Eczema: Causes, Symptoms and Treatments

Eczema is "a general term for any superficial inflammatory process involving the epidermis primarily, marked early by redness, itching, minute papules and vesicles, weeping, oozing and crusting, and later by scaling, lichenification and often pigmentation."It is also used specifically to refer to the condition atopic dermatitis.

The word eczema comes from the Greek word ekzein meaning "to boil out"; the Greek word ek means "out," while the Greek word zema means "boiling."

Fast facts on eczema

Here are some key points about eczema. More detail and supporting information is in the main article.

Eczema affects an estimated 9-30% of the US population.
People living in dry climates and cities appear to be more likely to develop eczema.
Eczema occurs equally in both males and females.
Eczema is likely related to conditions that adversely affect the skin's barrier function (including genetic factors, nutrient deficiencies, bacterial infection, and dry, irritated skin).
Stress and other emotional factors do not cause atopic dermatitis, but they can make the condition worse.
Certain foods such as nuts and dairy can trigger the symptoms.
Eczema can also be triggered by environmental factors such as smoke and pollen.
Atopic dermatitis has strong connections with other atopic diseases, such as asthma and hay fever.
Children with ADHD, or who attend day care have a higher risk of atopic dermatitis.
Treatment focuses on healing damaged skin and alleviating the symptoms.
There is no single test that can be used to diagnose eczema.
For some eczema will disappear completely, but for others it remains a lifelong condition.

Causes of eczema

The specific cause of eczema remains unknown, but it is believed to develop due to a combination of hereditary and environmental factors.

Children are more likely to develop eczema if a parent has had it or another atopic disease. If both parents have an atopic disease, the chances increase further.

Environmental factors are also known to bring out the symptoms of eczema.

These include:

Irritants: soaps, detergents, shampoos, disinfectants, juices from fresh fruits, meats or vegetables
Allergens: dust mites, pets, pollens, mold, dandruff
Microbes: bacteria such as Staphylococcus aureus, viruses, certain fungi
Hot and cold temperatures: hot weather, high and low humidity, perspiration from exercise
Foods: dairy products, eggs, nuts and seeds, soy products, wheat
Stress: it is not a cause of eczema but can make symptoms worse
Hormones: women can experience worsening of eczema symptoms at times when their hormone levels are changing, for example during pregnancy and at certain points in their menstrual cycle.

Symptoms of eczema

People with the condition will often experience periods of time where their symptoms will flare up or worsen, followed by periods of time where their symptoms will improve or clear up.

Infants:

• Rashes commonly appear on scalp and cheeks
• Rashes usually bubble up before weeping fluid
• Rashes can cause extreme itchiness, which may lead to trouble sleeping. Continuous rubbing and scratching can lead to skin infections.

Children, from 2 years old to puberty:

• Rashes commonly appear behind the creases of elbows or knees
• Also common on neck, wrists, ankles, crease between buttock and legs.

Over time, the following symptoms can manifest:

• Rashes can become bumpy, like goosebumps
• Rashes can lighten or darken in color
• Rashes can thicken (also known as lichenification) and then develop knots and a permanent itch.

Adults:

• Rashes commonly appear in creases of elbows or knees or nape of neck
• Rashes cover much of the body
• Rashes can be especially prominent on neck, face and around the eyes
• Rashes can cause very dry skin
• Rashes can be permanently itchy
• Rashes can cause scaly skin (more scaly than in children)
• Rashes can lead to skin infections.

Tests and diagnosis of eczema

There is no single test that is used in order to diagnose eczema.

A doctor may refer a patient onto either an allergist or dermatologist for further evaluation.

They may also attempt to rule out other conditions that can cause skin irritations. This can involve the following tests:

Patch testing: substances are placed onto the surface of the skin to test for skin allergies
Skin prick testing: a needle containing a small amount of a suspected allergen pricks the skin to test for allergies that do not necessarily occur on the skin, such as pollen or food
Supervised food challenges: foods are eliminated and then introduced into the diet to determine whether a food allergy is present.

Treatments for eczema

There is no overall cure for eczema. Treatment for the condition aims to heal the affected skin and prevent flaring of the symptoms. Doctors will suggest a plan of treatment based around a patient's age, symptoms and current state of health.

For some people, eczema goes away over time and for others it remains a lifelong condition.

There are numerous things that people with eczema can do to support skin health and alleviate symptoms, such as:

• Taking regular warm baths
• Applying moisturizer within 3 min of bathing to "lock in" moisture
• Moisturizing every day
• Wearing cotton and soft fabrics, avoiding rough, scratchy fibers and tight-fitting clothing
• Using mild soap or a non-soap cleanser when washing
• Air drying or gently patting skin dry with a towel, rather than rubbing skin dry after bathing
• Avoiding rapid changes of temperature and activities that make you sweat (where possible)
• Learning individual eczema triggers and avoiding them
• Using a humidifier in dry or cold weather
• Keeping fingernails short to prevent scratching from breaking skin.

There are several forms of medication that can be prescribed by doctors in order to treat the symptoms of eczema:

Topical corticosteroid creams and ointments. These are a type of anti-inflammatory medication and should relieve the main symptoms of eczema, such as skin inflammation and itchiness
If ineffective, systemic corticosteroids can be prescribed. These are either injected or taken by mouth, and are only used for short periods of time
Antibiotics
Medications to treat fungal and viral infections
Antihistamines that cause drowsiness are often recommended, as these can help to reduce the risk of nighttime scratching
Topical calcineurin inhibitors (a type of drug that suppresses the activities of the immune system) decreases inflammation and helps prevent flares
Barrier repair moisturizers reduce water loss and work to repair the skin
Phototherapy can be prescribed to treat mild to moderate dermatitis. It involves exposure to ultraviolet A or B waves, alone or combined, and the skin will be monitored carefully if they are used.

Even though the condition itself is not presently curable, there should be a particular treatment plan to suit each case. Even after an area of skin has healed it is important to keep looking after it, as it may easily become irritated again.