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Overview

Eczema, also known as atopic dermatitis, is a chronic, non-contagious, inflammatory skin condition characterized by severe itching, redness, oozing, and scaly rashes. Allergy plays a role in selected patients with eczema.

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Eczema comes and goes over time. It results in very dry and sensitive skin, and can be made worse by exposure to many different things, including allergens such as pet dander or dust mites. Other common triggers include soaps, detergents and lotions with heavy fragrances. Exposure to perfumes and cleaning products can also irritate eczema. For some people, weather changes (especially dry winter air) make eczema worse.

Eczema is particularly common in infants, and an estimated 10 to 20 percent of children have eczema. It is not contagious and is often hereditary. About 60 percent of those with eczema will experience symptoms by age 1, and another 30 percent will experience symptoms by age 5. Children born into families that have a history of allergic diseases such as asthma or hay fever are at an increased risk for developing eczema.

Eczema is considered to be part of the “atopic march.” The atopic march involves the diagnosis of eczema, food allergy, allergic rhinitis, and asthma, typically in that sequential order. Studies show up to 80 percent of children with AD develop asthma and/or allergic rhinitis later in childhood.

Although most children outgrow eczema, for adults who continue to suffer, it is a serious condition. Adult eczema is a chronic condition that involves inflamed, red, itchy patches of skin that can erupt in oozing flare-ups. Different areas of the body can be affected for adults, including face, hands and even eyelids. The itching for adults can feel unbearable as a flare-up can affect skin all over the body. There are treatments and medications which can help control some of the itchiness and pain caused by eczema. It is unusual to develop eczema after age 60. If it occurs, then it usually has to do with a more serious underlying medical condition and you should see your doctor.

Symptoms

Symptoms of eczema include:

  • A red rash or red patches of skin, especially inside the folds of the elbows and knees
  • Itching
  • Dry skin, which can crack and possibly bleed

The location of eczema may change with age. In infants and young children, eczema is usually located on the cheeks, outside of the elbows and on the knees. In older children and adults, eczema is typically on the hands and feet, the arms and on the back of knees.

Symptoms can be painful, cause skin coloring changes, and blisters. The itch associated with eczema can be severe, often interrupting sleep. Scratching of the skin may lead to an infection. Infants with eczema may rub against bedding or other things to relieve the itch.

Diagnosis

Allergists are specially trained to treat skin conditions such as eczema which are often related to an allergic response. You’ll likely be asked questions about the types of soap, detergent and skin care products you use, and about any other exposures that may be making your eczema worse.

Your allergist may perform a prick test, which involves a diluted allergen being applied with a prick or a puncture on the surface of the skin. The allergist observes the tested area for about 15 minutes to see if a bump (wheal) or redness (flare) develops. The test is usually done on the back or forearm in adults and on the back in children, with several allergens tested at once.

An allergist’s specialized training helps them to develop a treatment plan for your individual condition. The goal will be to enable you to lead a life that is as normal and symptom-free as possible. Your allergist might be able to determine possible allergic triggers for your eczema — and offer treatment suggestions to help provide relief from symptoms.

From 33 to 63 percent of young children with moderate to severe eczema also have food allergies. It is recommended that children under the age of 5 who have moderate to severe eczema be evaluated for milk, egg, peanut, wheat, and soy allergies, if the child continues to have eczema even after treatment. Testing is also recommended when the child has a history of reaction after eating a specific food. An allergist can help identify which foods, if any, to eliminate from your child’s diet.

Recent guidelines put infants who have severe eczema and/or egg allergy in the highest risk category for peanut allergy. These high risk infants should be seen by an allergist who can determine if they are candidates to be introduced to peanut-containing foods between 4-6 months in order to prevent peanut allergy.

 

Treatment and Management

Children and adults diagnosed with eczema can manage the condition with the guidance of an allergist. In cases of moderate or severe eczema, an allergist may recommend prescription medication, including topical steroids and/or antihistamine. Milder cases may be treated with ointments such as petroleum jelly, and moisturizers. Those should be applied daily, even when the skin appears clear, to help prevent dryness.

People with eczema should avoid harsh cleansers, drink water often, wear gloves in cold weather, and avoid wearing materials such as wool, which could irritate the skin. Flare-ups of eczema can be caused by foods, cosmetics, soaps, wool, dust mites, mold, pollen, dog or cat dander, dry climate and other variables.

If you have an infant with eczema, your allergist might advise you to bathe him at least once a day and immediately apply moisturizer after the bath. Limited use of pH balanced skin cleansers should also be part of frequent bathing, along with gentle patting dry, and the immediate application of a moisturizer to “seal” in moisture. This technique is called “soak and smear” and can provide relief from the itching that comes with eczema.

In 2016, the U.S. Food and Drug Administration (FDA) approved a topical treatment called crisaborole for children 2 years of age and older and adults with mild to moderate eczema. It was the first new FDA-approved medication for eczema in more than 10 years. Clinical trials showed the medication is effective at decreasing inflammation and is well-tolerated with long term use. In 2017, the FDA approved a new drug to treat serious cases of eczema in patients 18 years of age and older. The drug, dupilumab, is a twice-monthly injection under the skin that patients can do at home. The drug was made for those whose eczema can not be controlled well by topical therapies such as ointments or creams. Dupilumab can be used with or without topical corticosteroids.

FAQs

Will my eczema symptoms improve?

Eczema is a chronic condition, and the symptoms can come and go. The symptoms are treatable. Talk to your allergist about topical ointments or creams that can be applied to the skin. You can also help manage your eczema with regular moisturizing after baths and showers, avoiding things that may trigger a flare up (pollen or animal dander, for example), avoiding extremes in humidity levels, using non-perfumed soaps, and wearing loose-fitting, soft cotton clothing.

Is all eczema the same?

No. Many other types of inflammatory skin conditions are part of the eczema family. One such example is contact dermatitis, which is caused by direct contact with substances such as latex, detergents, perfumes, and a host of other allergens and substances to which an individual has developed sensitivities.

Will my child grow out of her eczema?

Many children find their eczema diminishes, or even disappears before they start grade school. That said, it’s hard to know which children will outgrow their eczema and which will have symptoms that continue into adulthood. Those who suffered from eczema as a child may always have a tendency towards dry skin. Most people who have eczema that continues into adulthood find methods to cope with their very dry skin including the use of moisturizers to help control flare-ups.

Is it possible to develop eczema later in life, as an adult?

Yes. Although most people associate the development of eczema in childhood, it can also appear as an adult. Eczema most commonly presents before the age of 5, but adolescents and adults can also develop this condition. The condition seems to be more common in urban areas and developed countries and affects men and women of all races equally. Either way, eczema is not contagious. You or your child cannot “catch” it from another person, or give it to someone else.