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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:

• Itching

• 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.

Types of Eczema

There are several types of eczema. You can develop more than one kind of eczema at a time.

• Atopic dermatitis is a chronic condition that often begins in childhood. If you have asthma or hay fever or a family history of atopic dermatitis, you are at higher risk. Many children grow out of this skin disease, though it can sometimes last into adulthood.

• Contact dermatitis is a rash that develops when your skin touches something you are allergic to. This can include detergents, tobacco smoke, paint, bleach, wool, astringents, acidic food, certain soaps, fragrances, and skin care products, as well as animal dander or pollen.

• Dyshidrotic eczema produces itchy blisters on the edges of the fingers, toes, palms, and soles of the feet. It is often a response to stress, allergies, moist hands and feet, or exposure to metals such as nickel, cobalt, and chromium salts.

• Nummular eczema causes circular, dry spots on the skin that can be very itchy. Researchers believe that it might be related to insect bites, skin inflammation, or dry skin in the winter.

• Seborrheic dermatitis causes skin redness and flaking that tends to appear on the scalp, face, and upper chest. In babies, we call this condition “cradle cap,” though it happens to people of all ages.

• Stasis dermatitis presents as redness, scaling, itching, and pain. You are more likely to have this condition if you have chronic ankle/calf swelling. Usually what happens is you have poor blood flow in your leg veins and some of the fluid leaks out of the veins and irritates the skin.  In more severe cases, you could develop oozing, open sores, and infection.

Why choose PHP Aesthetic

At our clinic of Excellence in Eczema directed by DrPhilippe and his team, we treat eczema patients from all over the world. Thanks to our research efforts, we can offer the most advanced therapies for this condition.

We can also test to see if you have an allergy that is making your eczema worse, or is causing contact dermatitis. We design our patch testing to meet your individual needs. Studies have found that food allergies can make eczema symptoms worse in some children. When appropriate, we may refer you to our nutritionist.

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— 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.