Eczema | Atopic dermatitis

Eczema is a disease that causes patches of dry, red skin, often accompanied by intense itchiness. Scratching the skin can damage its surface and make the rash worse.

The most common form of eczema is atopic dermatitis. This disease usually begins very early in life. It often occurs in infants and young children. While most people who get atopic dermatitis develop it before age 5, it also can begin during puberty or later.

Eczema tends to come and go, often without warning. A board-certified dermatologist can evaluate this condition and recommend a treatment plan, including skin care to reduce flare-ups and ease discomfort.

WHAT CAUSES ECZEMA?

No one knows for sure what causes eczema. Dermatologists and scientists are studying the role that genes may play in the disease.

People who get eczema usually have a parent or family member who has eczema, asthma or hay fever. Living in an urban area and/or living in a cold or dry climate also may contribute to the development of eczema.

Atopic dermatitis is not contagious. You or your child cannot catch this condition from anyone and cannot give it to anyone.

WHAT ARE THE SYMPTOMS OF ECZEMA?

If your child has eczema, you will see dry, scaly, red patches on his or her skin. In infants, these patches often appear on the cheeks, as well as the scalp and forehead. Eczema is itchy, so you may see your baby rubbing against bedding or carpeting to relieve the itch.

When the disease begins between 2 years of age and puberty, the child often develops eczema patches in the creases of the elbows or knees, as well as on the neck, wrists and ankles, and in the crease between the buttocks and legs.

Eczema/Atopic dermatitis

In adults, eczema patches often appear at the nape of the neck or in the creases of the elbows. The hands also are commonly affected, especially in those who wash their hands often or those who frequently have their hands in water. Adult eczema may cover most of the body and can be especially noticeable on the neck and face, particularly around the eyes.

No matter where the eczema patches appear, they tend to be very itchy. Repeatedly scratching these areas can cause the skin to look and feel leathery. The skin also may feel inflamed and sore.

Eczema patches may crust, crack and leak clear fluid. Infections can develop if germs enter the body through broken skin.

HOW IS ECZEMA DIAGNOSED?

Many skin diseases can cause a rash, so an accurate diagnosis is important. If you suspect that you or your child has eczema, you should see a board-certified dermatologist.

A board-certified dermatologist often diagnoses eczema just by looking at the affected skin. The dermatologist also may ask some questions, such as when the symptoms first appeared and whether any close blood relatives have eczema, hay fever or asthma. If allergy testing or a skin biopsy to rule out other skin conditions is necessary, your dermatologist will tell you.

HOW LONG WILL MY CHILD HAVE ECZEMA?

For many children, atopic dermatitis goes away with time. However, about half of the children who get this disease will have it as an adult.

There is no way to know whether the eczema will go away or become a lifelong disease.

Early treatment can prevent the condition from getting worse. The more severe it becomes, the more difficult it can be to treat.

Eczema/Atopic dermatitis

HOW IS ECZEMA TREATED?

A board-certified dermatologist can create a treatment plan tailored to each patient’s needs. Treatment plans may include skin care recommendations, medical therapies and tips to avoid flare-ups.

Your dermatologist’s skin care recommendations may include using a mild, fragrance-free cleanser and applying a moisturizer after bathing or throughout the day. Moisturizers can help to decrease dryness and scaling, so the skin feels more comfortable. Research has shown that applying moisturizer twice a day can decrease the need for eczema medications and may be the only treatment required in mild cases.

When selecting a moisturizer, make sure to choose a fragrance-free product, and consider using a thick cream or ointment. Petroleum jelly is an inexpensive product that works well for many patients. You may want to sample many different moisturizer types to identify the best one for you or your child.

Mild Eczema Treatments

Dermatologists recommend the following treatments to manage mild to moderate eczema:

• Topical medications

Topical corticosteroids are the No. 1 medicine used to treat eczema. When applied to the skin, these medicines can reduce inflammation (redness, swelling, heat) and itch.

The U.S. Food and Drug Administration has approved several topical prescription corticosteroids to treat eczema in adults and children, and some are approved to treat eczema in infants. Mild corticosteroids, such as hydrocortisone cream, are available over-the-counter.

Corticosteroids should be used under the direction of a board-certified dermatologist. Because children are more sensitive to these medicines than adults, you should only apply them to your child’s skin if a dermatologist includes them in your child’s treatment plan. When used as directed, these medications are safe, with a low risk of side effects. If you have any questions about the safety or side effects of these medications, ask your dermatologist.

Other topical medications the FDA has approved for eczema treatment are:

• Topical calcineurin inhibitors, which are applied to the skin to reduce inflammation and itch. The FDA has approved two TCIs to treat eczema: pimecrolimus cream and tacrolimus ointment. These medications may cause a burning sensation when first applied, but this is normal and should subside in 24 to 48
• Crisaborole, which is approved for the treatment of mild to moderate atopic dermatitis in patients 2 and older. Like other topical eczema treatments, this medication, known as PDE-4 inhibitor, can reduce inflammation on the skin. Application may cause a burning or warm

Your dermatologist may also recommend a barrier repair cream as part of your treatment plan. Barrier repair creams help to improve the barrier function of the skin that is compromised in eczema. Some barrier repair creams are available over-the-counter, while others require a prescription.

Follow the dermatologist’s instructions carefully. Your doctor may recommend that you apply different medications to different parts of the body, or that you apply one medication for a few days and then switch to another medication. Additionally, if your eczema tends to recur in the same spots, your doctor may instruct you to use a topical medication on these spots two or three times per week to reduce these recurrences.

Atopic dermatitis

• Antimicrobials

People who have eczema are prone to skin infections. Antimicrobials treat infection but not eczema.

Antimicrobial is a term that includes antibiotics, which kill bacteria; antiviral medicines, which kill viruses; and antifungal medicines, which kill fungi.

Use this medicine exactly as prescribed. This will help treat the infection as quickly as possible and prevent it from spreading.

• Bleach bath therapy

A diluted bleach bath may reduce the symptoms of eczema by reducing bacteria and inflammation on the skin. Create a bleach bath by adding 5 percent household bleach to bathwater. Use a half cup of bleach for a full bathtub of water or a quarter cup of bleach for a half-full tub of water. Do not use concentrated bleach. Use this therapy only if a dermatologist recommends it, and follow the dermatologist’s instructions on how to use this treatment safely. Visit aad.org/eczema for a video demonstration on how to give a bleach bath.

• Wet wraps

Wet wrap therapy involves moisturizing the skin, wrapping it in a layer of wet bandages and applying a layer of dry bandages over the wet bandages. This can help the skin absorb medication, keep the skin hydrated and reduce eczema flares. Wet wraps also provide a physical barrier against scratching. Your dermatologist can help you create a wet wrap routine that is best for you or your child.

• Antihistamines

When intense itching results in sleeplessness, your dermatologist may recommend an over-the-counter sedating antihistamine. While this medication can improve sleep, it will not treat eczema.

Severe Eczema Treatments

If you or your child has severe atopic dermatitis and the symptoms have not improved, a board-certified dermatologist may recommend the following treatments:

• Phototherapy

This type of treatment, which uses ultraviolet light, can reduce itch and inflammation, and is usually used in combination with topical medications or moisturizers.

Phototherapy is a time-intensive treatment that may require two to three visits to the dermatologist’s office or a hospital every week. It will take time, sometimes one to two months, for the skin to show improvement.

While phototherapy is safe because it uses UV light in a specific and controlled way, it still can cause burns, accelerate skin aging and increase skin cancer risk. Talk with your dermatologist about the benefits and risks of this treatment.

• Systemic medications

These medicines, often taken orally, are used when eczema does not respond to other therapies. Systemic immunomodulators control the immune system to calm eczema flare-ups and give the skin a chance to heal. This is especially important if scratching has led to cuts or sores on the skin.

The FDA has approved a systemic injectable medication called dupilumab for the treatment of moderate to severe atopic dermatitis in adults who don’t respond to topical treatments. Although this is the first systemic medication approved by the FDA to treat eczema, your dermatologist may prescribe another systemic medication, including cyclosporine, methotrexate, mycophenolate and azathioprine.

A board-certified dermatologist is a medical doctor who specializes in the diagnosis and medical, surgical and cosmetic treatment of skin, hair and nail conditions. To learn more about eczema or to find a board-certified dermatologist in your area, visit aad.org/eczema or call toll-free (888) 462-DERM (3376).

All content solely developed by the American Academy of Dermatology.Copyright © by the American Academy of Dermatology and the American Academy of Dermatology Association.

Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides

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