Eczema

What is Eczema?

Eczema is the name for a common group of skin conditions that typically cause flares of itchy, dry, and inflamed skin. Itchy skin is the most common symptom of eczema. There are many different types of eczema or dermatitis, including atopic, contact, stasis, nummular, dyshidrotic and hand eczema.

More than 31 million Americans have some form of eczema. It can start during childhood, adolescence, or adulthood - and it can range from mild to severe.

Atopic dermatitis is the most common type of eczema, impacting 1 in 10 Americans. Symptoms range from excessively dry, itchy, or painful skin rashes. Eczema is not contagious. You can’t “catch it” from someone else. While the exact cause of eczema is unknown, researchers know that people develop eczema because of a combination of genes and environmental triggers. Many people with eczema also have related conditions, such as asthma, hay fever, and food allergies. Proper, consistent skin care is essential in managing eczema.

What are the signs and symptoms of eczema?

Eczema looks and feels different for everyone, but the most common symptom is itchy skin. Other common symptoms include dryness, sensitive skin, discoloration, thickened skin, scaly rashes, oozing or crusting, and areas of swelling.

Eczema is more common in skin creases and bends, like your inner elbows, wrists, ankles, and behind your knees. It can get worse in the winter, because cold weather makes your skin more dry. Allergens, like pollen or dust, can also worsen eczema symptoms. Fragrances and chemicals from personal care or cleaning products can irritate the skin and cause flare ups, as well.

Do I have eczema? Does my child have eczema?

Eczema is very common, but there are many different types of eczema, and it is important to get a proper diagnosis. To diagnose eczema, your expert provider carefully examines you or your child’s skin and asks questions.

That’s why it’s important to talk to an expert provider if you think you or your child may have eczema. Your doctor will carefully look at your skin and ask you questions about your symptoms and medical history.

Getting the right diagnosis can help you and your doctor figure out what treatment and skin care plan is best for you or your child.

What causes eczema?

Eczema is a skin disease caused by an interaction between a person’s environment and their genes. People with eczema usually have an overactive immune system that responds to irritants or allergens by producing inflammation.

There are many risk factors for eczema, such as stress or exposure to allergens. Having dry skin, coming in contact with certain fragrances or chemicals, food allergies, cold weather, or hot and swampy weather can all contribute to the severity and number of flare ups, if you are predisposed to eczema.

Research has also found that some people with eczema have a mutation of the gene responsible for filaggrin. Filaggrin is a protein that helps our bodies maintain a healthy, protective barrier on the skin. Without enough fillagrin, moisture can escape and allow bacteria and allergens to enter the body more easily. This ‘leaky’ skin barrier can lead to itchy and dry skin, as well as blisters, skin infections, and other symptoms. Common triggers include dry skin, irritants from everyday household products, and stress.

Eczema impacts everyone differently, and each person has different triggers. Your expert doctor will help you figure out what triggers you or your child’s eczema. They will help design a treatment plan customized for your individual needs, so you can find the regimen that works best for you.

How do I treat my eczema?

Your expert doctor will help you find the right treatment to help you feel better, and get your eczema under control. Every treatment plan is customized based on your individual eczema symptoms.

Depending on your age and the severity of your eczema, these treatments might include: medical grade moisturizing creams, prescription topical medications (including topical corticosteroids, over-the-counter creams and lotions, oral, and injectable medications, called biologics. Many people with eczema also find success with specific natural and alternative treatments, including bleach baths, meditation, and more.

Your doctor will help you come up with a comprehensive plan that meets your specific needs and personal preferences.

Eczema & related health conditions

Asthma

About 20% of adults with atopic dermatitis also have asthma, an allergic condition which causes a person’s airways to become inflamed, swollen and narrow. This narrowing makes it difficult to breathe, leading to tightness in the chest, coughing and wheezing. Asthma usually first appears in childhood and can continue throughout a person’s lifetime. Some people with asthma only experience it from time to time, while others need ongoing treatment in order to keep it under control.

Allergic Rhinitis

Also called “hay fever,” allergic rhinitis is inflammation in the nose and sinuses caused by allergens like pollen, dust mites and pet dander. Symptoms for hay fever can include:

• an itchy nose, mouth, eyes or skin
• a runny or stuffy nose
• sneezing
• watery eyes
• sore throat

Food Allergies

Up to 15% of children aged 3 to 18 months with atopic dermatitis have an allergy to one or more types of food. The most common food allergies in children are milk, eggs, peanuts, wheat and soy. Symptoms of food allergies typically appear within 30 minutes of eating or breathing in a food allergen and can include:

• itchy mouth and swelling of the lips
• vomiting, diarrhea, painful stomach cramps
• hives, rash or reddening of the skin
• blood pressure drop

Infections

Due to problems with the skin barrier and an increase of bacteria on the skin, people with eczema are more prone to skin infections from both bacteria and viruses, especially staph and herpes. Symptoms of a skin infection include redness, skin that is warm/hot to the touch, pus-filled bumps (pustules), and cold sores or fever blisters. Your expert doctor can help if you think you or your child have a skin infection.

• Eczema herpeticum affects people with atopic dermatitis and other inflammatory skin diseases. The eczema herpeticum infection can be very serious, especially when it spreads over wide areas of skin.
• Staph infections: People with atopic dermatitis are more likely than the general population to have “colonized” Staphylococcus aureus (also called “staph”) bacteria, leaving them more prone to staph infections. Common types of staph infections include:
• Furuncles, also known as boils, start in the hair follicle and are caused by both bacteria and fungi. Furuncles are usually red, warm and tender to the touch.
• Impetigo is a common and contagious kind of staph infection. It can occur in eczema-affected skin that’s open and “weepy.” If you have impetigo, honey-colored crusts may form on the open areas of your skin and can become painful and red. Impetigo is easily treated.
• Cellulitis is a deep infection in the skin and is usually very painful and tender to the touch. In addition to redness, other cellulitis symptoms include swollen skin that is warm or hot to the touch. In severe cases, people with cellulitis develop a fever and elevated white blood cell count and may need to be hospitalized, so please talk to a doctor as soon as possible if you think you may have cellulitis.

Mental Health Conditions

Research suggests that people with eczema, particularly atopic dermatitis, have higher rates of depression, anxiety and conduct disorders. Much remains unknown about the relationship between these conditions.

According to the National Institute of Mental Health, if a person has experienced some of the following symptoms for two weeks or longer, they might have depression and should consult a healthcare provider:

• feeling sad, empty and/or anxious
• feeling hopeless
• loss of interest in hobbies or other activities
• decreased energy, feeling tired more often
• difficulty concentrating
• restlessness, unable to sit still
• problems sleeping
• weight change
• thoughts of death or suicide

Other Related Conditions

Research shows that adults with atopic dermatitis may have a higher risk of developing heart disease, high blood pressure and stroke.
Many factors can contribute to eczema, including an interaction between your environment and your genes. When an irritant or an allergen from outside or inside the body “switches on” the immune system, it produces inflammation, or a flare-up, on the surface of the skin. This inflammation causes the symptoms common to most types of eczema. Creases of the skin, especially the flexural areas behind the knees, elbows, lower legs and other areas of skin that rub against each other can lead to irritation. There is also a potential genetic component to eczema that includes a protein called “filaggrin” that helps maintain moisture in your skin; a filaggrin deficiency can lead to drier, itchier skin.

Many common household items are also potential environmental irritants and can cause allergic reactions leading to an eczema flare. Additional common triggers of eczema may include:

• extended exposure to dry air, extreme heat or cold
• some types of soap, shampoo, bubble bath, body wash, facial cleansers
• laundry detergents and fabric softeners with chemical additives
• certain fabrics like wool or polyester in clothing and sheets
• surface cleaners and disinfectants
• natural liquids like the juice from fruit, vegetables and meats
• fragrances in candles
• metals, especially nickel, in jewelry or utensils
• formaldehyde, which is found in household disinfectants, some vaccines, glues and adhesives
• isothiazolinone, an antibacterial found in personal care products like baby wipes
• cocamidopropyl betaine, which is used to thicken shampoos and lotions
• paraphenylene-diamine, which is used in leather dyes and temporary tattoos

Emotional stress can also trigger an eczema flare-up, but it’s not exactly known why. Some people’s eczema symptoms and flare-ups get worse when they’re feeling “stressed.” Others may become stressed, just knowing they have eczema, and this can make their skin flare up.

The most important thing to remember is that eczema and its symptoms are different for everyone. Every individual’s skin care routine will also impact the affected areas of the skin differently. Your eczema may not look the same on you as it does on another adult or on your child. Different types of eczema can appear on different affected areas of the body at different times.

Eczema almost always includes itchy skin. For many people, the itch can range from mild to moderate. Sometimes the itch gets so bad that people scratch it until it bleeds. This is called the “itch-scratch cycle.”

Symptoms of eczema often include:

• Itch
• Dryness, sensitive skin
• Inflamed, discolored skin
• Rough, leathery or scaly skin, appearing as scaly patches
• Oozing or crusting
• Areas of swelling

You might have all of these symptoms of eczema or only just a few. You might have some flare-ups or your symptoms could go away entirely. Eczema can appear red in lighter skin, whereas people of color may experience eczema as ashen skin, gray skin, darker brown or purple in color.

For most types of eczema, managing flares comes down to these basics:

• Know your triggers so that you can avoid exposure;
• Implement a daily bathing and moisturizing routine;
• Use OTC creams and prescription medication consistently and as prescribed.

Symptoms can vary from one child to the next. Usually, eczema gets better as a child grows older, though some children will continue to experience eczema into adulthood. Adults can develop eczema, too, even if they never had it as a child.

The best way to find out if you have eczema is to talk to your Tono dermatologist, who has expertise in diagnosing and treating eczema.