Eczema, also known as atopic dermatitis, is an inflammation of the skin which is chronic in nature. Patients having this condition have severe itching in the regions affected by eczema. This condition can also be accompanied by hay fever or asthma. Any part of the skin can be affected by eczema; however, arms and posterior region of the knee are more commonly affected. Eczema has the tendency to flare up for some time and then subside for some time, even a few years. The cause for eczema is not known; although it is believed to occur as a result of inherited predisposition towards a sensitive skin and dysfunction of the immune system.
Eczema commonly starts during childhood and can continue till adulthood. In some patients, this condition has periodic flare ups and then there is relief for some time, even for some years. There can be severe itching experienced where the patient scratches his/her skin thus making itching and inflammation worse. Scratching also causes a break in the skin which makes the skin susceptible to bacterial infections, particularly Staphylococcus aureus. It is very important to break this itch and scratch cycle.
Treatment comprises of avoiding irritants, such as soaps and using soothing ointments and creams for relieving the itching. Prescription medications, such as corticosteroid creams are also used. Light therapy also helps with eczema.
Infantile Eczema or Atopic Dermatitis
When infants are affected by atopic dermatitis or eczema, then it is known as Infantile Eczema. This can persist into adolescence and adulthood. Infantile eczema is characterized by a rash which oozes and crusts, primarily on the scalp and face. As the rash continues into adolescence, it becomes drier and the color changes to red or brown-grayish. The skin can also become thickened and scaly and more sensitive. Patient continues to have severe itching.
Causes of Eczema or Atopic Dermatitis
The cause of Eczema or Atopic Dermatitis is not known. Experts believe it occurs as a result of skin dryness and irritation combined with dysfunction in the body's immune system. Certain factors like stress and other emotional problems can worsen Eczema or Atopic Dermatitis. According to experts, eczema has a genetic source and could be related to hay fever and asthma; however, nothing has been proved yet.
Symptoms of Eczema or Atopic Dermatitis
- Appearance of patches on the skin, which are red to brownish-gray in color.
- Constant itching, which can be very severe at night.
- Presence of small, elevated bumps with leaking fluid and crusting.
- Thick and scaly skin.
- Scratching results in raw and sensitive skin.
Common Regions Where These Patches Appear Are:
- Hands and feet.
- Anterior to the elbow crook.
- Posterior to knees.
- Face, neck and upper chest.
- Eyelids can also be affected.
Serious Symptoms of Eczema or Atopic Dermatitis
- If your quality of life is affected.
- If you are losing sleep.
- If you are experiencing pain in the rashes.
- If you think there is an infection of the skin.
- If conservative measures, such as avoiding the irritants and applying soothing ointment/cream, have not helped.
Risk Factors Which Worsen Eczema or Atopic Dermatitis
- Taking long, hot showers/baths.
- Dry skin.
- Stress/emotional problems.
- Pollution and cigarette smoke.
- Rapid temperature changes.
- Decreased humidity.
- Irritants, such as soaps, detergents, solvents and cleaners.
- Sand/ dust.
- Certain clothing/fabric.
- Certain food groups like milk, eggs, soy, fish, wheat etc.
Investigations for Eczema or Atopic Dermatitis
There are no tests for conclusively diagnosing eczema. Physical examination and medical history are usually sufficient for diagnosis of this condition.
Treatment for Eczema or Atopic Dermatitis
The aim of treatment is to relieve itching, decrease inflammation and prevent further flare-ups. OTC soothing and anti-itch ointment and creams are used along with other conservative treatment measures and these are usually sufficient in relief from mild eczema.
Medications Used in Eczema or Atopic Dermatitis Include:
- Topical corticosteroids help in alleviating itching and scaling of the skin. Always consult your doctor before applying topical corticosteroids. Side effects include discoloration/ irritation of the skin, infection, stretch marks and thinning of the skin.
- Mild astringent wet dressings can be used to prevent infection.
- Antibiotics are given if there is a bacterial skin infection or if there is an open fissure or break in the skin, occurring as a result of scratching.
- Oral antihistamines, such as diphenhydramine, help with severe itching; however, they can cause drowsiness.
- Injected or oral corticosteroids, such as prednisone, are prescribed in severe eczema. Corticosteroids can also be injected intramuscularly to decrease inflammation and other symptoms. These medications, although effective, can have some serious side effects, such as osteoporosis, cataracts, muscle weakness, decreased immunity, hypertension and skin thinning.
- Immunomodulators are a group of medications, which include pimecrolimus and tacrolimus, and they work by affecting the immune system and help in maintaining the normal texture of the skin and decreasing the number of eczema flare ups. This medication is available by prescription only and is strictly used for adults and children over 2 years. These medications are recommended only if other treatments fail.
- Phototherapy or Light Therapy: This treatment involves the use of light (artificial or natural) by exposing your skin to limited durations of natural sunlight or artificial UVA (ultraviolet A) or UVB (ultraviolet B) light or NBUVB (narrow band ultraviolet B). This therapy can be done individually or along with medications. Side effects include increased risk of skin cancer and premature aging.
Treatment for Infantile Eczema or Atopic Dermatitis
- Treatment mainly comprises of avoiding skin irritants and lubricating or moisturizing the baby's skin using lotions, ointments, bath oils, lotions, creams etc.
- If all this doesn't improve your baby's rash and if you suspect skin infection, then you need to consult pediatrician/doctor ASAP for prescription medications and further treatment.
Home Remedies and Prevention of Eczema or Atopic Dermatitis
- Identify and avoid triggers, such as stress, sweating, detergents etc. which worsen itching and inflammation.
- Always use mild soaps/cleanser/detergents etc. without perfumes or dyes.
- Always rinse off soap thoroughly from your body.
- Do your best to avoid scratching. Cover the rash areas, regularly trim your nails and wear cotton gloves when you are sleeping.
- Application of OTC soothing calamine lotion and anti-itch cream to the rashes.
- Application of wet /cool compresses help in soothing and protecting the skin.
- A warm bath with uncooked oatmeal or colloidal oatmeal or baking soda added to it, helps with eczema.
- Moisturize/lubricate your skin using cream or oil immediately after taking a shower or a bath.
- Humidifier should be used if the indoor air is hot and dry, as it can worsen the skin flaking and itching.
- Always wear smooth-textured cotton fabric/clothes. Avoid clothes which are tight, rough/scratchy etc.