Dermatitis & Eczema

Overview

Eczema (or dermatitis) is very common condition that affects millions of people of all ages. In mild cases of eczema, the skin is dry, scaly, red and itchy. In more severe cases there may be weeping, crusting and bleeding. Constant scratching causes the skin to split and bleed and also leaves it open to infection.

0% children under 18

0% all people in the US

If you have eczema, your skin may not produce as much fats and oils as other people’s, and will be less able to retain water. The protective barrier is therefore not as good as it should be. Everyday substances like soap or hand sanitizer contribute to breaking down the skin. Skin with eczema is more liable to become red and inflamed on contact with substances that are known to irritate or cause an allergic reaction.

Types

Asteatotic Eczema
Also known as “eczema cracquelée”, Asteatotic eczema almost always affects people over the age of 60.
The cause is not known but asteatotic eczema can be linked to a decrease in the oils on the skin surface, low humidity, over cleansing of the skin, hot baths, scrubbing the skin and vigourous towel drying. Pre-existing dryness and roughness of the skin are also linked to this type of eczema.
Asteatotic eczema initially appears on the shins with a ‘crazy paving’ appearance. Fissures or grooves can appear which look pink and red, but tend to only affect the superficial layers of the skin. Other areas that can be affected are upper arms, thighs and lower back but it is usually linked to the legs. It can cause a great deal of discomfort including soreness and itching.
Atopic Eczema
Atopic eczema is a dry skin condition that may become red and sore – called a ‘flare-up’. The skin may then calm down for a time, but tends to be dry and itchy. Itch is the chief characteristic of atopic eczema and can be almost unbearable, making you want to scratch constantly, especially at night, which interrupts sleep. Atopic eczema can be present in large or small patches in any body area, usually starting on the face in babies and often affecting the skin creases, neck, back of the knees, inside of the elbows and the wrists.
Contact Dermatitis
Contact eczema, or contact dermatitis as it is more commonly referred to, is the name given to those types of eczema that occur as a result of contact with irritants or allergens in the environment.
Allergic
Allergic contact dermatitis is much less common than irritant contact dermatitis. Minute quantities of apparently harmless substances may cause severe allergic contact dermatitis. For allergy to develop, repeated exposure to the chemical is required over a period of time, usually months or years.
The reaction can be immediate or delayed depending on the type of allergen in question. Most frequently seen on the hands, allergic contact dermatitis can cause the skin to become dry, red, split, cracked, weeping, fluid filled and intensely itchy, sore, painful and stinging. The severity will depend upon the allergen and the length of time it is in contact with the skin.
Irritant
Irritant contact dermatitis is a reaction to frequent contact with everyday things which irritate the skin, such as soap, detergents, hair cosmetics, bleach, cold wind and raw food.
Common sites for irritant contact dermatitis are the hands and face, but the condition can affect other parts of the body. A person who had atopic eczema as a child is at an increased risk of developing irritant contact dermatitis.
Discoid Eczema
It is very distinct with ‘coin shaped’ discs of eczema the size of a fifty pence piece that start off slightly bumpy, usually on the lower legs, trunk or forearms. Within a few days the patches begin to ooze, and can become very itchy, crusted and infected.
Later on, the surface becomes scaly and the centre of the discs clear, leaving the skin dry and flaky. Like most types of eczema the exact cause is not clear, although dry skin is perhaps the most common feature seen in people with this condition. Other factors include the use of soaps and detergents, and previous experience of atopic eczema.
Dyshidrotic Eczema/Pomphylox
Dyshidrotic eczema is a type of eczema that is usually restricted to the hands and feet. In most cases, pompholyx involves the development of intensely itchy watery blisters, mostly affecting the sides of the fingers, the palms of the hands and the soles of feet. This condition can occur at any age but is most common before the age of 40 years.
The skin is initially very itchy with a burning sensation of heat and prickling in the palms and/or soles. This is followed by a sudden crop of small blisters, which turn into bigger weepy blisters and can become infected, causing redness, pain, swelling and pustules. There is often subsequent peeling as the skin dries out, and then the skin can become red and dry with painful cracks. Pompholyx eczema can also affect the nail folds and skin around the nails causing swelling.
Neurodermatitis
Neurodermatitis is a skin condition that starts with an itchy patch of skin. Scratching makes it even itchier. This itch-scratch cycle causes the affected skin to become thick and leathery.
Breaking the itch-scratch cycle of neurodermatitis is challenging, and neurodermatitis is usually a lifelong condition. Treatment success depends on resisting the urge to rub or scratch the affected areas. Over-the-counter or prescription medications may help ease the itching. You'll also need to identify and eliminate factors that may be aggravating the problem.

Treatment

Eczema is a chronic condition; it typically improves and then flares (gets worse) periodically. Some people have no symptoms for several years. Eczema is not curable, although it is possible to control your symptoms with a variety of self-care measures and medications.

Skin Care

Emollients
Emollients are creams and ointments that moisturize the skin and prevent it from drying out. The best emollients for people with eczema are thick creams (such as Eucerin, Cetaphil, and Nutraderm) or ointments (such as petroleum jelly, Aquaphor, and Vaseline), which contain little to no water. Emollients are most effective when applied immediately after bathing. Emollients can be applied twice a day or more often if needed. Lotions contain more water than creams and ointments and are less effective for moisturizing the skin.
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Bathing
It is not clear if showers or baths are better for keeping the skin hydrated. Lukewarm baths or showers can hydrate and cool the skin, temporarily relieving itching from eczema. An unscented, mild soap or non-soap cleanser should be used sparingly. Apply an emollient immediately after bathing or showering to prevent your skin from drying out as a result of water evaporation. Emollient bath additives (products you add to the bath water) have not been found to help relieve symptoms.
In some cases, health care providers may recommend dilute bleach baths for people with eczema. These baths help to decrease the number of bacteria on the skin that can cause infections or worsen symptoms. To prepare a bleach bath, one-fourth to one-half cup of bleach is placed in a full bathtub (about 40 gallons) of water. Bleach baths are usually taken for 5 to 10 minutes twice per week and should be followed by application of an emollient.
smoking
Triggers
Eliminating factors that aggravate your eczema symptoms can help to control the symptoms. Possible triggers may include:
Cold or dry environments
Emotional stress of anxiety
Rapid temperature changes
Sweating
Avoid exposure to certain chemicals and/or cleaning solutions, including soaps and detergents, perfumes and cosmetics, wool or synthetic fibers, dust, sand, and cigarette smoke

Medications

Topical steroids
Steroid creams or ointments are usually applied to the skin once or twice per day. These help to reduce symptoms and moisturize your skin. As the skin improves, you can switch to a non-medicated emollient. Strong topical steroids may be needed to control severe flares of eczema; however, these should be used for only short periods of time to prevent thinning of the skin that can result from long-term use.
Topical immunomodulaters
Topical immunomodulators are a fairly recent development in the treatment of atopic eczema. The term immunomodulator refers to a drug that is able to modulate or alter the immune system in some way. This helps to reduce inflammation and redness.
They are not steroids and therefore do not have the concerns about potential skin thinning associated with inappropriate use or overuse of topical corticosteroid treatments.
Oral antihistamines
Oral antihistamines sometimes help relieve the itching of eczema. The over-the-counter antihistamine diphenhydramine (Benadryl) and prescription antihistamines, such as hydroxyzine (Vistaril, Atarax) and cyproheptadine, are most effective for itching caused by eczema, although these drugs can cause drowsiness.
The nonsedating antihistamines such as cetirizine (Zyrtec) and loratadine (Alavert, Claritin) may relieve itching; both are available without a prescription and cause less drowsiness.
Oral steroids
Oral steroids (prednisone) or injected steroids (triamcinolone) occasionally are used for a short period of time to treat a severe flare of eczema, although this treatment is not usually recommended on a regular basis or for prolonged periods of time because of potential side effects.
Oral antibiotics
Antibiotics are often used to treat bacterial infections, open sores, or cracking in the skin caused by frequent scratching. A skin care professional can prescribe antibiotics for a length of time based on the condition of your skin issue and your specific needs. Taking the required antibiotics for the recommended time will continue to prevent infections from reoccurring.
Immunosuppressives
Drugs that weaken the immune system may be recommended for people with severe eczema who do not improve with other treatments. However, treatment with these drugs can cause serious side effects, including an increased risk for infection. They are not recommended for use in infants or young children.
Biologics
The injectable biologic medication dupilumab (Dupixent) may be beneficial for treating eczema. Due to its high cost and potential side effects, this drug is reserved for adults with moderate to severe eczema that has not responded to other treatments.
Phototherapy
Ultraviolet light therapy (also called phototherapy) can effectively control eczema. However, this therapy is expensive and may increase your risk of skin cancer, and is therefore recommended only for people with severe eczema whose symptoms do not respond to other treatments.