Eczema

Table of Contents

What is Eczema?

Eczema, also known as atopic dermatitis, is a chronic skin condition characterized by inflammation, redness, itching, and sometimes the formation of small, fluid-filled blisters. It can affect people of all ages but is most common in infants and children. Eczema can vary in severity, with symptoms ranging from mild discomfort to intense itching and pain.

What causes Eczema?

The exact cause of eczema is not fully understood, but it is believed to involve a combination of genetic, environmental, and immune system factors. Some factors that may contribute to the development of eczema include:

Genetics: Eczema often runs in families, suggesting a genetic predisposition. Specific genes associated with eczema have been identified, particularly those related to the skin barrier function and immune response.
Abnormal immune response: People with eczema tend to have an overactive immune system that responds abnormally to triggers, leading to inflammation and skin irritation.
Skin barrier dysfunction: Eczema is associated with a weakened skin barrier, which allows irritants, allergens, and bacteria to penetrate the skin more easily, triggering inflammation and itching.
Environmental factors: Exposure to certain environmental factors, such as harsh chemicals, dry air, extreme temperatures, and allergens like pollen, dust mites, pet dander, and certain foods, can exacerbate eczema symptoms in susceptible individuals.
Microbial factors: Bacterial, viral, and fungal infections can aggravate eczema symptoms, particularly in cases where the skin barrier is compromised.
Stress: Emotional stress and psychological factors can worsen eczema symptoms or trigger flare-ups in some individuals.

It’s important to note that eczema can vary widely from person to person, and what triggers symptoms in one individual may not affect another. Identifying and avoiding personal triggers is an essential part of managing eczema effectively.

What are the symptoms of Eczema?

Eczema, or atopic dermatitis, can present with a variety of symptoms that can vary in severity from person to person. Common symptoms of eczema include:

Itching (pruritus): This is often the most prominent symptom of eczema and can be intense, leading to scratching and skin damage.
Redness (erythema): Affected areas of the skin may appear red or inflamed.
Dryness: Eczema-prone skin tends to be dry, rough, and scaly.
Rash: Eczema can cause patches of irritated skin that may be raised, swollen, or have small bumps.
Cracking: The skin may become cracked, especially in areas where it bends, such as the elbows or behind the knees.
Blisters: In some cases, eczema can lead to the formation of small, fluid-filled blisters, especially during flare-ups.
Thickened skin (lichenification): Persistent scratching or rubbing can lead to thickened, leathery skin in affected areas.
Oozing or weeping: During severe flare-ups, eczema lesions may ooze clear fluid or become wet.
Pain: Severe itching and scratching can cause pain and discomfort, especially if the skin becomes damaged or infected.

Eczema can occur on any part of the body but is commonly found on the face, hands, wrists, elbows, knees, and ankles. Symptoms may come and go in cycles, with periods of flare-ups followed by times of remission.

How do I know if I have Eczema?

Determining if you have eczema typically involves a combination of medical history, physical examination, and sometimes additional tests. Here’s what you can expect:

Medical history: Your healthcare provider will ask about your symptoms, including when they first appeared, how long they have been present, any triggers or aggravating factors, and any family history of eczema or other allergic conditions.
Physical examination: Your healthcare provider will examine your skin, looking for characteristic signs of eczema such as redness, dryness, rash, itching, and any other symptoms present. They may also assess the distribution and pattern of the rash, as eczema tends to appear in specific areas of the body.
Diagnostic tests: In some cases, additional tests may be needed to confirm a diagnosis or rule out other conditions. These tests may include:
- Skin biopsy: A small sample of skin may be taken and examined under a microscope to rule out other skin conditions.
- Patch testing: If allergic contact dermatitis is suspected, patch testing may be performed to identify specific allergens that may be triggering the eczema.
- Blood tests: These may be done to check for elevated levels of immunoglobulin E (IgE) antibodies, which are often associated with allergic conditions.

Based on the findings from your medical history, physical examination, and any additional tests, your healthcare provider can make a diagnosis of eczema and recommend an appropriate treatment plan. It’s essential to consult a healthcare professional for an accurate diagnosis and personalized management of eczema symptoms.

What are the risk factors of Eczema?

Several factors can increase the risk of developing eczema (atopic dermatitis). These include:

Family history: Eczema often runs in families, suggesting a genetic predisposition. If one or both parents have eczema, asthma, or hay fever, their children are more likely to develop eczema.
Age: Eczema can affect individuals of all ages, but it is most common in infants and young children. Many children outgrow eczema by adulthood, but some continue to experience symptoms into adulthood.
Allergies: People with allergies, particularly food allergies or allergic rhinitis (hay fever), are at a higher risk of developing eczema. Allergens can trigger immune system responses that lead to eczema flare-ups.
Asthma: There is a strong association between eczema and asthma. Individuals with asthma are more likely to have eczema, and vice versa. Both conditions involve underlying inflammation and immune system dysfunction.
Environmental factors: Exposure to certain environmental factors, such as dry air, harsh chemicals, extreme temperatures, and indoor or outdoor allergens like pollen, dust mites, and pet dander, can increase the risk of eczema or exacerbate symptoms in susceptible individuals.
Skin barrier dysfunction: Eczema is associated with a weakened skin barrier, which allows irritants, allergens, and bacteria to penetrate the skin more easily, triggering inflammation and itching. Factors that can impair the skin barrier, such as frequent bathing, use of harsh soaps or detergents, and certain occupations that involve frequent hand washing or exposure to chemicals, may increase the risk of eczema.
Stress: Emotional stress and psychological factors can worsen eczema symptoms or trigger flare-ups in some individuals. Stress can disrupt the immune system and exacerbate inflammation, leading to increased eczema severity.
Ethnicity: Eczema is more common in certain ethnic groups, particularly those of African American, Asian, or Hispanic descent.

While these factors can increase the risk of developing eczema, it’s important to remember that not everyone with these risk factors will develop the condition, and eczema can occur in individuals without any known risk factors.

Complications

Eczema (atopic dermatitis) can lead to several complications, especially if the condition is severe or poorly managed. Some potential complications of eczema include:

Skin infections: Scratching can break the skin barrier, making it more susceptible to bacterial, viral, or fungal infections. Common skin infections associated with eczema include impetigo, herpes simplex (cold sores), and eczema herpeticum (a widespread herpes infection).
Contact dermatitis: People with eczema may develop allergic contact dermatitis or irritant contact dermatitis when their skin comes into contact with certain substances, such as harsh chemicals, metals, or fragrances.
Sleep disturbances: Intense itching and discomfort can disrupt sleep patterns, leading to sleep deprivation and daytime fatigue. This can impact overall quality of life and may exacerbate other health conditions.
Psychological effects: Living with a chronic skin condition like eczema can take a toll on mental health, leading to increased stress, anxiety, depression, and reduced self-esteem. The visible nature of eczema lesions may also contribute to social stigma and feelings of embarrassment or self-consciousness.
Thickened skin (lichenification): Persistent scratching or rubbing can lead to thickened, leathery skin in affected areas, known as lichenification. This can make eczema more difficult to manage and may require more aggressive treatment approaches.
Hyperpigmentation or hypopigmentation: Eczema lesions may cause changes in skin pigmentation, leading to darker (hyperpigmentation) or lighter (hypopigmentation) patches of skin. These changes may persist even after the eczema has resolved.
Eczema herpeticum: This is a rare but serious complication of eczema characterized by a widespread herpes simplex virus infection. It can lead to fever, swollen lymph nodes, and painful skin lesions, requiring prompt medical treatment.
Chronic itch-scratch cycle: Continuous scratching can perpetuate a cycle of itching and scratching, leading to further skin damage, inflammation, and itching. Breaking this cycle can be challenging and may require a comprehensive management plan.

How to prevent Eczema

While there’s no definitive evidence that specific dietary changes can prevent eczema, some individuals may find that certain dietary modifications help manage their symptoms or reduce the frequency of flare-ups. Here are some dietary strategies that may be beneficial for some people with eczema:

Identify and avoid trigger foods: Some individuals with eczema may have food sensitivities or allergies that trigger or exacerbate their symptoms. Common trigger foods include dairy, eggs, gluten-containing grains, nuts, seeds, soy, and certain fruits and vegetables. Keeping a food diary and working with a healthcare professional can help identify trigger foods to avoid.
Consider an elimination diet: In some cases, an elimination diet may be recommended to identify specific food triggers. This involves temporarily removing common allergenic foods from the diet and gradually reintroducing them while monitoring for eczema flare-ups.
Focus on anti-inflammatory foods: Incorporating anti-inflammatory foods into the diet may help reduce inflammation and support overall skin health. Examples of anti-inflammatory foods include fatty fish (such as salmon, mackerel, and sardines), flaxseeds, chia seeds, walnuts, leafy greens, berries, turmeric, ginger, and green tea.
Stay hydrated: Drinking plenty of water helps keep the skin hydrated from the inside out, which can help improve eczema symptoms. Limiting alcohol and caffeine intake, which can be dehydrating, may also be beneficial.
Eat foods rich in essential fatty acids: Essential fatty acids, such as omega-3 and omega-6 fatty acids, play a crucial role in maintaining healthy skin barrier function and reducing inflammation. Good dietary sources of omega-3 fatty acids include fatty fish, flaxseeds, chia seeds, and walnuts.
Limit processed and sugary foods: Processed foods high in refined carbohydrates, added sugars, and unhealthy fats may promote inflammation and exacerbate eczema symptoms in some individuals. Opt for whole, minimally processed foods whenever possible.
Consider probiotics: Some research suggests that probiotics, which are beneficial bacteria that promote gut health, may help reduce the severity and frequency of eczema flare-ups, especially in infants and young children. Probiotic-rich foods include yogurt, kefir, sauerkraut, kimchi, and kombucha.

Natural remedies for treating Eczema

While natural remedies may not cure eczema, they can help alleviate symptoms and improve the overall health of the skin. Here are some natural remedies and lifestyle changes that may help mitigate eczema symptoms:

Moisturize regularly: Keeping the skin hydrated is essential for managing eczema. Use moisturizers or emollients that are fragrance-free and hypoallergenic. Apply moisturizer immediately after bathing to lock in moisture.
Avoid triggers: Identify and avoid triggers that worsen eczema symptoms, such as certain fabrics, harsh soaps or detergents, extreme temperatures, and stress. Keep a diary to track flare-ups and identify potential triggers.
Use gentle skincare products: Choose mild, fragrance-free skincare products formulated for sensitive skin. Avoid products containing alcohol, fragrances, dyes, and other potential irritants.
Take short, lukewarm baths: Long, hot showers or baths can strip the skin of its natural oils and exacerbate eczema symptoms. Take short baths or showers with lukewarm water, and use gentle, fragrance-free cleansers.
Apply topical treatments: Natural ingredients such as aloe vera, coconut oil, colloidal oatmeal, and shea butter may help soothe and moisturize the skin. Apply these ingredients topically to affected areas as needed.
Try wet wrap therapy: Wet wrap therapy involves applying a damp layer of clothing or bandages over moisturized skin to help lock in moisture and reduce inflammation. It can be particularly beneficial for severe eczema flare-ups.
Manage stress: Stress can exacerbate eczema symptoms, so it’s important to find ways to manage stress effectively. Practice relaxation techniques such as deep breathing, meditation, yoga, or tai chi.
Opt for breathable fabrics: Choose soft, breathable fabrics such as cotton and silk for clothing and bedding. Avoid rough or scratchy fabrics that can irritate the skin.
Use a humidifier: Adding moisture to the air with a humidifier can help prevent dry skin and reduce itching, especially during the winter months when indoor air tends to be dry.
Maintain a healthy diet: Eat a balanced diet rich in fruits, vegetables, lean proteins, and healthy fats to support overall skin health. Some individuals may find that certain dietary changes, such as eliminating dairy or gluten, help improve eczema symptoms.

Coping Strategies for living with Eczema

Living with eczema can be challenging, but there are several coping strategies that can help manage symptoms and improve quality of life. Here are some coping strategies for living with eczema:

Establish a skincare routine: Develop a daily skincare routine that includes gentle cleansing and moisturizing. Use fragrance-free, hypoallergenic skincare products and avoid harsh soaps or detergents that can irritate the skin.
Identify and avoid triggers: Pay attention to factors that trigger or worsen your eczema symptoms, such as certain fabrics, environmental allergens, stress, and dietary factors. Take steps to minimize exposure to these triggers whenever possible.
Manage stress: Stress can exacerbate eczema symptoms, so it’s important to find healthy ways to manage stress. Practice relaxation techniques such as deep breathing, meditation, yoga, or mindfulness.
Seek support: Living with eczema can be emotionally challenging, so it’s essential to seek support from friends, family, or support groups. Sharing experiences and coping strategies with others who have eczema can be helpful and reassuring.
Keep skin hydrated: Moisturizing regularly is crucial for managing eczema. Use moisturizers or emollients that are fragrance-free and hypoallergenic, and apply them immediately after bathing to lock in moisture.
Avoid scratching: Scratching can further irritate the skin and worsen eczema symptoms. Keep nails short and wear cotton gloves at night to prevent scratching while sleeping. Use cooling compresses or anti-itch creams to relieve itching.
Wear comfortable clothing: Choose soft, breathable fabrics such as cotton and silk for clothing and bedding. Avoid rough or scratchy fabrics that can irritate the skin, and wash new clothes before wearing them to remove any potential irritants.
Stay informed: Educate yourself about eczema and stay up-to-date on the latest treatment options and management strategies. Ask your healthcare provider or dermatologist any questions you may have about your condition.
Maintain a healthy lifestyle: Eat a balanced diet, exercise regularly, get enough sleep, and avoid smoking and excessive alcohol consumption. A healthy lifestyle can help support overall skin health and reduce inflammation.
Follow your treatment plan: Work closely with your healthcare provider or dermatologist to develop a personalized treatment plan for managing your eczema. This may include prescription medications, topical treatments, phototherapy, or other interventions tailored to your specific needs.

Some common Eczema Medications

Several medications are commonly used to manage eczema (atopic dermatitis) symptoms, both for short-term relief of flare-ups and for long-term maintenance. Here are some of the top medications available for eczema:

Topical corticosteroids: These are the most commonly prescribed medications for eczema flare-ups. Topical corticosteroids help reduce inflammation, redness, and itching. They come in various strengths and formulations, from mild to potent, and are typically applied directly to the affected skin for a limited period. Examples include hydrocortisone, triamcinolone, and clobetasol.
Topical calcineurin inhibitors: These medications are often used as an alternative to corticosteroids, especially for sensitive areas of the skin or when corticosteroids are not appropriate for long-term use. Topical calcineurin inhibitors, such as tacrolimus (Protopic) and pimecrolimus (Elidel), work by suppressing the immune response and reducing inflammation.
Topical phosphodiesterase-4 (PDE4) inhibitors: Crisaborole (Eucrisa) is a newer medication that belongs to this class. It works by inhibiting the enzyme phosphodiesterase-4, which plays a role in the inflammatory response. Crisaborole is used topically to reduce inflammation and itching in mild to moderate eczema.
Topical corticosteroid and calcineurin inhibitor combination: Some medications combine a corticosteroid with a calcineurin inhibitor to provide both anti-inflammatory and immunosuppressive effects. An example is betamethasone and calcipotriene (Taclonex).
Systemic corticosteroids: In severe cases of eczema that do not respond to topical treatments, oral or injectable corticosteroids may be prescribed for short-term use to quickly reduce inflammation and control symptoms. However, systemic corticosteroids are generally not recommended for long-term use due to the risk of serious side effects.
Systemic immunosuppressants: For individuals with severe eczema that is unresponsive to other treatments, systemic immunosuppressant medications may be prescribed to suppress the immune system and reduce inflammation. Examples include cyclosporine, methotrexate, azathioprine, and mycophenolate mofetil.
Biologic therapies: Biologic drugs are a newer class of medications that target specific molecules involved in the inflammatory response. Dupilumab (Dupixent) is the first biologic therapy approved for the treatment of moderate to severe eczema in adults and children. It works by blocking interleukin-4 and interleukin-13, two cytokines involved in the immune response.

These are some of the top medications commonly used to manage eczema symptoms. However, treatment should be individualized based on the severity of the condition, the patient’s age, medical history, and other factors. It’s essential to work closely with a healthcare provider or dermatologist to determine the most appropriate treatment plan for your specific needs.