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Diseases & Conditions

Eczema

What is eczema?

Eczema is a general term for a group of conditions that cause the skin to become inflamed, red, dry, bumpy and itchy. However, this term is most often used to refer to a condition called atopic dermatitis. In atopic dermatitis, skin barrier function (the "glue" of the skin) is impaired. This makes the skin dry out and become infected more easily.

What are the symptoms of eczema?

Common symptoms of eczema include:

  • Itchiness
  • Skin redness
  • Dry, scaly, or crusted skin that might become thick and leathery from scratching
  • Formation of bumps or small, fluid-filled blisters that might ooze when scratched

In adults, eczema most often affects the hands. In children, eczema is more common in "bending" areas such as the insides of the elbows and backs of the knees. In babies, eczema is usually worst on the face, neck and scalp.

What causes eczema?

The exact cause of eczema is not known. However, it appears to run in families and occurs more often in people who have a personal or family history of asthma, hay fever, and other allergies, suggesting a genetic (hereditary) factor in the development of eczema. In addition, eczema symptoms tend to flare up or worsen when the person is exposed to certain substances and situations, called triggers. Eczema triggers might include:

  • Skin irritants — Irritants are substances that cause burning, itching, or redness. They include harsh soaps, chemicals, perfumes, and skin care products that contain fragrance or alcohol. Some fabrics, such as wool, and tight clothing can also irritate the skin.
  • Allergens — Allergens are substances that trigger an allergic reaction, which may include sneezing, itching, watery eyes, and a stuffed or runny nose. Some allergens such as pollens, pet hair or foods (in rare cases) can also trigger or worsen eczema symptoms.
  • Climate and environment — Low humidity (dry air) can cause the skin to become dry and itchy. Heat and high humidity cause sweating, which can make itching worse.
  • Stress — Stress has been shown to trigger flare-ups in some people with eczema. In addition, it may be more difficult to avoid scratching irritated skin when under stress.

How common is eczema?

Eczema is a common skin condition, affecting as many as 15 million Americans. It most often occurs in very young children. Ten percent to 20 percent of all infants have eczema, according to the National Institutes of Health. However, nearly half outgrow the condition. It affects males and females equally, and is more common in people who have a personal or family history of asthma and allergies.

How is eczema diagnosed?

In most cases, eczema is diagnosed from the person's history of symptoms and by examining the skin. The doctor might test an area of scaly or crusted skin to rule out other skin diseases or infections.

How is eczema treated?

Treatment varies depending on the symptoms (for example, dry skin is treated differently than oozing blisters); as well as the factors that trigger or worsen symptoms. No one treatment is best for all people. The goal of treatment is to reduce itching and discomfort as well as to prevent infection and further flare-ups.

Treatment options include:

Prevention

Preventing flare-ups is the best way to manage eczema. For that reason, it is important to try to identify and avoid symptom triggers, such as particular detergents or food allergens.

Skin care

Keeping your skin moist is important, because itching increases when the skin is dry. Use a moisturizing cream or ointment. Lotions are less effective. It is important to keep skin moisturized by applying creams or ointments several times a day — including after bathing/showering — to keep your skin moist. Use mild soaps and products that are free of perfumes, dyes and alcohol. Look for products that are “fragrance free,” “hypoallergenic” and “for sensitive skin.” New products containing “ceramide” actually replace some of the “glue” which is missing in the skin of eczema patients.

Medications

Over-the-counter creams and ointments containing the steroid cortisone — such as hydrocortisone (Cortisone 10®) and hydrocortisone acetate (Cort-Aid®) — may be used to help control the itching, swelling, and redness associated with eczema. Stronger, prescription-strength steroid creams are also available. Steroid pills and shots may be used in the short term to get control of severe eczema, but long-term use of these is not recommended because of the possible side effects, which include high blood pressure, weight gain, and thinning of the skin.

Newer medications, called topical immunomodulators (TIMs), are showing progress in treating patients with moderate to severe eczema, particularly those patients who do not respond to traditional treatment. TIMS — such as tacrolimus (Protopic®) and pimecrolimus (Elidel) — work by modulating (altering) the body's immune response to allergens. TIMs also have fewer side effects than steroids. The most common side effect reported with tacrolimus is a temporary stinging or burning sensation that generally improves after a few days of use.

Other medications that might be used for patients with eczema include antibiotics if the skin becomes infected and antihistamines to help control itching.

Phototherapy

The ultraviolet light waves found in sunlight have been shown to benefit certain skin disorders, including eczema. Phototherapy uses ultraviolet light, usually ultraviolet B (UVB), from special lamps to treat people with severe eczema.

Are there any complications associated with eczema?

  • Scratching or rubbing itchy areas can break the skin, allowing bacteria to enter and cause infection
  • Scars can form when the skin is damaged from prolonged scratching.
  • Very itchy eczema can disturb sleep.
  • Some people with eczema avoid social activities because they are uncomfortable and/or self-conscious.
  • In persons with darker skin, eczema may leave dark marks which linger for months.

What is the outlook for people with eczema?

Nearly half of children with eczema will outgrow the condition or experience great improvement by the time they reach puberty. Others will continue to have some form of the disease. For adults with eczema, the disease can generally be well managed with good skin care and treatment, although flare-ups of symptoms can occur throughout life.

Can eczema be prevented?

There are steps you can take to prevent eczema outbreaks, including:

  • Establish a skin care routine, and follow your doctor's recommendations for keeping your skin healthy.
  • Wear gloves for jobs that require putting your hands in water. Wear cotton gloves under plastic gloves to absorb sweat, and wear gloves outside, especially during the winter months.
  • Use mild soap for your bath or shower, and pat your skin dry instead of rubbing. Apply a moisturizing cream or ointment immediately after drying your skin to help seal in the moisture. Reapply cream or ointment 2 to 3 times a day.
  • Take baths or showers with tepid as opposed to hot water temperature.
  • Drink at least 8 glasses of water each day. Water helps to keep your skin moist.
  • Try to avoid getting too hot and sweaty.
  • Wear loose clothes made of cotton and other natural materials. Wash new clothing before wearing. Avoid wool.
  • Avoid sudden changes in temperature and humidity.
  • Learn to recognize stress in your life and how to manage it. Regular aerobic exercise, hobbies, and stress-management techniques — such as meditation or yoga — might help.
  • Limit your exposure to known irritants and allergens.
  • Avoid scratching or rubbing itchy areas of skin.

Can eczema be cured?

Currently, there is no cure for eczema. However, proper treatment and good skin care can often control or minimize symptoms.

References

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Can't find the health information you’re looking for?

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 12/2/2013…#9998