• Eczema

    (Atopic Dermatitis)

    Definition

    Eczema, also known as atopic dermatitis, is a chronic inflammation of the outer layers of the skin.

    Causes

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

    Risk Factors

    Eczema is more common in people of African or Asian descent.
    Factors that increase your chance of eczema include:
    • Asthma or hay fever
    • 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
    • Immunosuppressant medications
    • Excess weight or obesity

    Symptoms

    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
    • Symptoms that worsen in the winter when inside air is dry due to central heating

    Diagnosis

    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. A dermatologist focuses on skin disorders. An allergist focuses on allergies.

    Treatment

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

    Medications

    In some cases, medication may also be needed and may 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, such as prednisone or cyclosporine for severe cases

    Phototherapy

    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

    It is difficult to prevent eczema. This is most true when there is a strong family history.

    RESOURCES

    American Academy of Allergy, Asthma, and Immunology http://www.aaaai.org

    National Eczema Society http://www.eczema.org

    CANADIAN RESOURCES

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

    Health Canada http://www.hc-sc.gc.ca

    References

    Atopic dermatitis. American Academy of Dermatology website. Available at: https://www.aad.org/public/diseases/eczema/atopic-dermatitis. Accessed January 22, 2015.

    Atopic dermatitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Atopic%5FDermatitis. Updated May 2013. Accessed January 22, 2015.

    Brehler R, Hildebrand A, Luger T. Recent developments in treatment of atopic eczema. J Am Acad Dermatol. 1997;36(6 Pt 1):983-994.

    Mohla G, Horvath N, Stevens S. Quality of life improvement in a patient with severe atopic dermatitis treated with photopheresis. J Am Acad Dermatol. 1999;40(5 Pt 1):780-782.

    Saarinen UM, Kajosaari M. Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old. Lancet. 1995;346:1065-1069.

    Skin allergy. American Academy of Allergy, Asthma, and Immunology website. Available at: http://www.aaaai.org/conditions-and-treatments/allergies/Skin-Allergy.aspx. Accessed January 22, 2015.

    7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Langan SM, Flohr C, Williams HC. The role of furry pets in eczema: a systematic review. Arch Dermatol. 2007;143:1570-1577.

    6/4/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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.

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