What is eczema?
Eczema is a group of conditions that make your skin irritated or inflamed. Symptoms of Eczema damages the skin barrier function (the "glue" of your skin). This loss of barrier makes your skin more sensitive and prone to infections and dryness.
The most common type is called atopic dermatitis or atopic eczema. "Atopic" refers to a person's tendency to get allergic conditions such as asthma and hay fever.
Eczema affects about 10% to 20% of infants and about 3% of adults and children in the U.S.
Most children will outgrow it by the age of 10. Some people may continue to have symptoms on and off for the rest of their life.
There is no cure for eczema but most people manage their eczema by getting treatments and avoiding irritants.
Eczema affects around 32 million people in the United States, equating to more than 10% of the population.
In the word "dermatitis", "derm" means"skin" and "itis" means "inflammation". The word as a whole means " inflammation of the skin". "Eczema" originates from the Greek word "ekzein" which means "boil over" or "break out".
It may show up on different parts of your body and will vary widely from person to person. Not everyone's symptoms will be the same or in the same places. Some people have the symptoms worse than others.
Some people may mistake the symptoms of psoriasis for eczema, even though these two conditions are completely different.
No matter which part of your skin is infected, eczema is almost always itchy. The itching may sometimes start before the rash does.
Eczema (atopic dermatitis) symptoms are:
- Dry skin
- Itchy skin/ itchy rash
- Red rashes
- Bumps on the skin
- Scaly skin/ scaly patches
- Leathery patches of skin
- Crusting skin
- Swollen skin
If you have eczema, you might have another condition that doesn't cause it, but is often found alongside it:
- Sleep loss
You might have all the symptoms or you might only have a few. You might have a flare up now and then or your symptoms could go away entirely.
Eczema symptoms in people of color
People with darker toned skin an eczema rash may appear grey or brown. This can make outbreaks harder to notice.
The infected areas may be swollen, warm, itchy, dry, or scaly.
However, people of color who get eczema may also get dark or light patches of skin even after it goes away. These can last a long time. Doctors call these patches hyperpigmentation, and depigmentation or hypopigmentation.
Eczema can appear anywhere on the body but black people are more prone to papular lesions, which look like small bumps on the torso, arms, and legs.
A dermatologist can evaluate the patches, which can respond to treatments like steroid creams.
Symptoms of eczema in infants
These symptoms of atopic dermatitis are common in babies under the age of 2:
- Rashes on the scalp and cheeks
- Rashes that bubble up before leaking fluids.
- Rashes that can cause extreme itchiness, which might interfere with their sleep
Symptoms of eczema in children
These symptoms are common in children age 2 and above:
- Rashes that appear behind the creases of elbows or knees
- Rashes that appear on the neck, wrists, ankles, and the creases between the buttocks and legs
- Bumpy rashes
- Rashes that can become darker and lighter
- Skin thickening, also known as lichenification, which can then develop into a permanent itch
Most people with the condition develop it before the age of five years old. An estimated 60% of children will no longer show symptoms by adolescence.
African American and Hispanic children may have more severe eczema than children that are white.
Symptoms of eczema in adults
These symptoms are common in adult eczema:
- Rashes that are more scaly than the ones in children
- Rashes that usually appear on the creases of the elbows or knees or the nape of the neck
- Rashes that cover much of the body
- Very dry skin on the affected areas
- Skin infections
Adults that develop atopic dermatitis as children but no longer experience the condition may still have dry or easily irritated skin, hand eczema, and eczema on the eyelids.
The appearance of skin affected by atopic dermatitis will depend on how much a person scratches and whether the skin is infected or not. Scratching and rubbing may cause further irritation to the skin, increase inflammation, and make the itching worse.
In fair-skinned people, these areas may start out reddish and then turn brown and in darker skin tones, eczema can affect skin pigments, making the affected area lighter or darker.
When to see a doctor
Talk to a doctor if you or your child:
- Has symptoms of atopic dermatitis
- Is so uncomfortable that it is affecting sleep or daily activities
- Has a skin infection - look for new streaks, pus, or yellow scabs
- Has symptoms even after trying self-care routine
Seek medical help immediately if you or your child has a fever and the rash looks infected.
Types of eczema
There are a few types of eczema.
Eczema includes conditions such as:
This is what people will usually be talking about when they talk about "eczema". This is the most common form of eczema, and it affects more than 7% of American adults. It is also linked to other allergic disorders, like asthma and hay fever, and often starts in childhood.
Nearly everyone gets this at one point in their lives. It happens when your skin comes in contact with something that can cause a rash. The trigger can cause irritation or an allergic reaction. Triggers are unique to each person and vary by two types of contact dermatitis.
- Irritant dermatitis is the more common kind and is more closely linked to people who have atopic dermatitis. Triggers may include skin products, soaps, detergents, jewelry from nickel, and industrial chemicals like solvents and cement.
- Allergic contact dermatitis flares when your skin comes into contact with something you are allergic to. Common allergies include poison ivy, nickel and other metals, fragrances, and beauty products with fragrances, rubber, latex and the preservative thimerosal. For some people it takes sunlight to provoke a reaction.
This is a less common but a way more challenging form of eczema. It causes breakouts of tiny blisters on the palms of your hand, soles of the feet, and sides of the fingers. It can be triggered by sweating or irritants like metal.
This type of eczema tends to cause just one or two intensely itchy patches, they will often be on the nape of the neck, an arm, or a leg. Risk factors include having another form of eczema, like atopic or contact dermatitis, or just very dry skin.
It is also linked to mental health issues such as anxiety disorder and obsessive-compulsive disorder (ocd).
Women between the ages of 30 and 50 have a higher chance of getting this than anyone else.
This coin shaped eczema may often appear after skin injury like a burn or insect bite. You are more likely to develop nummular eczema if you or your family has atopic dermatitis, allergies, or asthma.
This type of eczema happens in the areas of your body with lots of oil glands. When it is on your scalp it is called dandruff. Seborrheic dermatitis more than likely results from a severe reaction to a high amount of Malassezia yeast, a common organism, on the skin. It is also linked to other conditions, like psoriasis, acne and rosacea, as well as a variety of other diseases.
This type happens in people who have poor blood flow, usually in the lower legs. Unlike some other types of eczema, these plaques are not linked to faulty genes. Some lifestyle habits raise the risk too, like being overweight and not get enough activity.
Where does eczema commonly occur?
Eczema can show up anywhere on your skin. In teens and adult it is typically found on your hands, neck, inner elbows, ankles, feet, and around your eyes.
Who is at risk of eczema?
Eczema (atopic dermatitis) usually starts as young as childhood, but anyone at any age can get it. You are at risk if you are:
- African American
- Diagnosed with hay fever or asthma
- Part of a family with history of dermatitis, hay fever or asthma.
Is it contagious?
No type of dermatitis is contagious, it cannot be spread to anyone else. So do not worry about that if you have any type of dermatitis.
Does it hurt or burn?
Although some types of dermatitis are painful or cause a burning sensation, eczema is usually just itchy.
Can eczema kill me or hurt the rest of my body?
Eczema and other types of dermatitis are not harmful to the rest of your body and the condition is not deadly.
Causes of eczema
Eczema (atopic dermatitis) is caused by immune system activation, genetics, environmental triggers and stress.
Your immune system
If you have eczema your immune system overreacts to small irritants or allergens. This overreaction can cause inflamed skin.
You are more likely to have eczema if there is a history in your family of dermatitis. You are also at higher risk if there is a history of asthma, hay fever, or allergens. Allergens are substances like pollen, pet hair, or food allergies. Also, there may be a change in your genes that control a protein that helps your body maintain healthy skin. Without normal levels of that protein, your skin will not be completely healthy.
Your stress levels can worsen your eczema. There are mental/ emotional signs of stress and physical signs of stress. They include:
- Difficulty relaxing
- Use of tobacco, alcohol or illegal drugs to relax
- A negative opinion of yourself (low self-esteem)
- Anxiety, constant worrying
- Feeling overwhelmed
- Difficulty with concentration
- Irritable mood swings, or a short temper
- Nausea and dizziness
- Not wanting to have sex
- Sleeping too much
- Sleeping too little
- Muscle tension
- Aches and pains
Some people have a flare up of the itchy rash in response to these:
- Rough or coarse fabrics
- Feeling too hot or cold
- Household products like soap or detergents
- Animal dander
- Respiratory infections or colds
Diagnosis of eczema
How is eczema diagnosed? What tests are done?
Your health care provider will take a close look at your skin. They will look for the classic signs of eczema such as redness and dryness. They will also ask about the symptoms you are experiencing.
Usually your health care provider will be able to diagnose the eczema based on examining your skin. However, if there is doubt, they may/will perform the following tests:
- An allergy skin test
- Blood tests to check for causes of the rash that may be unrelated to dermatitis
- A skin biopsy to distinguish one type of dermatitis from another
What questions will my healthcare provider ask to diagnose eczema?
- Where is your eczema located?
- What have you used to try treat your eczema?
- What medical conditions do you have? Asthma? Hay fever?
- Is there any history of eczema in your family?
- How long have you had symptoms of eczema?
- Do you take hot showers?
- Is there anything making your symptoms worse?
- Have you noticed something that triggers or worsens your eczema? Soaps? Detergents? Cigarette smoke?
- Is there so much itchiness that you have trouble sleeping? Working? Living your normal life?
The doctor will recommend a treatment plan based on the individuals age, symptoms, and current state of health.
For some people eczema can go away over time but for others it is a lifelong condition.
There are many things people with eczema can do to help support skin issues and alleviate the symptoms.
They can try:
- Lukewarm baths
- Applying moisturize within 3 minutes of bathing to "lock in" moisture
- Moisturizing everyday
- Using alternative creams like CBD based Care & Comfort Moisturizer.
- Wearing cotton and soft fabrics
- Avoiding rough, scratchy fabrics and tight-fitting clothing
- Using humidifier in dry or cold weather
- Using mild soap or non-soap cleanser when washing
- Taking extra precautions to prevent eczema flares in winter
- Air drying or gently patting the skin dry with a towel
- Where possible, avoiding rapid changes of temperatures and activities that cause sweating
- Learning and avoiding individual eczema triggers
- Keeping fingernails short to prevent scratching from breaking the skin
People can also use natural remedies for eczema, including aloe vera, coconut oil, and apple cider vinegar.
Doctors can prescribe several medications, including:
Topical corticosteroid creams and ointments
These are anti-inflammatory medications and may relieve the main symptoms of eczema, such as inflammation and itchiness. People can apply them directly to the skin. Some people may benefit from prescription- strength medications.
If topical treatments are not effective, a doctor might prescribe oral medications like systemic corticosteroids or immunosuppressants. These are available as injections or oral tablets. People should only use these for a short period of time. Also it is important to note the symptoms may worsen upon stopping these drugs if they are not already taking other medications.
Doctors might prescribe antibiotics if eczema occurs alongside a bacterial infection.
These may reduce the risk of nighttime scratching, as they tend to cause drowsiness.
Topical calcineurin inhibitors
This drug suppresses the activities of the immune system. It decreases inflammation and helps prevent flare ups.
Barrier repair moisturizers
These help to reduce water loss and help to repair the skin.
This involves exposure to UVA or UVB waves. This method can treat moderate eczema.
INJECTED BIOLOGIC DRUG
These medications block proteins in the immune system to limit immune system response.
Even though the condition itself is not curable, you should still speak to a doctor to get a tailored treatment plan.