Dermatitis, Atopic (Eczema)

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Overview

Eczema, formally known as atopic dermatitis, is a common disorder in infants and is associated with dry and itchy patches of skin. Young children will often scratch at the dry skin, causing bleeding in the affected area. Eczema can occur on any part of the body and is most common on skin that is stretched often (eg, the back of elbows and front of knees).

Eczema is not contagious and it is not an infection, but prolonged scratching can allow bacteria to get through the skin and cause an infection. Some common triggers that cause eczema include:

  • Heat and humidity
  • Abrasive clothing
  • Tobacco smoke and chemicals
  • Some soaps and detergents

Who's at risk?

Infants are more likely to have eczema if they have other allergies, such as to foods or milk, as well as seasonal allergies, or if they have other family members who were affected with eczema as an infant. Infants who have asthma are also more likely to have eczema.

Signs and Symptoms

The most common locations for eczema are, in general, the face, neck, in front of the elbows, behind the knees, and on the extremities. The first location in an infant is usually the cheek area.

  • Thickened, scaly, pink to red bumps (papules) and slightly elevated lesions (plaques) are seen in these areas.
    • Mild eczema – few, scattered areas of involvement, which are easily treated with self-care measures
    • Moderate eczema – more extensive involvement, which is more difficult to control with self-care measures and may require prescription therapy
    • Severe eczema – diffuse involvement, which is difficult to treat even with prescription therapy
  • Infants with eczema may have prominent involvement of the face, scalp, and the skin on the arms and legs overlying the elbows and knees.
  • 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 daily to damp skin after 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 air from getting too dry by using a humidifier or by setting out bowls of water, especially in the bedroom.

When to Seek Medical Care

See your child's doctor or a dermatologist 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 medications for eczema can include:

  • Topical steroid creams or ointments may be prescribed to treat active areas of localized eczema. Lower-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 and obstructed areas due to the risk of thinning (atrophy) 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. These medications are not approved for children under the age of 2. These medications have a warning about the risk of malignancy.
  • Oral antihistamines may be prescribed to decrease itching.
  • If a superimposed 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.

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.