, and by physical trauma, such as from digging in the garden with bare hands or handling large quantities of paper.
Hand eczema can be stubborn. It may take months for the patches of red, scaly, inflamed skin to heal. Proper treatment is critical to prevent hand eczema from interfering with everyday activities and work tasks.
How to Treat Eczema
If you have eczema symptoms, it’s important to see a dermatologist or other skin care provider to get an accurate diagnosis. If lifestyle changes aren’t enough to manage eczema, a provider can prescribe treatments to help reduce the inflammation and itch.
Common eczema treatments include:
- Topical corticosteroids
- Topical non-steroidal immune-modifying medications such a calcineurin inhibitors, PDE4 inhibitors and JAK inhibitors
- Biologic drugs, often given by injection
- Oral JAK inhibitors
The first JAK inhibitor cream for atopic dermatitis, called ruxolitinib (brand name Opzelura), was approved in 2021. Not a steroid, it works by blocking two enzymes involved in skin inflammation. It’s prescribed for short-term treatment of mild to moderate atopic dermatitis when other topical treatments have failed. For many people, it leads to clear or almost clear skin and a major reduction of itching. It’s for people 12 and over.
For best results, use medications as prescribed.
Other treatments for eczema include antihistamines (if eczema is triggered by allergies), oral or injectable immunosuppressants (for moderate to severe cases) and phototherapy, also called UV light therapy. If the skin is infected, which is common with eczema, the provider may prescribe an antibiotic.
A person with eczema who also has hay fever or asthma may be referred to an allergist for allergy testing. Identifying allergens or environmental factors that trigger or contribute to eczema can be beneficial. Sometimes eliminating allergens brings great relief when combined with appropriate treatment and lifestyle changes.
How to Prevent Eczema Flares
On their own or in conjunction with medication, lifestyle changes can go a long way toward keeping eczema in check.
Avoid Eczema Triggers
For starters, learn your triggers. Common eczema triggers include:
- Soaps and household cleansers
- Rough, courses fabrics like wool and stiff synthetics
- Metals, especially nickel
- Hot weather and perspiration
- Cold weather and low humidity
- Cigarette smoke
Other Eczema Prevention Tips
These strategies can reduce itching and discomfort and help prevent flare-ups and infection.
- Moisturize at least twice a day with a cream or ointment. These have more oil and less water than lotions, so they’re better at sealing in moisture and keeping out irritants. Moisturizers that contain ceramides are particularly good for people with eczema. Apply moisturizer after you shower or wash your hands to help lock in hydration.
- Use lukewarm water in the tub or shower instead of hot water, which can strip away protective skin oils.
- Choose skincare products and laundry detergents free of dyes and fragrances. Look for products labeled “fragrance-free,” “hypoallergenic” and “for sensitive skin.” Don’t use fabric softener.
- Use a humidifier to add moisture to dry indoor air. Aim for humidity levels of 30% to 50%.
- Wear gloves. This is particularly important if you have hand eczema. Wearing gloves when outdoors in cold weather helps prevent dry, chapped skin. For household tasks, rubber or PVC gloves with a cotton liner, or PVC gloves worn over cotton gloves, should provide enough protection from harsh soaps and household chemicals. To prevent scratching at night, consider wearing cotton gloves to bed.
- Trim your nails short and file them smooth to limit the damage you do when you scratch. Try using the side or top of your hand to scratch instead of your nails.
- Manage stress. Stress can exacerbate eczema. Flare-ups are more likely to start or intensify as stress levels rise. To help tame tension, try yoga, meditation or deep breathing. Soaking for 10 to 15 minutes in a warm bath sprinkled with baking soda, uncooked oatmeal or colloidal oatmeal can help ease stress and also soothe skin.
Above all, avoid scratching. Scratching causes the release of inflammatory compounds that lead to more itching and dryness — and more scratching.
Is Eczema Contagious?
Eczema isn’t contagious. You can’t “catch” it from another person, and you can’t give it to someone by touching them.
Is Eczema Genetic?
You’re more likely to have eczema if you have a family history of the condition. You’re also at higher risk if you have asthma and/or hay fever or have family members who do. Some people with eczema have a mutation of the gene responsible for creating a protein, called filaggrin, that helps maintain a healthy, protective skin barrier. Without normal levels of filaggrin, skin is often very dry and prone to infection.
Is Eczema an Autoimmune Disease?
Eczema is an immunological disease, which means it involves the immune system. There is some evidence that it’s an autoimmune disease (a disease in which the immune system attacks healthy cells), but more research is necessary to confirm this.
Does Eczema Go Away?
Children often outgrow eczema, but it can be a lifelong condition that waxes and wanes, with periods of flares and periods of remission. Since eczema can be unpredictable, it’s important to work your dermatologist to find effective treatments that are appropriate for long-term use.
What’s the Difference Between Eczema and Psoriasis?
Both conditions can cause a rash and appear in the same places of the body, though they are most common in different areas. But on close inspection, the rashes look different. Eczema presents as thinner patches of dry, red, bumpy skin in Caucasians. In people of color, the patches may be brown, purple or grey. Plaque psoriasis presents as dry, red, raised patches of skin with silvery scales in Caucasians. In people of color, the patches can be dark brown or purple and the scales may be gray. In psoriasis, the borders of the rash tend to be more clearly defined. Psoriasis also causes milder itching. With psoriasis, soreness or pain due to the cracking skin is more of a complaint, along with joint pain.
Should You Avoid Certain Foods If You Have Eczema?
Foods don’t directly cause eczema, but several studies suggest that certain food sensitivities are associated with infantile eczema and childhood eczema. Food allergies are also common in children who have eczema. About 40% of babies and young kids with moderate or severe eczema also have allergies to food, most commonly:
- An egg allergy is six times more common in infants with eczema compared to those without eczema.
- Cow’s milk and other dairy foods
- A peanut allergy is 11 times more common in infants with eczema.
- Soybeans and foods made from them
Sometimes, allergic reactions to foods cause skin symptoms. If a child with eczema has a flare shortly after eating a certain food, they should be tested for food allergies. Testing is also recommended if a child’s eczema hasn’t improved with standard medical care or if it’s becoming more severe.
Some evidence suggests that avoiding foods to which there is a known food allergy or sensitivity may reduce the severity and extent of eczema, but the reason for this is unclear. Parents should know that when a child with eczema has a food allergy or sensitivity, removing the problem food or foods from their diet may not stop their eczema. Before eliminating foods from a child’s diet, discuss the plan with a medical provider to help to ensure the child receives proper nutrition.
Are allergy shots useful?
Allergy shots such as those given for hay fever, pet allergies and other allergies have not proven reliable for relieving atopic dermatitis. They may even make it worse in some patients. However, if the shots help the lung allergies, the skin may get better. Consult a dermatologist before considering allergy shots.
If you or a loved one has skin symptoms similar to eczema symptoms, schedule an appointment to get an accurate diagnosis and start on the path to relief.