What Is Eczema?
It’s sometimes called “the itch that rashes,” because the itching usually comes first. Atopic dermatitis is a common, often inherited form of eczema, but there are other types and many treatments.
Itching is the main one. Scratching makes your skin inflamed and itchier, and it can look different. You may notice:
– Affected areas may be red (light skin) or darker brown, purple, or ash gray (brown skin).
– Dry, scaly areas
– Warmth, possibly also with some swelling
– Small, rough bumps
– Thick leathery patches
– Bumps that leak and crust over
– After healing, the affected area might look lighter or darker than the rest of your skin.
You might notice itchy patches on the hands, elbows, and in the “bending” areas of the body, such as the inside of the elbows and back of the knees. But eczema can appear anywhere, including the neck, chest, and eyelids. People who had atopic dermatitis as a child may see drier, scaly rashes as adults. The skin may be discolored or thickened.
If a rash won’t go away, is uncomfortable, or gets a crust or pus-filled blister, see your doctor. They’ll check your medical history, symptoms, and ask you about any allergies that run in your family. You may also get allergy tests or a microscopic exam of a skin scraping to rule out infections.
Eczema and Allergies
Triggers that bring on an allergy attack — such as pollen, animal dander, and dust mites — can cause some people with atopic dermatitis to break out in a rash. These allergens cause the immune system to overreact, leading to skin inflammation.
Other Eczema Triggers
Irritants can cause inflammation and itching, bringing on eczema. Harsh chemicals can cause a rash in anyone, but people with eczema may be sensitive to mild irritants, such as wool and synthetic fabrics, detergents, soaps, perfumes, and cosmetics. Stress or anxiety can cause a flare-up, too. So can sweating, along with wetting and drying your skin a lot, such as when you wash your hands. Cold, dry environments can also cause a flare.
Your skin’s outer layer protects the inner layers from irritants and infections. People with atopic dermatitis have dry skin that isn’t as protective. If you have eczema, use mild cleansers and a moisturizer after you wash. And don’t take hot showers or baths, or linger too long while showering or bathing.
What Causes Eczema?
Doctors don’t know exactly what causes atopic dermatitis, the most common form of eczema. Genes likely play a role. An immune system problem could create inflammation in the skin. Emotional problems aren’t a cause, but stress can make symptoms worse.
Try Not to Scratch
It’s easier said than done, of course. Eczema is very itchy. But scratching worsens the rash and can make an infection more likely. Use a cold compress to soothe the skin. Try to distract children with activities. Moisturizers are soothing, and some medicated creams or ointments may help, too.
Over-the-counter hydrocortisone may ease mild eczema. Don’t use them for more than 7 days. Sometimes, stronger corticosteroids are needed to control inflammation. Side effects, like thinning skin, infections, and stretch marks, are more likely with long-term use. For severe eczema, your doctor may recommend steroid shots or pills. There’s also a steroid-free prescription ointment.
These medicines may provide relief from the cycle of itching and scratching for some people with atopic dermatitis. They can make you drowsy, so that you fall asleep more easily and hopefully scratch less when you’re asleep. Many over-the-counter and prescription-only options are available, each with slightly different dosing and side effects. Check with your doctor for a recommendation.
Taming the Immune Response
Prescription skin meds that calm an overactive immune system can treat eczema from atopic dermatitis. Doctors generally prescribe them only for short-term use in people who’ve tried other treatments that haven’t helped. They have a “black box” warning due to a higher cancer risk. So ask your doctor about the pros and cons. A biologic medication called Dupixent, given as a shot, also works on the immune system to treat atopic dermatitis.
Alitretinoin, a relative of vitamin A, may improve or even clear up this condition when other treatments don’t work. It can give you headaches or dry, flushing, or sun-sensitive skin. Alitretinoin can cause severe birth defects, so you shouldn’t take it when you’re planning to get pregnant.
UV light affects the immune system. In some people, it can improve moderate to severe cases of eczema from atopic dermatitis or contact dermatitis. Usually, these treatments use UVB light. “PUVA” is a UV treatment combined with a drug called psoralen. But it doesn’t work for everyone, and it makes some people’s eczema worse. Too much UV light is bad for your skin. So you should talk to your doctor about the risks and benefits.
A small amount of household bleach in the bath may help tame inflammation, though recent research shows it may not help prevent infections. Talk to a dermatologist or other doctor first. These baths use a specific amount of bleach, greatly diluted. Never put bleach directly onto skin!
Natural Eczema Treatments
Some research shows that coconut oil, sunflower oil, and vitamin B12 skin creams may help. So can massage and other things that lower your stress level, since stress can make eczema worse. Herbs and supplements can have side effects, so talk to your doctor first.
Eczema and Infections
These can look a lot alike. You’ll want to make sure that it really is eczema, and not an infection. Tell your doctor about symptoms of an infection, such as honey-colored crusts, pus- or fluid-filled blisters, scaly patches, swelling, or a fever.
Caring for Dry Skin
Even when the eczema eases up, your skin may still be dry. Take short daily baths in warm water. Pat your skin partially dry and use a thick moisturizer, as well as any medication, right after your bath. Moisturize throughout the day and stick to mild soaps or cleansers. Look for fragrance-free products to help prevent a reaction. Remember, “unscented” may just mean the product has another ingredient to mask the scent.
Living With Eczema
Those of you with Eczema condition may also need to take a look at their routines to avoid exposure to some chemicals in cleaning products, perfumes, and cosmetics, as well as cigarette smoke.