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Eczema

(Atopic Dermatitis)

Definition

Eczema is a chronic inflammation of the outer layers of the skin.

Causes    TOP

The exact cause of eczema is not known. Factors that may contribute to eczema include:

Risk Factors    TOP

Eczema is more common in people of African or Asian descent.

Other factors that may increase your chances of eczema:

  • A personal history of asthma or allergies
  • Urban areas or places with low humidity
  • A family history of eczema or allergic disorders
  • Exposure to certain fabrics, perfumes in soaps, dust mites (common), or foods
  • Stress, especially if it leads to scratching
  • Frequent washing of affected areas
  • Use of rubber gloves in persons sensitive to latex
  • Scratching or rubbing of skin
  • Medications that suppress the immune system
  • Excess weight or obesity

Symptoms    TOP

The symptoms vary from person to person. Scratching and rubbing can cause or worsen some of the symptoms. Symptoms include:

  • Dry, itchy skin
  • Cracks behind the ears or in other skin creases
  • Red rashes on the cheeks, arms, and legs
  • Red, scaly skin
  • Thick, leathery skin
  • Small, raised bumps on the skin
  • Crusting, oozing, or cracking of the skin

Diagnosis    TOP

You will be asked about your symptoms and medical history. A physical exam will be done. The diagnosis is made by the appearance and location of the rash. You may be referred to specialist.

Treatment    TOP

The main goals of eczema treatments are to:

  • Heal the skin and keep it healthy
  • Stop scratching or rubbing
  • Avoid skin infection
  • Prevent flare-ups
  • Identify and avoid triggers

Treatment options may vary. Your doctor may recommend more than one depending on your condition. They include:

Skin Care

Proper skin care may allow the skin to heal. Treatment may include:

  • Avoiding hot or long baths or showers. Keep them less than 15 minutes.
  • Using mild, unscented bar soap or non-soap cleanser. Use it sparingly.
  • Air-drying or gently pat drying after bathing. Apply gentle moisturizer when your skin is still damp.
  • Treating skin infections right away.

Medications

In some cases, medications may be needed. Examples include:

  • Prescription creams and ointments containing cortisone, tacrolimus, or pimecrolimus
  • Prescription or over-the-counter antihistamines to help prevent itching
  • Antibiotics applied directly to the skin or taken by mouth in order to treat infections
  • Oral medications to reduce inflammation
  • Monoclonal antibody injection to reduce inflammation

Phototherapy    TOP

If skin care and medications are not effective, light therapy may be used. This may include:

  • Treatment with ultraviolet A light and 5-methoxypsoralen (PUVA)
  • Photopheresis for severe cases

Prevention    TOP

Eczema is difficult to prevent, especially if there is a family history.

RESOURCES:

American Academy of Allergy, Asthma, and Immunology
http://www.aaaai.org
National Eczema Association
https://nationaleczema.org

CANADIAN RESOURCES:

Canadian Dermatology Association
https://www.dermatology.ca

References:

Atopic dermatitis. American Academy of Dermatology website. Available at: https://www.aad.org/public/diseases/eczema/atopic-dermatitis. Accessed December 20, 2017.
Atopic dermatitis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115212/Atopic-dermatitis. Updated July 3, 2017. Accessed December 20, 2017.
Atopic dermatitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: https://www.niams.nih.gov/health-topics/atopic-dermatitis. Updated July 31, 2016. Accessed December 20, 2017.
Eczema and atopic dermatitis. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/eczema-and-atopic-dermatitis. Updated June 2017. Accessed December 20, 2017.
What is eczema? National Eczema Association website. Available at: https://nationaleczema.org/eczema. Accessed December 20, 2017.
Plötz SG, Wiesender M, Todorova A, Ring J. What is new in atopic dermatitis/eczema? Expert Opin Emerg Drugs. 2014;19(4):441-458.
7/6/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115212/Atopic-dermatitis: Langan SM, Flohr C, Williams HC. The role of furry pets in eczema: a systematic review. Arch Dermatol. 2007;143(12):1570-1577.
6/4/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115212/Atopic-dermatitis: Alexander DD, Cabana MD. Partially hydrolyzed 100% whey protein infant formula and reduced risk of atopic dermatitis: a meta-analysis. J Pediatr Gastroenterol Nutr. 2010;50(4):422-430.
1/4/2016 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115212/Atopic-dermatitis: Zhang A, Silverberg JI. Association of atopic dermatitis with being overweight and obese: a systematic review and metaanalysis. J Am Acad Dermatol. 2015;72(4):606-618.
7/14/2017 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115212/Atopic-dermatitis: Blauvelt A, deBruin-Weller M, et al. Long-term management of moderate-to-severe atopic dermatitis with dupilumab and cocomitant topical corticosteroids (LIBERTY AND CHRONOS): a 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial. Lancet. 2017;389(10086):2287-2303.
Last reviewed March 2017 by EBSCO Medical Review Board Warren A. Bodine, DO, CAQSM
Last Updated: 1/4/2016

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