Eczema

Eczema

Eczema or atopic dermatitis, is a skin condition that has also been called “the itch that rashes” as severe itching leads to scratching which then leads to the eczema rash. This rash often appears as dry, cracked, scaly skin. It’s common, not contagious, and treatable. However, there is no cure.  It is often associated with or predate other allergic conditions such as allergic rhinitis and asthma.  There are often hereditary components to its origin, and individuals who develop eczema are thought to have a defective skin barrier and may even have low or poorly functioning filaggrin which is one type of protein in the skin.

If someone has eczema, it means their immune system is overreacting to certain irritants or allergens that trigger it. Other triggers include stress, sweating, skin infections (such as impetigo), and cold/dry air. These trigger induce itching, which then results in inflammation/atopic dermatitis flare.

Symptoms

Eczema can show up anywhere on the body.  However tends to occur in infants on skin surfaces which rub on the ground when crawling such as outer portions of the elbows and knees and on the face, and also on hands, wrists, feet and ankles.  In older children it tends to involve the inner portions of the elbow and knees as well as the ankles, wrists, hands.  The skin is red, excoriated from scratching, scaly, and cracking.  Because the skin is not acting as an effective barrier infections of the skin can occur.  Infections such as impetigo (staphylococcal skin infections).

• Skin that is dry, sensitive, itchy, inflamed, discolored, rough, cracked, leathery or scaly.
• Scaly patches
• Oozing or crusting
• Areas of swelling.
• Small, raised bumps
• Darkening of the skin around the eyes

Causes and Risk Factors

If there’s a family history of eczema, or if your family members are prone to allergic reactions like hay fever, asthma, or other allergies, you’re more likely to develop eczema. And if you are already prone to eczema, heightened stressors, or anxiety, or depression might bring on a flare-up of your symptoms.

Exposure to a number of things can also cause eczema to flare up, including:

• Allergens and irritants in the environment such as pet dander, dust mites, pollen, mold, dampness, and cigarette smoke
• Occasionally food allergens like milk, wheat, eggs, and nuts can exacerbate eczema – but due to the risk of false positives food allergy panels should not be routinely done, rather testing should be based off of a history of an immediate reaction to a specific food(s).
• Extended exposure to dry air, extreme heat, or cold
• Chemical additives in soaps, laundry detergents, fabric softeners, and disinfectants
• Wool clothing
• Cleaners and disinfectants
• Overabundance of bacteria on the skin
• Sometimes individuals with eczema will also develop allergic contact dermatitis, which can be triggered by allergens such as nickel, formaldehyde, fragrances, etc.

Complications

Persons with eczema are also prone to further complications. Among these are:

• Sleep problems
• Mental health problems
• Food allergies
• Asthma
• Hay fever
• Other types of dermatitis, such as contact dermatitis.
• Chronic itchy, leathery skin.
• Patches of skin that are darker or lighter than the surrounding area.
• Skin infections.

When to Seek Medical Help

Most children with eczema outgrow it. And the symptoms can come and go. However, see a healthcare professional if the symptoms keep you from your normal level of function, you are having trouble sleeping, you think you are developing an infection,  self-care techniques are not working, symptoms persist after trying self-care steps.

Prevention and Treatments

Healthcare professionals have many treatment options, and can suggest steps to prevent outbreaks. The mainstay of treatment of eczema is moisturizing with thick creams. Anti-inflammatory medications are usually topical creams and/or ointments, such as topical corticosteroids, calcineurin inhibitors, Eucrisa.  For severe unremitting eczema stronger medications such as biologics or JAK inhibitors can be prescribed.

Skin care

Eczema-irritated skin is more likely than normal skin to lose the oils that naturally moisturize it.

• Moisturize. Apply THICK creams and/or ointments (without fragrance or essential oils) at least twice a day.
• Use gentle soap. Most soaps will be too harsh and will remove the skin’s moisture and leave it dry. Choose soap that will gently remove dirt and sweat yet keep skin moisturized. A medical professional can recommend the right soap.

Topical Anti-inflammatory Treatments such as Topical Corticosteroids

Corticosteroid creams and ointments applied to the skin can reduce itching and inflammation. Some people can manage symptoms just by using the right moisturizer, while others benefit from adding topical anti-inflammatory treatments to their skin-care regimen.

Dupixent and other biologics

Dupixent, a biologic drug, works by blocking the signals of two of the proteins that contribute to inflammation. It can reduce redness and relieve itching, and tends to be used for people with severe atopic eczema.

Other Skin Treatments such as Eucrisa

Eucrisa is a relatively new nonsteroidal topical ointment that can help in cases of mild to moderate eczema by addressing the inflammation, rash, and itching.

Triggers

It’s unknown just what causes eczema, but an abundance of caution might help you to avoid triggering an immune system that overreacts to allergens and irritants.

• Be careful when choosing makeup and skin care items
• Don’t let your skin get too dry
• When hand eczema is present, try to avoid alcohol based hand sanitizer – instead use gentle soaps
• Stay away from smoke and other environmental pollutants
• Choose soft fabrics that’ll be against your skin with care
• Avoid stress
• Don’t get too hot and sweaty
• Avoid provoking allergens, based on an properly performed allergy test, such as dust mites and pet dander

Getting Help with Eczema

Florida Medical Center’s allergy and immunology specialists can help you develop a management plan for living a full life without being hampered by eczema.

Click here to schedule an appointment.

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