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 damaged. This loss of barrier function makes the skin more sensitive and more prone to infection and to becoming dry.
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 or have significant improvement as they get older. Eczema affects males and females equally, and is more common in people who have a personal or family history of asthma and allergies.
What are the symptoms of eczema?
Common symptoms of eczema include:
- 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. This suggests that there is a genetic (hereditary) factor in the development of eczema (runs in the family).
In addition, eczema symptoms tend to flare up or get worse 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.
Diagnosis and Tests
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.
Management and Treatment
How is eczema treated?
Treatment of eczema depends on the symptoms (for example, dry skin is treated differently than oozing blisters) and 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 and to prevent infection and additional 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 certain detergents or food allergens, and to moisturize the skin.
- 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 while skin is still damp — 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” that is missing in the skin of eczema patients and are the most effective moisturizers.
- 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 (changing) 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. Some patients with severe eczema may require oral immunomodulatory or immunosuppressant medications to control their skin disease.
- Phototherapy: The ultraviolet light waves found in sunlight have been shown to help certain skin disorders, including eczema. Phototherapy uses ultraviolet light, usually ultraviolet B (UVB), from special lamps to treat people who have severe eczema.
What complications are 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 continued 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, inflammation from eczema may leave dark marks that linger for months.
Can eczema be cured?
Currently, there is no cure for eczema. However, proper treatment and good skin care can often control or minimize symptoms.
Can eczema be prevented?
There are steps you can take to prevent eczema outbreaks:
- Establish a skin care routine, and follow your doctor's recommendations for keeping your skin healthy.
- Wear gloves for jobs in which you have to put 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 two to three times a day.
- Take baths or showers with tepid (lukewarm) rather than hot water temperature.
- Drink at least eight 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.
Outlook / Prognosis
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 be generally well-managed with good skin care and treatment, although flare-ups of symptoms can occur throughout life.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.
This document was last reviewed on: 01/10/2017