All You Need to Know About Eczema

Eczema refers to a cluster of skin condition where patches of skin become itchy, inflamed, red, cracked, and rough. This condition is also known as dermatitis. There are several different types of eczema, with atopic dermatitis being the most common.

Most children who develop eczema outgrow it by puberty, while others may continue to have symptoms intermittently throughout their life. Symptoms can range from mild to severe.

Symptoms

Different types of eczema have their own set of symptoms. Nevertheless, they share some common symptoms, such as:

  • Dry, scaly, thickened, leathery skin
  • Intense itching which may precede a rash outbreak
  • Redness
  • Dark-colored patches
  • Crusting and oozing

The rashes most commonly appear on the face, back of the knees, wrists, hands, or feet.

You may experience periods of flare-ups, whereby the symptoms worsen significantly before clearing up.

Causes and triggers

Eczema flare-ups may be triggered by a combination of genetic and environmental factors. Common triggers include:

  • Overactive immune response to irritants (e.g., detergents, soaps, shampoos, disinfectants, perfumes, fragrances)
  • Allergic reaction to allergens (e.g., pet hair, dust mites, mold, pollen, dandruff)
  • Food triggers (e.g., dairy products, eggs, soy products, wheat, nuts, seeds)
  • Personal or family history of other allergies
  • Infection from bacteria, virus, and certain fungi
  • Extremely hot or cold weather; high or low humidity
  • Certain fabrics with rough or coarse materials (e.g., wool and synthetic fabrics)
  • Hormonal changes (e.g., before periods or during pregnancy)

Types of eczema

Atopic dermatitis (atopic eczema)

Atopic dermatitis is the most typical of eczema. It is part of the “atopic triad,” which refers to a cluster of three commonly-related allergies – the other members that constitute this triad are hay fever and asthma (1). Hence, people with fever and asthma also have an increased risk of atopic dermatitis.

Atopic dermatitis happens when defects weaken the skin barrier, allowing moisture out and exposing it to allergens and irritants (2).

Atopic dermatitis is usually developed before the age of 5 years, and the symptoms may vary or dissipate with age.

Symptoms in infants under two years old

  • Rashes usually bubble up before oozing fluid
  • Rashes appear on the cheeks and scalp
  • Extreme itchiness, which may interfere with sleep
  • Continuous scratching and rubbing can lead to skin infections

Symptoms in children aged two years until puberty

  • Rash can cause uneven skin pigmentation
  • Rashes may appear behind the creases of knees or elbows, neck, ankles, wrists, and the crease between buttock and legs
  • Bumpy or thicken skin
  • Rashes can develop knots and a permanent itch

Symptoms in adults

  • Rashes that cover much of the body
  • Scaly and dehydrated skin
  • Permanently itchy
  • Susceptible to skin infections

Scratching the rash patches can worsen the itching and cause the patch of skin to thicken – this is known as lichen simplex chronicus (LSC). The skin may also be broken, creating a wound that’s susceptible to infection.

Contact dermatitis

Contact dermatitis is a skin reaction that occurs when you come into contact with an irritant or allergen. It tends to affect people with sensitive skin.

Symptoms of contact dermatitis include:

  • Dry, itchy, and burning sensation
  • Itchy small, red bumps (hives)
  • Fluid-filled blisters that may ooze and crust over
  • Skin that may feel thick, scaly, or leathery

There are two common types of contact dermatitis: irritant and allergic.

Irritant contact dermatitis

Irritant contact dermatitis can result from persistent exposure to a strong irritant, such as:

  • Acids and alkalis
  • Harsh detergents
  • Solvents
  • Fabric softeners
  • Hair dyes
  • Weed killers
  • Cement
  • Some shampoos

People who regularly come into contact with these substances have a higher risk of developing irritant contact dermatitis.

Allergic contact dermatitis

Allergic contact dermatitis is an immune reaction following exposure to a substance that the immune system recognizes as foreign (allergen). Once you develop an allergy, usually have it for life.

Allergens that could trigger allergic contact dermatitis include:

  • Pollen
  • Pet dander
  • Mold
  • Foods
  • Glues and adhesives
  • Latex and rubber
  • Certain fabrics (e.g., wool) and clothing dyes
  • Some medications, such as oral and topical antibiotics
  • Some plants, including poison oak, poison ivy, and sumac
  • Certain metals, such as cobalt and nickel

Dyshidrotic eczema (pompholyx eczema)

Dyshidrotic eczema is an irritation of the skin on the soles of the feet and the palms of the hands.

Causes of dyshidrotic eczema:

  • Allergies
  • Damp hands and feet
  • A personal or family history of dermatitis
  • Emotional stress
  • Fungal skin infections
  • Changes in weather
  • Exposure to substances such as cobalt, nickel, or chromium salt

Symptoms of dyshidrotic eczema:

  • Severe itching
  • Small fluid-filled blisters on the feet and hands
  • Eventually, the blisters clear up and the skin may become dry and cracked

Nummular eczema (discoid eczema)

Nummular eczema is characterized by circular coin-shaped patches of red itchy skin that can be crusty, scaly, and swollen.

Risk factors of nummular eczema

  • Dry skin
  • Cold, dry air
  • Exposure to chemicals (e.g., formaldehyde)
  • Skin injuries (e.g., friction, burns)
  • Exposure to metals (e.g., nickel)
  • Insect bites
  • Bacterial infections
  • Poor blood flow
  • Certain medication
  • Another type of eczema (e.g., atopic dermatitis)

Symptoms of nummular eczema

  • Round, coin-shaped spots
  • Itchy and scaly skin

The rash most often appears on the:

  • Torso
  • Lower legs
  • Hips
  • Forearm
  • Bak of the hands
  • Lower back

Stasis dermatitis (varicose eczema)

Stasis dermatitis is a type of skin irritation of the lower leg. It is typically seen in older adults with varicose veins, particularly when the veins in the lower legs have poor blood circulation. The pooling of blood in your lower legs can cause it to swell.

Symptoms of stasis dermatitis

  • Crusty and weepy skin
  • Hot, itchy blisters or spots
  • Dry, scaly, cracked skin
  • Swollen lower leg
  • Aching or heavy legs
  • Thick, ropey, damaged varicose veins in lower legs
  • Open sores on lower legs

The skin on your lower leg may become fragile, so it is essential to avoid scratching and picking the blisters and spots.

Asteatotic eczema (eczema craquele; xerotic eczema)

Asteatotic eczema usually only affects people over 60 years of age.

Triggers of asteatotic eczema

  • Hot baths
  • Dry, cold weather
  • Soaps and detergents
  • Excessive cleaning or scrubbing of the skin
  • Rough towel drying

Symptoms of asteatotic eczema

  • Cracked, dry skin
  • Pink or red grooves or cracks
  • Scaling
  • Soreness and itching

Asteaototic eczema typically occurs on the lower legs, but it can also appear on other parts of the body.

Neurodermatitis

Neurodermatitis forms scaly, itchy patches on the forearms, scalp, genitals, back, lower legs, and wrists. You may scratch the affected areas without realizing it.

Causes of neurodermatitis:

Neurodermatitis usually occurs in people who have other forms of eczema or psoriasis. It can also be triggered by stress.

Symptoms of neurodermatitis:

  • Thick, scaly patches form on the skin
  • Itchy, especially when asleep or relaxed
  • Skin thickening and wrinkling
  • Scratching can cause an open wound that is susceptible to infection

Eczema and infection FAQ

Is eczema contagious?

Eczema is not contagious, which means that it cannot be transmitted via bodily contact between you and another person. However, if your skin cracks as a result of eczema, it can be susceptible to secondary infections, which may be contagious.

How does eczema become infected?

Broken skin caused by eczema can be vulnerable to contagious infections, which can be transmitted to someone else through direct contact.

Symptoms of infected eczema include:

  • Blisters or boils
  • Pain
  • Severe itchiness
  • Redness that spreads around the original rash
  • Clear or yellow discharge

Is infected eczema preventable?

There are several steps to reduce your risk of developing a secondary infection following eczema flare-up. This include:

  • Resisting the urge to scratch the skin so that there won’t be any broken skin.
  • Covering any areas of cracked skin or open wounds
  • Applying moisturizer regularly to minimize itching
  • Managing eczema flare-ups promptly

Medical treatment

There is no cure for eczema, but medical treatments can manage the symptoms by:

  • Controlling the itch
  • Preventing flares
  • Healing the skin
  • Preventing infections

Steroid creams and ointments

Hydrocortisone creams and ointments are often the first-line of treatment for mild eczema. They are a type of topical anti-inflammatory medication that could relieve skin inflammation and itchiness. You can get mild hydrocortisone 1% cream over-the-counter (OTC) or obtain stronger prescription hydrocortisone creams from your doctor’s office. Side effects (e.g., thinning skin and stretch marks) are rare if you take them as directed.

NSAID ointment

A prescription NSAID called crisaborole (Eucrisa) can be applied topically to treat mild to moderate forms of eczema. It works by reducing inflammation, eventually helping the skin to return to a healthy appearance.

Apply barrier repair moisturizer

Barrier repair moisturizers may minimize water loss, ease dryness, and repair skin damage. It can also reduce redness and itching. These medicated moisturizers are available over-the-counter or by prescription.

Topical calcineurin inhibitors (topical immunomodulators)

The FDA has approved the use of topical calcineurin inhibitors for the treatment of mild-to-moderate eczema (3). Examples include pimecrolimus (Elidel) and tacrolimus (Protopic). This class of drug works by suppressing the immune system to decrease inflammation and prevent flare-ups.

Serious side effects exist for calcineurin inhibitors, including non-Hodgkin’s lymphoma and skin cancer. Hence, the FDA issued a “black box” warning to alert doctors to these potential risks. It should only be used after other eczema treatments have failed.

Systemic corticosteroids

Systemic corticosteroids may be prescribed for eczema flare-ups in people with severe or hard-to-treat eczema. These are either injected or taken orally. Because of potential side effects such as skin thinning and bone loss, it’s only used for brief periods.

Drugs that suppress the immune system

Medications that suppress your immune system can help prevent it from overreacting. They may be prescribed for moderate-to-severe eczema that fails to respond to other treatments. Examples include cyclosporin, methotrexate, and mycophenolate mofetil. You can take them as liquids, pills, or as a shot. Take these medications for only a short period to avoid serious side effects such as kidney problems and high blood pressure.

Antihistamines to lessen severe itching

Antihistamines such as diphenhydramine (Benadryl) can control the itch, especially at night. It induces drowsiness when you take them before bedtime, which can reduce the risk of nighttime scratching and can help you sleep.

Phototherapy

In phototherapy, the skin is exposed to ultraviolet A or B waves, alone or combined, under careful supervision. It can be used to treat moderate-to-severe eczema by preventing the immune system from overreacting.

There are two main types of phototherapy – UV light therapy and PUVA therapy. In the latter, psoralen is prescribed to increase sensitivity to UV light in people who haven’t gotten results from UV treatment alone.

Home remedies for eczema

Numerous home remedies and lifestyle changes can soothe the dry, itching skin that comes with eczema.

Bathing habits

There are some bathing habits that you should adhere to:

  • Bathe in lukewarm water instead of hot or cold water.
  • Avoid washing too often because it can dry out the skin and make eczema worse.
  • Don’t use washcloths or body scrubbers, which can be irritating.

Use gentle cleansers

Avoid bar soaps or detergents because their alkalinity can dry out your skin. Also, you should avoid products to avoid cleansers with exfoliating properties, as these can further irritate the skin.

Instead, you should opt for mild, gentle cleansers that strip away the impurities without leaving your skin dry.

Dry gently

Air dry or gently pat your skin dry with a soft microfiber towel. Be sure to leave your skin slightly damp. Avoid rubbing the skin dry.

Apply moisturizers daily

Since eczema makes the skin dry and itchy, you should apply a liberal amount of moisturizer to keep the skin moist. Apply it within 3 minutes after bathing, when the skin is still damp to “lock-in” moisture. They can also combat inflammation and prevent bacterial infection.

Choose fragrance-free moisturizers that won’t irritate your skin.

Aloe vera gel

Aloe vera gel can soothe your skin. It has the following properties:

  • Antibacterial
  • Antimicrobial
  • Immune system-boosting
  • Wound healing

The antibacterial and antimicrobial effects can prevent skin infections commonly associated with dry, cracked skin. Meanwhile, the immune-boosting and wound healing properties of aloe vera may soothe broken skin, prevent flare-ups, and facilitate healing.

Choose aloe vera gel products with few ingredients. Avoid additives such as preservatives, alcohol, fragrances, and colors, all of which can irritate sensitive skin.

Colloidal oatmeal

Colloidal oatmeal has antioxidant and anti-inflammatory properties. It can reduce skin dryness, scaling, roughness, and itch intensity.

Choose a colloidal oatmeal moisturizer without any additives.

Nevertheless, if you have gluten sensitivity, you should avoid colloidal oatmeal.

Coconut oil

Coconut oil comprises of healthy fatty acids that can infuse moisture into the skin. It can also protect the skin against inflammation and by improving the integrity of the skin barrier.

Apply cold-pressed virgin coconut oil directly onto the skin within 3 minutes after a bath. Use it up to several times a day, including before bed.

However, if you are allergic to coconuts, you should not use coconut oil.

Tea tree oil

Tea tree oil has anti-inflammatory, antibacterial, and wound-healing properties. It may help relieve skin itching and dryness and help prevent infections.

Dilute the tea tree oil with a carrier oil before using them on the skin.

Cold compress

Apply cold compress before using corticosteroid cream because it can help the medicine penetrate the skin more readily. Cold compresses can also relieve itching.

Wear proper fabrics

Wear cotton and soft fabrics that fit comfortably. In particular, you should wear cotton socks and gloves during bedtime to lock in moisture and also keep you from scratching in your sleep.

Avoid extreme temperature and humidity

Where possible, avoid rapid changes in temperature. Cold, harsh winter winds or extreme summer heat can dry out the skin and cause eczema flare-ups. Keep the skin covered when temperatures are extreme. Cover your face with a scarf. Use a humidifier in dry winter months.

Also, avoid activities that make you sweaty and hot because it could trigger itching. Rinse off with lukewarm water immediately after a workout.

Limit contact with skin irritants

Avoid any contact with skin irritants, such as laundry detergents, household cleaners, perfumed soaps, cosmetics, and bubble baths. Know what irritates your skin so that you can avoid it.

Apply honey topically

Honey is a natural antibacterial, anti-inflammatory, and wound-healing agent. This means that it can help the body fight off infections and inflammation while also speeding up the healing process.

Preventing eczema flare-ups

Eczema flare-ups may be avoided or lessened by following these simple tips:

  • Avoid fragrances or perfumes
  • Use gentle soaps
  • Use lukewarm water for baths and showers
  • Dry the skin gently after bath or shower
  • Moisturize thoroughly and regularly with mild, oil-rich moisturizer
  • Avoid scratching or rubbing the affected area
  • Wear protective clothing and gloves whenever you handle chemicals
  • Avoid sweating or overheating
  • Avoid sudden changes in temperature or humidity
  • Use a humidifier in the bedroom
  • Minimize stress

The Bottom Line

Eczema can be a frustrating skin condition to deal with. While there is no cure for eczema, you can use several strategies to manage the symptoms and prevent further flare-ups. Work with your doctor to curate a treatment plan that soothes your skin.

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