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Definition

Eczema, also known as atopic dermatitis, is a chronic inflammation of the outer layers of the skin.

Causes

The exact cause of eczema is not known. Factors that may contribute to eczema include:

Risk Factors

Eczema is more common in people of African or Asian descent.

Factors that increase your chance of eczema:

  • Asthma or hay fever
  • Urban areas or places with low humidity
  • A family history of eczema or allergic disorders
  • Exposure to certain fabrics, perfumes in soaps, dust mites (common), or foods
  • Stress, especially if it leads to scratching
  • Frequent washing of affected areas
  • Use of rubber gloves in persons sensitive to latex
  • Scratching or rubbing of skin
  • Immunosuppressant medications

Inflamed Lung and Asthma

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Symptoms

The symptoms vary from person to person. Scratching and rubbing can cause or worsen some of the symptoms. Symptoms include:

  • Dry, itchy skin
  • Cracks behind the ears or in other skin creases
  • Red rashes on the cheeks, arms, and legs
  • Red, scaly skin
  • Thick, leathery skin
  • Small, raised bumps on the skin
  • Crusting, oozing, or cracking of the skin
  • Symptoms that worsen in the winter when inside air is dry due to central heating
Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. The diagnosis is made by the appearance and location of the rash. You may be referred to specialist. A dermatologist focuses on skin disorders. An allergist focuses on allergies.

Treatment

The main goals of eczema treatments are to:

  • Heal the skin and keep it healthy
  • Stop scratching or rubbing
  • Avoid skin infection
  • Prevent flare-ups
  • Identify and avoid triggers

Treatment options may vary. Your doctor may recommend more than one depending on your condition. They include:

Skin Care

Proper skin care may allow the skin to heal. Treatment may include the following:

  • Avoid hot or long baths or showers. Keep them less than 15 minutes.
  • Use mild, unscented bar soap or non-soap cleanser. Use it sparingly.
  • Air-dry or gently pat dry after bathing. Apply gentle moisturizer when you skin is still damp.
  • Treat skin infections right away.
Medications

In some cases, medication may also be needed and may include:

  • Prescription creams and ointments containing cortisone, tacrolimus, or pimecrolimus
  • Prescription or over-the-counter antihistamines to help prevent itching
  • Antibiotics applied directly to the skin or taken by mouth in order to treat infections
  • Oral medications, such as prednisone or cyclosporine for severe cases
Phototherapy

If skin care and medications are not effective, light therapy may be used. This may include:

  • Treatment with ultraviolet A light and 5-methoxypsoralen (PUVA)
  • Photopheresis—For severe cases
Prevention

It is difficult to prevent eczema. This is most true when there is a strong family history.

RESOURCES:

American Academy of Allergy, Asthma, and Immunology
http://www.aaaai.org

National Eczema Society
http://www.eczema.org

CANADIAN RESOURCES:

Canadian Dermatology Association
http://www.dermatology.ca

Health Canada
http://www.hc-sc.gc.ca

References:

Atopic dermatitis. American Academy of Dermatology website. Available at: http://www.aad.org/skin-conditions/dermatology-a-to-z/atopic-dermatitis. Accessed November 6, 2014.

Atopic dermatitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health_Info/Atopic_Dermatitis/. Updated May 2013. Accessed November 6, 2014.

Barnetson RS, Rogers M. Childhood atopic eczema. BMJ. 2002;324:1376-1379.

Brehler R, Hildebrand A, Luger T. Recent developments in treatment of atopic eczema. J Am Acad Dermatol. 1997;36:983-994.

Holscher B, Frye C, Wichmann HE, Heinrich J. Exposure to pets and allergies in children. Pediatr Allergy Immunol. 2002;13:334-341.

Mohla G, Horvath N, Stevens S. Quality of life improvement in a patient with severe atopic dermatitis treated with photopheresis. J Am Acad Dermatol. 1999;40(5 Pt 1):780-782.

Saarinen UM, Kajosaari M. Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old. Lancet. 1995;346:1065-1069.

Skin allergy. American Academy of Allergy, Asthma, and Immunology website. Available at: http://www.aaaai.org/patients/allergic_conditions/eczema.stm. Updated May 2013. Accessed November 6, 2014.

Wahn U, Bos JD, Goodfield M, et al. Efficacy and safety of pimecrolimus cream in the long-term management of atopic dermatitis in children. Pediatrics. 2002;110(1 Pt 1):e2.

7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Langan SM, Flohr C, Williams HC. The role of furry pets in eczema: a systematic review. Arch Dermatol. 2007;143:1570-1577.

6/4/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Alexander DD, Cabana MD. Partially hydrolyzed 100% whey protein infant formula and reduced risk of atopic dermatitis: a meta-analysis. J Pediatr Gastroenterol Nutr. 2010;50(4):422-430.

1/4/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Dotterud CK, Storr O, Johnsen R, Oien T. Probiotics in pregnant women to prevent allergic disease: a randomized, double-blind trial. Br J Dermatol. 2010;163:616-623.



Last reviewed March 2014 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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