Eczema

What is eczema?

Eczema is defined as dry, itchy, flaky skin which can have many causes. Contact dermatitis is a type of eczema where the skin comes in contact with an allergen like poison ivy. This type of eczema usually resolves when the offending allergen is identified and avoided. However, most cases of dry itchy skin are caused by atopic dermatitis (AD).

AD is a common, chronic, inflammatory skin condition that comes and goes (relapses and remits). It usually begins in infancy and persists into adulthood. It affects almost 10 million children and about 17 million adults in the US. Most develop the disease within the first two years of life and experience episodes of symptoms (flares) throughout childhood and adulthood. About half of affected children will grow out of the condition. It is not curable but can be controlled.

What causes eczema?

Recent research reports that AD is a lifelong genetic predisposition to environmental allergens that causes episodes of skin lesions as well as other allergic diseases including food allergies, asthma and allergic rhinitis (hay fever). It is not contagious and runs in families.

The genetic predisposition causes an overactive immune system which creates inflammation that damages the skin barrier yielding dry, itchy, scaly skin predisposed to itching and rashes. Eczema usually precedes the development of food allergies. Allergen exposure through inflamed skin causes the lesions commonly associated with AD. Triggers include dry skin, irritants like pet dander and dust, soaps and detergents, infections, dry or hot and humid environments or cold winter air, sweating and stress.

What are the symptoms of eczema?

In infancy the symptoms are dry, scaly patches of skin on the face, body, arms and legs. In children and adults, the skin in body creases becomes red (inflamed) and intensely itchy and creates a rash that when scratched can become raw and painful, ooze and crust.

Eczema is known for creating an itch so intense (pruritus) that the victim scratches until the skin bleeds, leading to more inflammation and itching and even scarring. This is known as the itch-scratch cycle. Constant itching causes patches of skin to become scaly, and leathery which is uncomfortable and embarrassing. Excessive itch interferes with sleep. The greatest risk is serious skin infections.

How is eczema diagnosed?

Dr. Anna Chacon may be able to diagnose your condition easily by examination. However, there are some skin diseases that can be confused with eczema including scabies, psoriasis, fungal infections, contact dermatitis, and seborrheic dermatitis. If she has questions about your condition she may order an allergy skin test, blood tests and even a biopsy but most often she can make the diagnosis without further testing.

Dr. Chacon will review your medical history and inquire about whether any family members have similar symptoms or diagnoses of atopic dermatitis or eczema, and the age at which you began to have itchy rashes. She will discuss your symptoms and triggers and suggest ways to improve your symptoms.

How is eczema treated?

Initially the goal is to identify triggers and adopt lifestyle changes to avoid them in order to improve sleep, reduce stress and protect the skin. Then the goal is to control itching and infection and heal the skin. Various over-the-counter treatments may be helpful to reduce itching, redness and irritation. These may include oral antihistamines like Benadryl, Tylenol (acetaminophen) and NSAIDs for pain and inflammation, hydrocortisone to reduce irritation, itching and inflammation, and medicated shampoos; and creams to restore the skin barrier.

Prescription medications to treat symptoms and reduce inflammation include topical corticosteroid creams to reduce inflammation and itching, and nonsteroidal topical creams called Protopic® and Elidel® and generic options address immune system dysfunction.

Eucrisa® is an FDA approved drug to treat mild to moderate AD. Prescriptions antibiotics may be recommended to prevent infections. Oral corticosteroids can help in severe cases, but there are potentially serious side effects. A new injectable biologic drug called Dupixent® may be offered to people with severe cases that fail to respond to all other treatments.

UV Light therapy can be effective at treating mild to severe atopic dermatitis by addressing inflammation and itching. It may be combined with a drug called psoralen that makes the skin more sensitive to the effects of ultraviolet light, but the use of this drug increases risks of the treatment.

Treatment options are based on your medical history, symptoms and your age. Typically, a combination of treatments will be necessary to find relief.

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