Dermatitis, Atopic (Eczema)

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Overview

Eczema (atopic dermatitis) is a disorder associated with dry skin, which begins with intense itching that is aggravated by scratching. The exact cause of eczema is unknown, and there is no known cure.

  • It is a condition primarily affecting allergy-prone people.
  • Heat, humidity, detergents/soaps, abrasive clothing (eg, very scratchy wools), chemicals, smoke, as well as stress may trigger eczema.
  • Scratching increases the chances of developing a superimposed infection because it produces breaks in the skin.

Who's at risk?

Infants and children are most frequently affected, but eczema may persist into adulthood in some individuals.

Signs and Symptoms

The most common locations for eczema include the face, neck, in front of the elbows, behind the knees, and on the extremities. Adults with eczema may notice the most irritation on the arms and legs, particularly in front of the elbows and behind the knees.

  • Thickened, scaly, pink to red papules and plaques are seen in these areas.
    • Mild – few, scattered areas of involvement that are easily treated with self-care measures
    • Moderate – more extensive involvement that is more difficult to control with self-care measures and may require prescription therapy
    • Severe – diffuse involvement that is difficult to treat even with prescription therapy
  • Some adults may have primarily chronic hand involvement.
  • Areas with superimposed infection can develop thick crusts.
  • Blacks frequently have extensive accentuation of the hair follicles and shininess without obvious thickened, raised areas.

Self-Care Guidelines

Maintaining healthy skin is very important for sufferers of eczema.

  • Moisturizing skin-care routines are essential.
  • Non-soap cleansers, such as Cetaphil®, or moisturizing soaps, such as Dove®, are recommended.
  • Thick moisturizers such as petroleum jelly, Aquaphor® ointment, Eucerin® cream, CeraVe™ cream, and Cetaphil® cream should be applied to damp skin after daily bathing.
  • Attempt to minimize exposure to heat, humidity, detergents/soaps, abrasive clothing, chemicals, smoke, and stress.
  • Fragrance-free laundry detergent may be beneficial.
  • Keep the home from getting too dry by using a humidifier or by setting out bowls of water, especially in the bedroom.

When to Seek Medical Care

You should seek medical care if there is a lack of response to self-care measures or the condition worsens or flares.

Treatments Your Physician May Prescribe

Topical or oral (systemic) medications can include:

  • Topical steroid creams or ointments may be prescribed to treat active areas of localized eczema. Low-strength steroids may be used on the face and medium- to high-strength steroids may be used on the trunk and extremities.
  • Care should be taken when using topical steroids in skin folds because of the risk of atrophy or thinning of the skin.
  • Steroid-sparing agents, such as topical tacrolimus or pimecrolimus, may be prescribed for milder disease or for certain areas of involvement, such as the face.
  • Oral antihistamines may be prescribed to decrease itching.
  • If an infection is suspected, topical or oral antibiotics may be prescribed.
  • In patients who have multiple areas of broken skin or a history of bacterial skin infections, dilute bleach baths may be prescribed.
Procedures:
  • For more extensive eczema, forms of light therapy may be recommended.
  • Patients with resistant cases may be treated with oral medications used to suppress the immune system, such as cyclosporine or tacrolimus.

Trusted Links

MedlinePlus: Eczema

References

Bolognia, Jean L., ed. Dermatology, pp.1999-2414. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.1180, 1188-1189. New York: McGraw-Hill, 2003.