Eczema

What is eczema?

Eczema is a skin problem that causes itching, dryness, fine scales or flaking, and sometimes mild redness.

Eczema can be a mild skin irritation that does not need medical treatment. Sometimes, however, it causes relentless itching and scratching. The skin may become scaly, raw, or thickened from constant or repeated bouts of eczema. This more severe form of eczema, called atopic dermatitis, may always be present or may appear just in certain seasons or with stress. Atopic dermatitis usually appears first in childhood or early adulthood.

How does it occur?

Flare-ups of eczema can be caused by:

• dry skin
• allergies, for example to a food or medicine
• hot baths or showers
• soap
• scratchy or tight clothing
• quick temperature or humidity changes
• emotional upsets.

Often the tendency for severe eczema seems to be inherited along with asthma or hay fever. Eczema is not contagious.

What are the symptoms?

The main symptom of mild eczema is an area of fine, dry scaling on the skin, often on the arms or legs. The skin may or may not itch.

Severe eczema causes intense itching. The most common areas of itching are the fronts of the elbows, backs of the knees, and face. However, any area of skin may be affected. The skin is usually very sensitive to being touched. Even a light touch may cause itching. Many people who have severe eczema are quite sensitive to scratchy fabrics, especially wool. Eczema often becomes worse in the winter, when the air is very dry.

How is it diagnosed?

Your healthcare provider will examine your skin. He or she will ask about your history and your family's history of rashes and about other problems such as allergies or asthma.

How is it treated?

Mild eczema sometimes does not need any treatment. It may help to use a nonirritating moisturizer. Or it may go away if you put 1% hydrocortisone cream on the area up to 4 times a day. No prescription is needed for this cream.

More severe eczema can be more difficult to treat. However, medicines such as antihistamines and steroid creams can help prevent or control the itching.

Antihistamine pills can usually prevent the itching of severe eczema. Some antihistamines cause drowsiness, so you may want to take the medicine only at bedtime. (It is important to prevent scratching during sleep.) Some antihistamines are available, however, that do not cause drowsiness. These nonsedating antihistamines can be taken day or night to prevent itching. Your healthcare provider may recommend that you take antihistamines daily to prevent itching, or you may be able to take them just when you need them.

Prescription steroid creams or ointments can help control the itching and rash caused by severe eczema. Use these medicines exactly as prescribed by your healthcare provider for the best results. Steroid creams and ointments come in many different strengths. Some should be used just once a day. Do not use them more often than recommended. You can have serious complications if you use too much steroid medicine. Do not use steroid medicines on your face unless your healthcare provider has told you to do so.

Keep your skin well lubricated. To prevent your skin from becoming too dry, avoid exposing your skin to a lot of water. This seems surprising, but in fact, every time the skin gets wet, evaporation of water from the skin dries the skin even more. For this reason, if you have severe eczema you should take baths or showers less often. Keep them brief and use lukewarm (not hot) water. Take sponge baths between baths or showers. Use moisturizing creams or ointments, rather than water-based lotions, regularly (several times a day, if possible).

Recent research has suggested that people who are allergic to dust mites may be more likely to have severe eczema. Some healthcare providers may recommend testing for an allergy to dust mites. If test results clearly show you are allergic to dust mites, your provider may recommend that you try to rid dust mites from your home. Before you have allergy tests, you might first see if your symptoms improve if you do everything you can to eliminate dust mites from your home.

To reduce the population of dust mites in your home, all surfaces must be dusted often. Bed pillows and mattresses should have anti-allergy covers to minimize exposure to the mites. Bedding should be washed often (every week or two) to keep the mite population down.

If possible, you also need to eliminate the surfaces from which dust mites can never be completely removed. These surfaces include wall-to-wall carpets and draperies with horizontal folds, which catch dust and cannot be damp-wiped or laundered.

In some cases, allergy shots for dust mites may be helpful. You should consider this treatment only after seeing a dermatologist (a skin specialist) or an allergist (an allergy specialist).

What else can I do to help myself?

• Do not scratch your skin even though it itches. Scratching may cause infection.
• Bathe without soap or use a gentle soap or nonsoap cleanser.
• Avoid the things that you know will make your skin rash worse, such as wearing tight or scratchy clothing.
• Avoid contact with allergens and irritants that increase your symptoms.
• Wash clothes and bedding in mild soap. Rinse your laundry twice to get rid of more detergent residue.
• Avoid humidity and sudden changes in temperature when possible.
• Avoid over-heating.

How long will the effects last?

Eczema that begins in childhood may improve or even go away by adulthood. However, in many cases it may be a lifelong problem.

What can be done to prevent eczema?

For mild eczema, you may need to try to avoid certain foods or medicines if they seem to make the eczema worse. Keep your skin well lubricated and avoid irritating substances such as scratchy fabrics or chemicals such as laundry detergent residue.

Because severe eczema is usually an inherited disorder, there is no known way to prevent it. However, as with many medical conditions, there seems to be a relationship between flare-ups of atopic dermatitis and stress. When you can, avoid or minimize stressful situations. Since this is not always possible, it may help to know that a worsening of symptoms during times of stress is only temporary.