Article updated and reviewed by Michael S. Lehrer, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania on April 18, 2005.
Eczema, also known as atopic dermatitis, is a skin condition that usually appears first in infancy and then at intervals in adult life. (also see Health Profile: Eczema) It is characterized by dry, itchy, pink skin.
Eczema (atopic dermatitis) is often seen in association with other atopic conditions, such as hay fever,asthma, or hives, but is generally not triggered by pollen or other airborne irritants. The disease often runs a chronic course.
When the disease starts in infancy, it is sometimes called infantile eczema. This is a red, itching, oozing, crusting dermatitis that tends to be localized primarily on the face and scalp, although spots can appear at other sites. In attempts to relieve the intolerable itching, the child rubs his head, cheeks, and other affected areas with a hand, a pillow, or anything within reach.
In older children and adults, eczema appears as a red, itchy rash, sometimes with a thickening or discoloration of the skin. From puberty on, it usually appears as dry, itchy patches in the folds of the elbows and knees. The face, neck, and upper trunk may be involved. The skin may become dry and leathery after repeated scratching.
Eczema causes the skin to itch intensely, and many of the problems seen by doctors are a result of “itch-scratch-itch” syndrome. Areas that itch tend to be scratched by the patient, and scratching makes the eczema worse.
A person with eczema often has a history of allergic manifestations such as asthma or hay fever, or a family history of asthma, hay fever, or atopic dermatitis. The term “atopic” is derived from the Greek word atopos, which means “away from the place.” It describes a family of sensitivities to ordinary substances to which most people have no reaction. Hence, the sensitivity is “out of place”.
Though much of atopic dermatitis is genetic and caused by the “atopic” or reactive immune system, environmental factors are also very important. Eczema may be set off by extreme temperatures, stress, sweating, medication, clothing (especially wool or silk), grease, oils, soap and detergents, and environmental allergens. Dryness is perhaps the most important trigger. Drying soaps should be avoided, and the skin should be moisturized frequently.
Patients with eczema are also very susceptible to severe infections from certain viruses, for example, the herpes simplex virus that produces fever blisters and sores.
The diagnosis is often made based on the medical history and physical exam alone. If your dermatologist is unsure about the diagnosis, he may choose to perform a skin biopsy.
There is no cure for eczema, but there are a number of ways to relieve it.
Topical steroids may be prescribed to reduce skin inflammation during an eczema flare-up. Topical steroids come in four strengths: mild, moderately potent, potent, and very potent. The strength of the steroid cream your doctor will prescribe depends on several factors, including the severity of the condition. (View list of topical steroids).
Systemic corticosteroids are sometimes prescribed in very severe cases and usually under the direction of a dermatologist. Oral prednisone and injected triamcinalone (Kenalog) are examples. Even stronger medications such as cyclosporine A (Neoral) are sometimes used in severe cases.
Topical immunomodulators are relatively new drugs available for use in treating atopic eczema. They include tacrolimus (Protopic) and pimecrolimus (Elidel). These medications are similar to those taken internally by patients who have received organ transplants. When applied to the skin, they may decrease inflammation without thinning the skin surface as a steroid cream might do.
Antihistamines, such as hydroxyzine (Atarax, Vistaril) and doxepin (Sinequan), may be prescribed to control itching. These medications, however, cause drowsiness and do not clear up the eczema. Antibiotics may be given if there is sign of bacterial infection.
Patients with severe eczema may benefit from phototherapy (light treatment) with ultraviolet A or B performed in the physician’s office.
How serious is eczema (atopic dermatitis)?
What caused the problem?
What type of treatment will you be recommending?
Will you be prescribing any medication?
What are the side effects?
The following is a partial list of topical steroids used to treat eczema.
Betamethasone dipropionate (Diprolene)
Clobetasol 17-Propionate 0.05% (Dermovate)
Halcinonide 0.1% (Halog)
Amcinonide 0.1% (Cyclocort)
Betamethasone dipropionate 0.5 mg (Diprolene, generics)
Betamethasone valerate 0.05% (Betaderm, Celestoderm,Prevex)
Desoximetasone 0.25% (Desoxi,Topicort)
Diflucortolone valerate 0.1% (Nerisone)
Fluocinonlone acetonide 0.25% (Derma,Fluoderm,Synalar)
Fluocinonide 0.05% (Lidemol,Lidex,Tyderm,Tiamol,Topsyn)
Mometasone furoate 0.1% (Elocom)
Desonide 0.05% (Desowen)
Hydrocortisone valerate 0.2% (Westcort)
Prednicarbate 0.1% (Dermatop)
Hydrocortisone 1.0% (Cortaid)
Editorial review provided by VeriMed Healthcare Network.
Patients with eczema have hyperirritable skin. Therefore, anything that dries or irritates the skin will be a problem.
The aims of home therapy are to decrease trigger factors, reduce itching, suppress inflammation, lubricate the skin, and alleviate anxiety.
Dermatologists generally recommend the following:
·Avoid rough, scratchy, tight clothing and woolens
·Avoid frequent use of soaps, hot water, and other cleansing procedures that tend to remove natural oil from the skin. Use a moisturizing soap such as Dove, Tone, Lever 2000, Eucerin, Aveeno, Basis, Alpha Keri, or Purpose, and recommended cleansers include Cetaphil and Aquanil.
·Bathe no more than once daily
·Washcloths and brushes should not be used while bathing
·After bathing, the skin should be patted dry (not rubbed) and then immediately (before it dries completely) covered with a thin film of moisturizer cream or ointment (not lotion) e.g. Aquaphor, Eucerin, Vaseline).