Eczema

Eczema is a skin condition that causes patches of dry, scaly, extremely itchy skin.

What is going on in the body?

Eczema usually results from a hypersensitivity, or allergy-like sensitivity, causing inflammation. The inflammation causes the skin to become itchy and scaly. Eczema is not a true allergy. Rather, it is a condition in which the skin may react or become sensitive to allergens, which are allergy-causing substances.

What are the causes and risks of the condition?

Eczema is usually related to a history of hypersensitivity or reaction in the body similar to an allergy. Although eczema is more common in babies and young children, older children and adults may also experience eczema. It seems to be more evident in those with a history of asthma or hay fever. It is also more common in a person who has a family history of eczema, hay fever, or other respiratory allergies.

Flare-ups of eczema may occur with exposure to environmental factors, such as stress, dry climate or high temperatures, soaps, chlorine, and other irritating substances. Foods that may cause worsening of symptoms include peanut butter, milk, or eggs.

What are the signs and symptoms of the condition?

Eczema causes dry, red patches of skin that are extremely itchy. The patches occur most often behind the knees, in the folds of the elbows and wrists, and on the neck, ankles, and feet. The itching worsens with heat, stress, or abrasions to the areas from scratching.

In infants from 2 to 6 months old, the patches may start as a rash on the cheeks of the face. As the infant starts to crawl, the rash appears on the forearms and lower legs.

The red patches may blister, and the blisters may ooze and crust over.

How is the condition diagnosed?

The healthcare provider will usually obtain a family and personal history of allergy-related conditions. A thorough exam will usually be done to examine the rash and rule out any other possible causes for the rash. The provider may take a sample of fluid oozing from a lesion and send it to the laboratory to identify what organism is present.

Sometimes a biopsy of the lesions may be done. For a skin biopsy, the provider takes a small sample of skin and sends it to the laboratory to rule out other causes. If the rash continues, blood tests may also be done.

What can be done to prevent the condition?

Eczema cannot be prevented, but progression of symptoms may be decreased by avoiding allergens that seem to cause flare-ups. Controlling stress or anxiety-producing situations may also decrease risk of eczema flare-ups.

What are the long-term effects of the condition?

Long-term effects of eczema include infection and scarring. Other long-term effects may include emotional frustration from scarring. Children will usually outgrow eczema by about 6 years of age, although sometimes improvement is not seen until puberty or adulthood. Long-term effects can usually be lessened with early treatment.

What are the risks to others?

Eczema is not contagious, but if the lesions become infected, the organism causing the infection may be contagious.

What are the treatments for the condition?

The main goal of treatment is to minimize and treat symptoms. Treatment may include the following recommendations:

Avoid irritants that tend to worsen symptoms.

Avoid scratching the lesions.

Keep the skin moist with lotions and ointments to reduce symptoms.

Avoid excessive bathing and lengthy exposure to baths to reduce flare-ups.

Don’t bathe babies with soap too frequently. Mild neutral soaps are recommended as needed, and bubble baths should be avoided.

Keep infants’ and children’s fingernails cut short to avoid irritating lesions from scratching.

Avoid heavy ointments such as petroleum jelly or vegetable shortening. These can make symptoms worse because these products block the sweat glands.

Medications used to treat eczema include the following:

topical ointment for lesions that are oozing or extremely itchy, including mild anti-itching lotions or topical steroids

coal-tar compound ointments or topical steroids for chronic thickened patches

oral steroids, such as prednisone, for severe cases of eczema or inflammation

antibiotics for secondary infection

antihistamines to reduce inflammation and itching

What are the side effects of the treatments?

Side effects to treatment depend on the treatment used. Topical steroid ointments and oral steroids can cause further irritation of the skin or secondary skin conditions. Antibiotics can cause stomach upset, diarrhea, and allergic reaction. Antihistamines may cause drowsiness.

What happens after treatment for the condition?

After treatment, a person who has eczema may need to avoid situations or conditions that make the eczema worse.

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare provider.