Eczema (Atopic Dermatitis)

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Images of Dermatitis, Atopic (Eczema)

Overview

Eczema, formally known as atopic dermatitis, is a very common allergic skin condition. Eczema looks different in people of different ages. In teens, it tends to look like red, dry, irritated skin on the hands, wrists, and legs, though it can appear anywhere.

Eczema is very itchy, and scratching tends to worsen the condition and can lead to infection of the skin caused by bacteria on the hands and nails. The key to controlling eczema is to avoid the triggers that bother it (eg, soaps, lotions, detergents, weather, and stress) and keep the skin well moisturized.

Who's at risk?

Anyone may have eczema, but it is more common in people with other allergies or with asthma. It is more commonly seen in infants and children, who usually grow out of it, but it is sometimes seen in teens and adults who may or may not have had eczema as children.

Signs and Symptoms

The most common locations for eczema include the face, neck, in front of the elbows, behind the knees, and the arms and legs (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 bumps and patches of skin are seen in these areas.
    • Mild – few, scattered areas of involvement, which are easily treated with self-care measures
    • Moderate – more extensive involvement, which are more difficult to control with self-care measures and may require prescription therapy
    • Severe – diffuse involvement, which is difficult to treat even with prescription therapy
  • Some adults may have primarily chronic hand involvement.
  • Areas of involvement that become infected can develop thick crusts.
  • Dark-skinned individuals with eczema 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 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

You should seek medical care if there is a lack of response to self-care measures or the eczema 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. Lower strength steroids may be used on the face and medium to high strength steroids may be used on the torso and arms and legs.
  • Care should be taken when using topical steroids in skin folds because of the risk of thinning of the skin.
  • Steroid-sparing agents such as topical tacrolimus or pimecrolimus may be prescribed for milder cases of eczema 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.
  • Those with resistant disease may be treated with oral medications used to suppress the immune system, such as cyclosporine or tacrolimus.

Trusted Links

Clinical Information and Differential Diagnosis of Dermatitis, Atopic (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.