Eczema and Atopic Dermatitis

Woman scratching her arm

What is eczema and atopic dermatitis?

Eczema is a general term for rash-like skin conditions. The most common type of eczema is called atopic dermatitis. Eczema is often very itchy. When you scratch it, your skin becomes red and inflamed (puffy). Eczema is most common in babies but also affects children and adults.

Atopic dermatitis is a chronic skin condition. It is caused by an allergic reaction. It is the most common type of eczema. “Atopic” describes an inherited tendency to develop dermatitis, asthma, and hay fever. “Dermatitis” means that the skin is red and itchy.

Atopic dermatitis usually starts during infancy and continues into childhood. There are times when the condition gets worse (called flare-ups). Flare-ups are followed by times when the skin will heal. During these times, there may be no signs of atopic dermatitis (called remission). Remission can last for weeks, months, or even years. Some children will outgrow atopic dermatitis. Others will still have it when they are adults. Flare-ups in adults tend to be less severe.

Symptoms of eczema and atopic dermatitis

Atopic dermatitis and eczema may start out as dry, extremely itchy skin. The rash may become very red, swollen, and sore. The more you scratch it, the worse it generally gets. A clear fluid may leak from the rash. Eventually, the rash will crust over and start to scale. Common places for the rash are in the elbow creases, behind the knees, on the cheeks, and on the buttocks.

What causes eczema and atopic dermatitis?

You are more likely to have atopic dermatitis or eczema if a family member has it. These conditions aren’t contagious. This means you can’t catch them from other people. The exact cause of eczema and atopic dermatitis is unknown.

How are eczema and atopic dermatitis diagnosed?

Your doctor will be able to diagnose eczema simply by looking. As part of your exam, he or she will also review your medical history. It is important to tell your doctor if you have allergies or asthma. He or she may order blood and skin patch tests to rule out other conditions.

Can eczema and atopic dermatitis be prevented or avoided?

You may never know what causes your eczema or atopic dermatitis. Without knowing, you can’t avoid them. They can’t be cured, but they can be managed. You can also learn to avoid the things that trigger them.

Limit your contact with things that can irritate your skin.

Some things that may irritate your skin include:

  • household cleansers

  • detergents

  • aftershave lotions

  • soap

  • gasoline

  • turpentine and other solvents

Try to avoid contact with things that make you break out with eczema. Soaps and wetness can cause skin irritation. Wash your hands only when necessary. Use a mild unscented soap such as Dove, Basis, or Olay, especially if you have eczema on your hands. Dry your hands completely after you wash them.

Wear gloves to protect the skin on your hands.

Wear vinyl or plastic gloves for work that requires you to have your hands in water. Also, wear gloves when your hands are exposed to anything that can irritate your skin. Wear cotton gloves under plastic gloves to soak up sweat from your hands. Take occasional breaks and remove your gloves. This will prevent a buildup of sweat inside your gloves.

Wear gloves when you go outside during the winter. Cold air and low humidity can dry your skin. Dryness can make your eczema worse. Wear clothes made of cotton or a cotton blend. Wool and some synthetic fabrics can irritate your skin.

Care for your skin in the bath or shower.

Bathe only with a mild unscented soap, such as Dove, Basis, or Olay. Use a small amount of soap. Keep the water temperature cool or warm, not hot. Soaking in the tub for a short time can be good for your skin. Doing so allows your skin’s outer layer to absorb water and become less dry. Soak for 15 to 20 minutes. Then use a soft towel to pat your skin dry without rubbing. Immediately after drying, apply a moisturizer to your skin. This helps seal in the moisture.

Use a moisturizer on your skin every day.

Moisturizers help keep your skin soft and flexible. They prevent skin cracks. A plain moisturizer is best. Avoid moisturizers with fragrances (perfume) and a lot of extra ingredients. A good, cheap moisturizer is plain petroleum jelly (such as Vaseline). Use moisturizers that are more greasy than creamy because creams usually have more preservatives in them.

Regular use of a moisturizer can help prevent the dry skin that is common in winter.

Avoid getting too hot and sweaty.

Too much heat and sweat can make your skin more irritated and itchy. Try to avoid activities that make you hot and sweaty.

Eczema and atopic dermatitis treatment

Your doctor may prescribe a corticosteroid cream or ointment to apply to your rash. This will help reduce itching and calm inflammation. Use it right after bathing. Follow your doctor’s directions for using this medicine or check the label for proper use. Call your doctor if your skin does not get better after 3 weeks of using the medicine.

Antihistamines like hydroxyzine reduce itching. They can help make it easier to not scratch. A new class of drugs, called immunomodulators, works well if you have a severe rash. Two drugs in this class are tacrolimus and pimecrolimus. These drugs keep your immune system from overreacting when stimulated by an allergen. However, they can affect your immune system. So the Food and Drug Administration recommends that these drugs be used only when other treatments won’t work.

Try not to scratch the irritated area on your skin, even if it itches. Scratching can break the skin. Bacteria can enter these breaks and cause infection. Moisturizing your skin will help prevent itchiness.

Living with eczema and atopic dermatitis

Eczema can flare up when you are under stress. Learn how to recognize and cope with stress. Stress reduction techniques can help. Changing your activities to reduce daily stress can also be helpful.

The area where you had the eczema may easily get irritated again, so it needs special care. Continue to follow the tips provided here even after your skin has healed.

Questions to ask your doctor

  • What treatment is best for me?

  • Should I use a steroid cream or ointment?

  • What are the side effects from the steroid cream or ointment?

  • Do I need to take any other medicines?

  • What is the best way to prevent flare-ups from eczema and atopic dermatitis?

  • Is there a certain type of soap I should use?

  • My child has eczema. What kind of moisturizer is best for him/her?

  • How can I keep my child from scratching the rash?

  • I have eczema. Will my children have it?

  • How should I care for the rash if I have a flare-up?

Resources

National Institute of Arthritis and Musculoskeletal and Skin Diseases: Atopic Dermatitis

National Institutes of Health, Medline Plus: Eczema

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This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Rash Decisions

How to Deal With Itchy, Red Skin

Illustration of a person putting cream on their arm

You’ve broken out in a red, itchy rash. You’re likely wondering where it came from—and, most importantly, how to make it go away.

Unfortunately, your mystery rash could have many causes. Maybe you switched to a new detergent or accidentally brushed against poison ivy. Maybe it came from a virus or fungus. It can be hard to pinpoint the cause.

Red, uncomfortable skin rashes are called dermatitis. “When we use the term dermatitis, all we really mean is skin inflammation,” says Dr. Brian Kim, a dermatologist at Washington University in St. Louis.

Our skin is a barrier, serving as the first line of defense against the outside world. It is filled with immune cells. These cells actively fight against viruses, bacteria, and other invaders. If a foreign substance is detected, immune cells start a chain reaction to neutralize the threat. This, in turn, causes inflammation.

Eczema

Many people are familiar with atopic dermatitis—the red, itchy rash commonly called eczema. “It affects up to 30% of people, particularly in childhood, and it tends to run in families,” explains Dr. Heidi Kong, a dermatologist at NIH. While some children may outgrow eczema, others will have the disease for life.

The cause of eczema is unknown. But skin microbes—bacteria, fungi, and viruses—may play a role. Kong is working to understand how the millions of microbes that live on your skin may contribute to eczema. Kong and her team have shown that certain types of bacteria are more commonly found on people with eczema. When applied to the skin of mice, these bacteria cause an immune response in the skin.

“We’re trying to understand the bacteria on a deeper level,” says Kong. “We see that they are associated with flares.” Flares are periods when eczema gets worse.

Treatment using bacteria normally found on healthy skin may help. In a small preliminary study, children and adults with eczema improved after using a spray that contained a specific kind of healthy bacteria. Research like this may one day lead to new treatments.

Scientists are also interested in understanding whether eczema can be prevented before it starts.

“I tell my patients that you were probably programmed from birth to be at risk for developing atopic dermatitis,” says Dr. Eric Simpson, a dermatologist at Oregon Health & Science University. Scientists estimate that the risk for eczema may be up to 60–70% genetic. But environmental causes also play a role.

What if a simple act, like moisturizing daily, could keep children from developing the disease? Doctors often prescribe moisturizing creams for people with eczema. These creams help to stop itching and restore the skin. Studies have shown that using moisturizers, sometimes called emollients, can prevent eczema flares.

In Simpson’s new study, parents will moisturize their baby’s entire body each day using one of several emollients. “Our idea was to repair the skin barrier that’s dysfunctional as early in life as you can,” says Simpson.

Over several years, the team will be able to see whether emollient treatment helped prevent eczema. They are also looking at whether regular moisturizing could impact allergies and asthma, which are common for children with eczema.

How do you choose a moisturizing product if you have eczema? “It’s a bit of trial and error,” Kong says. While some people prefer petroleum jelly-based products, other people find they have better results with cream-based lotions.

“But because of the tendency for a lot of these patients to have sensitive skin, we do recommend they avoid products that have a lot of fragrances or preservatives,” she says.

Other Rashes

Not all rashes are mysterious. Some have a very clear cause. If your skin touches something you’re allergic to, it’s bound to get red and itchy. Common triggers include fragrances in soaps, lotions, and cosmetics. Some people are sensitive to nickel, which is often found in jewelry.

Your doctor may recommend a “patch test.” Small amounts of different substances are applied to your skin to see if you have a reaction.

“People are very familiar with allergic contact dermatitis by way of poison ivy,” Kim says. “But there are many, many environmental allergens that can cause contact dermatitis.” Luckily, hydrocortisone cream may be all you need if the rash only covers a small area.

Psoriasis is another common form of dermatitis. It causes thick, red, scaly skin on the elbows, knees, scalp, and other parts of the body. It’s caused by an overactive immune system. Skin ointments and medications that quiet the immune system can help. A doctor may also prescribe light therapy, where the skin is regularly exposed to ultraviolet light.

Rashes can also be triggered by bacterial and viral infections. And certain drugs may cause an itchy skin rash if you’re allergic.

“That’s a few of probably hundreds of rashes you can get,” Kim says. But common to all of them? “A five-year-old child could tell you that whenever something’s rashy, it itches. Itch is probably the most common symptom in the field of dermatology.”

Itch Relief

For a long time, people questioned whether itch was even its own unique sensation. They thought it might be a mild form of pain. But scientists have discovered that itch has its own pathway in the brain.

That was the starting point for developing new treatments for chronic itch. Now researchers are focusing on finding drugs to help fight itch.

If you’re a little itchy, it’s okay to start with over-the-counter creams. Moisturizers and creams work well for dry, itchy skin. Mentholated moisturizers can cool the skin and provide relief. But some perfumes or dyes added to skin lotions may make things worse. For more tips on soothing a mild rash, see the “Wise Choices” box.

If you have a severe itch that’s been going on for a long time, you should see a doctor. For these types of severe itch, Kim says, trying to use over-the-counter treatments is “like trying to put out a fire with a garden hose.”

For an itchy rash, it’s important to understand the cause. Call your doctor if your rash is so uncomfortable that it interferes with your sleep or daily activities. You should also seek medical help if you break out in a rash after taking a new medication.

An itchy rash can be trying, but with help, you can calm your skin and feel better.

Source: NewsInHealth, NIH