Eczema

Eczema, or atopic dermatitis, is a chronic allergic skin condition mainly affecting infants and children. It often begins within the first year of life, with 60% of cases occurring by age 1 and up to 90% of cases by age 5. It may last until adolescence or adulthood. If eczema is diagnosed in adulthood, it is generally a long-term or recurring condition. Fifty percent to 75% of patients with eczema may eventually develop hay fever and/or asthma.

The main feature of eczema is itchy, dry skin that scales and flakes. Often, there is a personal or family history of eczema, hay fever, hives, food allergies or asthma. When skin itchiness is not controlled, an “itch/scratch cycle” leads to continued rubbing and scratching and subsequent thickening of the skin called lichenification.

The location of eczema on the body changes with age. In infants and young children, the cheeks, neck, knees and elbows are typically affected. In older children and adults, the hands, feet and areas inside the elbows and knees may be affected.

Symptoms may also include:

• Dry, leathery, scaly skin
• Intense itching
• Blisters with oozing and crusting
• Raw areas of the skin from scratching
• Skin color changes
• Skin redness or inflammation

Aggravating factors may include:

• Exposure to environmental allergens
• Exposure to food allergens, especially in infants
• Stress
• Temperature changes
• Clothing materials such as wool and synthetic fibers

There is no specific test for eczema. The diagnosis is based on skin appearance and on personal and family history.

There is no cure for eczema. The main goal of treatment is to remove any irritants and to decrease the amount of dryness and irritation of the skin.

Some specific treatments include:

• Daily baths using less soap than usual. After bathing, it is important to trap the moisture in the skin by applying a lubricating moisturizer while it is damp.
• Topical steroid creams to help decrease inflammation in the skin and thus reduce itching and swelling.
• Topical immunomodulators, which are steroid-sparing topical medicines, may be prescribed in some cases. These include tacrolimus (Protopic) and pimecrolimus (Elidel).
• Antihistamines such as diphenhydramine (Benadryl) or hydroxyzine (Atarax) to help decrease the amount of itching. These medications may cause drowsiness.
• Topical and/or oral antibiotics for skin that has become infected from frequent scratching. It is important to keep fingernails short.