Eczema is a catch-all term that is used to describe medical conditions that present with itchy, red, and/or rough skin due to inflammation or irritation. It most commonly refers to a condition called “atopic dermatitis.”
Atopic dermatitis is a common inflammatory skin condition that typically begins during infancy or early childhood and is often associated with other “atopic” disorders such as asthma and allergic rhinoconjunctivitis (hay fever). Atopic dermatitis can occur at any age. It has a genetic predisposition with environmental triggers, including dry skin, skin infections (typically from the bacteria Staphylococcus aureus), stress, food allergies (e.g. dairy, wheat, soy, peanuts, eggs, etc), airborne allergens (e.g. dust, mold, pollen, animal dander, etc), and contact allergies (e.g. preservatives, dyes, formaldehyde, etc).
How is eczema (atopic dermatitis) diagnosed?
Eczema is usually diagnosed by a dermatologist, pediatrician, or other primary care provider by clinically examining the skin and asking a few questions regarding the patient’s medical history. To be diagnosed with eczema, the patient must exhibit an itchy skin condition (or parents report scratching or rubbing in a child).
Classically, it involves skin creases such as folds of elbows, behind the knees, fronts of ankles, the neck, and around the eyes. In children under 4 years of age, more common sites of involvement include the cheeks/forehead and extensor limbs. Many adults may have eczema just on the hands or feet or distributed randomly throughout the body. The patient is also asked about a history of asthma or hay fever as well as a history of generally dry skin in the last year.
How is eczema (atopic dermatitis) treated?
The goal of treatment of eczema is to relieve and prevent itchy skin. Given that eczema-prone skin is usually dry and sensitive, proper skin care is extremely important and involves avoiding products (soaps, detergents, moisturizers, etc) that have fragrances or dyes as well as using moisturizers, ideally a cream with ceramides. Ceramides are lipid molecules that make up the lipid bilayer in the cell membrane. Individuals with eczema have an impaired skin barrier where the eczema occurs (making it more susceptible to environmental allergens and pathogens), and ceramide-based moisturizers help to repair this. In addition, thicker emollients, such as creams and ointments (like petroleum jelly) are better than lotions. When using non-soap cleansers, it is recommended that they have a neutral to low pH and are hypoallergenic and fragrance free. It can also be helpful to get tested for food, environmental, or contact allergens in the right clinical setting. Intermittent diluted bleach baths are recommended to decrease the bacterial load on the skin, another potential eczema trigger.
Standard prescription treatments from a dermatologist may include a topical steroid or topical calcineurin inhibitor (the strength depends on the severity of the eczema) to help alleviate the rash, usually along with a prescription antihistamine to help with the itching sensation. The more one scratches their skin, the worse the eczema can get, so it’s best to stop the itch-scratch cycle as early as possible. If the eczema is more severe, a dermatologist may also prescribe oral antibiotics, oral immunosuppressants, with or without narrow-band UVB light therapy.
Dr. Turegano is a dermatologist who treats patients in California and Virginia. She is delighted to also share information with people in other states and internationally. Learn more about eczema here.