What is eczema?
Eczema, or atopic dermatitis, is one of the most common inflammatory skin conditions that can cause itchy, dry, and/or scaly skin. It is often referred to as ‘the itch that rashes’ because the itchy dry skin results in rashes from intense scratching or rubbing.
Who is at risk?
Eczema is most commonly seen in children, but it can also occur later in life during adulthood. The estimated global prevalence is 15-20% among children and 10% among adults. Although eczema affects both sexes, studies have shown that it is slightly more common among female patients. Those with a family history of eczema are at increased risk for developing eczema.
What causes eczema?
The exact causes of eczema are unknown; however, it is thought to occur due to a combination of genetic and environmental factors. Most people with eczema have a genetic abnormality in the epidermis, the outermost layer of the skin, which interferes with its function as the body’s first line of defense against pathogens and irritants. Exposure to these pathogens or irritants, therefore, results in inflammation and the scaly, itchy, dry skin characteristic of eczema.
What are the symptoms?
Symptoms can vary widely between individuals and can change over time. Common symptoms include intense itching, scaly or flaky skin, and small bumps. Eczematous areas often also become discolored and may appear pink or red on those with lighter skin, or purple, brown, or gray on those with darker skin. Scratching from the itchiness can lead to infections, which can cause the formation of painful, pus-filled bumps and eventual scars.
In infants, eczema can be more widespread and involve many areas of the body, including the head, face, arms, and legs. The affected areas usually become more localized with age, and common areas for eczema among older children and adults include the elbows, the back of the neck, and the backs of the knees.
How is eczema diagnosed?
There is no laboratory test or scan that is used to diagnose eczema. Your doctor will make the diagnosis based on your medical history, family history, symptoms, and physical examination. Your doctor may recommend an allergy test to rule out allergy as a cause of your signs and symptoms.
How is eczema treated?
Eczema is a chronic condition that often comes and goes in flares. Although there is no cure for eczema, your physician can work with you to manage symptoms via the following: 1. Identifying triggers: Common triggers of eczema flares include sudden temperature changes, excessive sweating, stress, and exposure to irritants. 2. Ensuring skin hydration: Your physician may recommend an ointment or a cream that locks in moisture and prevent your skin from drying out. 3. Steroids: steroids help calm down the immune system, and can be administered either topically or orally. Usually, steroids will only be used temporarily in order to prevent the effects of long-term use, such as thinning of the skin.
4. Antihistamines: These can be taken orally and are often available over-the-counter. Antihistamines can help relieve itching, which subsequently helps prevent scratching and potential infections. 5. Light therapy: For those with severe eczema who do not respond to other treatments, the physician may recommend ultraviolet light therapy. This is often avoided due to its costliness and the increased risk for skin cancer. 6. Immunosuppressive drugs: Non-steroid immunosuppressive drugs may be used to weaken the immune system. Due to the potential side effects of these drugs, these are often used in cases of severe eczema that is not responsive to other treatments. What is the prognosis? Many children will outgrow eczema, and symptoms will resolve by adulthood. Children with severe or later-onset eczema is more likely to have persistent disease.
Sources
Nemeth V, Evans J. Eczema. [Updated 2020 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Stander S. Atopic Dermatitis. N Engl J Med (2021); 384:1136-43. Eczema Types: Atopic Dermatitis Overview. American Academy of Dermatology. Weston WL, Howe W. Patient education: Eczema (atopic dermatitis) (Beyond the Basics). In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. Weston WL, Howe W. Treatment of atopic dermatitis (eczema). In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. Weston WL, Howe W. Atopic dermatitis (eczema): Pathogenesis, clinical manifestations, and diagnosis. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MAe