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Eczema: Symptoms and Treatment

eczema
Eczema often appears as a bumpy, itchy rash.
Credit: Pan Xunbin | ShutterStock

Eczema, also referred to as dermatitis, is an inflammation of the skin characterized by reddening, swelling, bumps and crusting, followed by thickening and scaling, according to Dr. Jackie Suver, a dermatologist who practices in Maryland.

Eczema affects up to 15 million Americans, according to the Cleveland Clinic. Most of them are infants and children. Ten percent to 20 percent of all infants have eczema, according to the National Institutes of Health. However, nearly half outgrow the condition.

Eczema usually appears in children between 6 months and 5 years old, according to the National Eczema Association. Rashes usually begin on the face, scalp, hands and feet. The problem can last throughout childhood and into adulthood.

Symptoms & Causes

Doctors do not know the exact cause of eczema, Suver said. The current thinking is that it is triggered by a combination of factors, including genetics. People are more at risk of developing eczema if they have relatives with eczema, asthma, or seasonal allergies, she said. 

Environmental factors, such as low humidity, can make the skin dry and itchy, according to the Cleveland Clinic. Contact with harsh soaps, chemicals, perfumes and skin care products that contain fragrance or alcohol may irritate the skin, as will some fabrics, such as wool, and tight clothing.

According to the National Eczema Association, symptoms include:

  • Dry, sensitive skin
  • Red, inflamed skin
  • Intense itching
  • Scaly areas 
  • Recurring rash
  • Oozing and crusting
  • Rough, leathery patches
  • Swelling
  • Dark-colored patches of skin

Symptoms can flare or worsen when exposed to specific triggers, such as:

  • Allergens, including pollen, pet hair, dander, mold and foods such as eggs, wheat, nuts and dairy products
  • Skin irritants, including perfumes, harsh soaps, chemicals, alcohol-containing skin products, wool or tight clothing
  • Water, especially hot baths
  • Colds or flu
  • Climate conditions such as heat and low or high humidity
  • Stress

Diagnosis and tests

Eczema can be diagnosed by looking at a patient's skin. "There are no specific tests for the diagnosis of atopic dermatitis (eczema). A physician, preferably a dermatologist, will base diagnosis on a physical examination and detailed medical history. Environmental allergy testing may be conducted in order to rule out related skin conditions such as contact dermatitis," said Dr. Gur Roshwalb of Celsus Therapeutics, a company that makes anti-inflammatory drugs.

Treatment and medication

Eczema treatment depends largely on the severity of symptoms. "The best way to treat eczema is to take good care of your skin," Suver said. In order for prescription medicines to be most effective, a proper bathing and moisturizing routine is required. Suver advises taking warm (not hot) baths/showers and immediately applying a fragrance-free moisturizer to keep the affected skin moist. Wearing cotton clothing, sleeping with a humidifier and avoiding using products with harsh chemicals is helpful as well. 

For minor cases, some over-the-counter products can reduce itching and skin redness, according to the Cleveland Clinic. These include oral antihistamines, topical antibacterial and antifungal creams, and topical creams or ointments that contain the steroid cortisone, which reduces inflammation. More severe cases warrant prescription-strength cortisone products, including pills and topical creams. Additionally, the U.S. Food and Drug Administration approved a new class of drugs called topical immunomodulators (TIMs), which alter the body's response to allergens. 

"Topical corticosteroids have been the mainstay of treatment but well-known side effects make them unsuitable for long-term use," Roshwalb told Live Science. "There are a few non-steroidal anti-inflammatory creams available; however, the most promising have been associated with increased long term malignancy risk due to systemic immunosuppression and are not recommended as first-line therapy."

Phototherapy, which uses special lamps to bathe skin lesions in ultraviolet light, may also improve acute eczema. This is a costly treatment, though, and the treatment can burn the skin, according to the National Eczema Association

Some new treatments are currently being investigated, said Dr. Monika Kiripolksy of the Obagi Skin Health Institute. "The new drug on the horizon is Dupilumab, which is not yet FDA-approved. It is injected to interfere with the activity of two key proteins that are thought to be components of inflammatory processes that causes eczema. Early clinical trials have shown promise so far."

eczema
A chronic, itchy inflammation of the skin may be eczema.
Credit: Imcsike | ShutterStock

Coping tips

Avoiding triggers and minimizing scratching go a long way toward coping with eczema. According to the NIH and the Cleveland Clinic, effective home care can include:

  • Applying cold compresses to reduce severe itching
  • Cutting children's fingernails short to curtail scratching
  • Using less soap than usual
  • Taking shorter baths or showers
  • Avoiding sudden temperature and humidity changes
  • Wearing gloves for jobs that require putting hands in water
  • Drinking eight glasses of water a day to keep skin moist

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