Eczema

Eczema is a term for several different types of skin swelling. Eczema is also called dermatitis. It is not dangerous, but most types cause red, swollen, and itchy skin. Factors that can cause eczema include other diseases, irritating substances, allergies, and your genetic makeup. Eczema is not contagious.

More than 30 million Americans may have eczema. The red, itchy rash can appear all over the body. Babies often have eczema on the face, especially the cheeks and chin. They can also have it on the scalp, chest, back, and outer arms and legs. Children and adults tend to have eczema on the neck, wrists, and ankles, and in areas that bend, like the inner elbow and knee. The most common type of eczema is atopic dermatitis. It is an allergic condition that makes your skin dry and itchy. It is most common in babies and children.

People with eczema are usually diagnosed with it when they are babies or young children. Eczema symptoms often become less severe as children grow into adults. For some people, eczema continues into adulthood. Less often, it can start in adulthood. The rash of eczema is different for each person. It may even look different or affect different parts of your body from time to time. It can be mild, moderate, or severe. Generally, people with eczema suffer from dry, sensitive skin. Eczema is also known for its intense itch. The itch may be so bad that you scratch your skin until it bleeds, which can make your rash even worse, leading to even more inflammation and itching. This is called the itch-scratch cycle.

Eczema is a chronic disease. You can prevent some types of eczema by avoiding irritants, stress, and the things you are allergic to. Treatments and self-care measures can relieve itching and prevent new outbreaks.

Signs and symptoms of eczema vary widely from person to person and include:

• Itching, which may be severe, especially at night
• Red to brownish-gray patches, especially on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of the elbows and knees, and, in infants, the face and scalp
• Small, raised bumps, which may leak fluid and crust over when scratched
• Thickened, cracked, dry, scaly skin
• Raw, sensitive, swollen skin from scratching

Factors that can worsen eczema signs and symptoms include:

• Dry skin, which can result from long, hot baths or showers
• Scratching, which causes further skin damage
• Bacteria and viruses
• Stress
• Sweat
• Changes in heat and humidity
• Solvents, cleaners, soaps and detergents
• Wool in clothing, blankets and carpets
• Dust and pollen
• Tobacco smoke and air pollution
• Eggs, milk, peanuts, soybeans, fish and wheat, mostly in infants and children

The exact cause of eczema is unknown. Healthy skin helps retain moisture and protects you from bacteria, irritants, and allergens. Eczema is likely related to a mix of factors:

• Dry, irritable skin, which reduces the skin's ability to be an effective barrier
• A gene variation that affects the skin's barrier function
• Immune system dysfunction
• Bacteria, such as Staphylococcus aureus, on the skin that creates a film that blocks sweat glands
• Environmental conditions

No test is needed to diagnose eczema. Your doctor will likely identify it by examining your skin and reviewing your medical history. He or she may also use patch testing or other tests to rule out other skin diseases or identify conditions that accompany your eczema.

There are many things that can affect eczema: what you eat, how much exercise you get, and your home and work environment can either help or worsen your eczema.

To help reduce itching and soothe inflamed skin, try these self-care measures:

• Take an oral allergy or anti-itch medication. Options include nonprescription allergy medicines (antihistamines) such as cetirizine (Zyrtec) or fexofenadine (Allegra). Also, diphenhydramine (Benadryl, others) may be helpful if itching is severe.
• Apply an anti-itch cream or calamine lotion to the affected area. A nonprescription hydrocortisone cream, containing at least 1 percent hydrocortisone, can temporarily relieve the itch. Apply it to the affected area before you moisturize. Once your reaction has improved, you may use this type of cream less often to prevent flare-ups.
• Moisturize your skin at least twice a day. Use a moisturizer all over while your skin is still damp from a bath or shower. Pay special attention to your legs, arms, back and the sides of your body. If your skin is already dry, consider using oil or lubricating cream.
• Avoid scratching. Cover the itchy area if you cannot keep from scratching it. Trim nails and wear gloves at night.
• Apply cool, wet compresses. Covering the affected area with bandages and dressings helps protect the skin and prevent scratching.
• Take a warm bath. Sprinkle the bath water with baking soda, uncooked oatmeal or colloidal oatmeal — a finely ground oatmeal that is made for the bathtub (Aveeno, others). Soak for 10 to 15 minutes, then pat dry and apply medicated lotions, moisturizers or both (use the medicated form first).
• Choose mild soaps without dyes or perfumes. Be sure to rinse the soap completely off your body.
• Use a humidifier. Hot, dry indoor air can parch sensitive skin and worsen itching and flaking. A portable home humidifier or one attached to your furnace adds moisture to the air inside your home. Keep your humidifier clean to prevent the growth of bacteria and fungi.
• Wear cool, smooth-textured cotton clothing. Reduce irritation by avoiding clothing that's rough, tight, scratchy, or made from wool. Also, wear appropriate clothing in hot weather or during exercise to prevent excessive sweating.
• Treat stress and anxiety. Stress and other emotional disorders can worsen atopic dermatitis. Acknowledging those and trying to improve your emotional health can help.

Eczema can be persistent. You may need to try various treatments over months or years to control it. And even if you respond to treatment, your signs and symptoms may return (flare).

If regular moisturizing and other self-care steps do not help improve your symptoms, your doctor may suggest the following treatments and drugs:

• Creams that control itching and inflammation. Your doctor may prescribe a corticosteroid cream or ointment. Talk with your doctor before using any topical corticosteroid. Overuse of this drug may cause skin irritation or discoloration, thinning of the skin, infections, and stretch marks.
• Creams that help repair the skin. Drugs called calcineurin inhibitors such as tacrolimus (Protopic) and pimecrolimus (Elidel) affect your immune system. Applied to the skin, they help maintain normal skin, control itching and reduce flares of atopic dermatitis. Due to possible side effects, these prescription-only drugs are used only when other treatments have failed or if someone cannot tolerate other treatments. They are approved for children older than 2 and for adults.
• Drugs to fight infection. You may need antibiotics if you have a bacterial skin infection or an open sore or cracked skin caused by scratching. Your doctor may recommend taking oral antibiotics for a short time to treat an infection. Or he or she may suggest you take it for a longer time to reduce bacteria on your skin and to prevent another infection.
• Oral anti-itch drugs. If itching is severe, oral antihistamines may help. Diphenhydramine (Benadryl, others) can make you sleepy and may be especially helpful at bedtime.
• Oral or injected drugs that control inflammation. For more severe cases, your doctor may prescribe oral corticosteroids such as prednisone or an injected corticosteroid. These drugs are effective but cannot be used long term because of potential serious side effects. Continue moisturizing and using other self-care remedies to prevent a flare-up after you stop taking the corticosteroids.