Eczema (Atopic Dermatitis)

Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition characterized by dry, itchy, and inflamed skin. It typically appears as red, cracked, and scaly patches that may ooze or bleed when scratched. Eczema commonly begins in childhood and often improves with age, though some people experience symptoms throughout their lives. It frequently occurs in people who have a personal or family history of allergies or asthma. While not contagious, eczema can significantly impact quality of life due to persistent itching, sleep disturbances, and visible skin changes. Though there is no cure, proper treatment and management can help control symptoms and prevent flares.

Eczema (Atopic Dermatitis)

Causes

  • Genetic factors - Mutations in genes responsible for maintaining a healthy skin barrier, particularly the filaggrin gene, can make the skin more vulnerable to irritants and allergens.
  • Immune system dysfunction - An overactive immune response can trigger inflammation in the skin when exposed to certain substances.
  • Environmental triggers - Various external factors can worsen symptoms, including harsh soaps, detergents, certain fabrics, temperature extremes, and humidity changes.
  • Allergies - Many people with eczema also have food or environmental allergies that can trigger flare-ups.
  • Skin barrier dysfunction - The outermost layer of skin (stratum corneum) functions poorly in people with eczema, allowing moisture to escape and irritants to enter more easily.
  • Stress - Emotional stress can trigger or worsen eczema symptoms through immune system alterations and increased inflammation.
  • Microbiome imbalance - Changes in the normal balance of bacteria on the skin may contribute to eczema development and severity.
  • Hormonal changes - Some women experience eczema flares related to hormonal fluctuations during pregnancy, before menstrual periods, or during menopause.

Signs and Symptoms

  • Dry, sensitive skin that may appear reddened or inflamed
  • Intense itching, especially at night
  • Red to brownish-gray patches, particularly on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the elbows, and behind the knees
  • Small, raised bumps that may leak fluid and crust over when scratched
  • Thickened, cracked, or scaly skin
  • Raw, sensitive skin from scratching
  • Skin infections due to broken skin from frequent scratching
  • Sleep disturbances due to itching
  • Symptom flare-ups followed by periods of remission
  • In infants, rashes commonly appear on the scalp and cheeks and may bubble up before leaking fluid
  • Darkening of the skin around the eyes or eyelids
  • Changes in skin color after inflammation subsides (either lightening or darkening)

Diagnosis

Medical History and Physical Examination

Your dermatologist will examine your skin and ask about your symptoms, including when they began, what makes them better or worse, and any family history of eczema, allergies, or asthma. The pattern and appearance of the rash often help confirm the diagnosis.

Patch Testing

If contact dermatitis (a type of eczema triggered by specific substances) is suspected, patch testing may be performed. Small amounts of potential allergens are applied to the skin to identify specific triggers.

Skin Biopsy

In rare cases, a small sample of skin may be removed for microscopic examination to rule out other skin conditions that can resemble eczema, such as psoriasis or cutaneous T-cell lymphoma.

Allergy Testing

Blood tests or skin prick tests may be recommended to identify potential allergens that could be triggering eczema flares, particularly if there are associated respiratory or food allergy symptoms.

Evaluation for Infections

If your skin appears infected (with increased redness, warmth, swelling, or yellow crusting), your doctor may take samples to identify bacterial, viral, or fungal infections that can complicate eczema.

Treatment Options

Skin Care and Moisturizing

The foundation of eczema management is proper skin care with frequent application of thick moisturizers (emollients) to maintain skin hydration and repair the skin barrier. Look for products without fragrances or other potential irritants. Applying moisturizer immediately after bathing helps lock in moisture. Gentle cleansers should replace soaps, and bathing should be limited to short periods in lukewarm water.

Topical Medications

Topical corticosteroids of various strengths are often prescribed to reduce inflammation and itching during flares. For long-term management, non-steroidal options like topical calcineurin inhibitors (tacrolimus, pimecrolimus) or PDE4 inhibitors (crisaborole) may be used, especially for sensitive areas like the face or skin folds. These medications should be applied as directed by your doctor, as overuse of steroids can lead to skin thinning and other side effects.

Systemic Medications

For severe or widespread eczema that doesn't respond to topical treatments, oral or injectable medications that affect the immune system may be prescribed. These include oral corticosteroids (short-term use only), cyclosporine, methotrexate, azathioprine, or biologics like dupilumab, which targets specific parts of the immune response involved in eczema.

Phototherapy

Controlled exposure to ultraviolet (UV) light can reduce inflammation and itching. Narrowband UVB therapy is most commonly used for eczema and is administered in a dermatologist's office several times a week. This treatment is typically considered when topical treatments aren't effective and before moving to systemic medications.

Home Remedies

Wet Wrap Therapy

For severe flares, applying a layer of medication or moisturizer to affected areas, covering with a damp layer of cotton clothing or gauze, and then a dry layer on top can significantly improve hydration and medication absorption. This is particularly helpful for nighttime relief of intense itching.

Lukewarm Baths with Additives

Soaking in lukewarm water with colloidal oatmeal, baking soda, or bath oils for 10-15 minutes can soothe itchy skin. Pat skin partially dry and immediately apply medications and moisturizers afterward to seal in hydration.

Cold Compresses

Applying a clean, damp cloth that has been chilled in the refrigerator to itchy areas can provide temporary relief by numbing the skin and reducing the itch-scratch cycle.

Comfortable Clothing

Wear loose-fitting clothes made of soft, breathable fabrics like cotton. Avoid wool or synthetic fibers that can irritate the skin. Washing new clothes before wearing them and using fragrance-free detergents can also help prevent irritation.

Stress Management

Since stress can trigger flares, practices like deep breathing, meditation, progressive muscle relaxation, or gentle yoga may help manage eczema. Adequate sleep is also important, as fatigue can worsen itching and inflammation.

Preventive Care

  • Identify and avoid personal triggers that worsen your eczema, which may include certain foods, environmental allergens, or irritants.
  • Moisturize multiple times daily, especially after bathing, with fragrance-free products to maintain skin hydration.
  • Take short, lukewarm baths or showers (5-10 minutes) using gentle, fragrance-free cleansers instead of harsh soaps.
  • Pat skin partially dry after bathing rather than rubbing, and apply medications and moisturizers immediately while skin is still damp.
  • Use a humidifier in dry or cold weather to add moisture to the air and prevent skin dryness.
  • Wear loose-fitting, soft clothing, preferably made of cotton, and avoid wool and other rough fabrics that can irritate skin.
  • Manage stress through regular exercise, adequate sleep, and relaxation techniques like meditation or deep breathing.
  • Keep fingernails short and consider wearing cotton gloves at night to prevent damage from scratching during sleep.
  • Use fragrance-free and dye-free laundry detergents, and rinse clothes thoroughly.
  • Choose fragrance-free and hypoallergenic personal care products, cosmetics, and household cleaners.
  • Control dust in your home with regular cleaning, reducing carpet and upholstered furniture, and using allergen-proof covers on mattresses and pillows.

Surgical Options

Non-Surgical Condition

Eczema (atopic dermatitis) is primarily managed with non-surgical approaches including topical treatments, oral medications, phototherapy, and lifestyle modifications. There are no specific surgical interventions for treating eczema itself.

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Procedures for Complications

In rare cases where severe bacterial or viral infections have developed as a complication of eczema, minor surgical procedures might be needed to drain abscesses or treat extensive infections. However, these are not treatments for the eczema itself but for its complications.

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If you're experiencing symptoms of eczema (atopic dermatitis), our expert team is here to help you find the right treatment approach for your specific needs.

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