About the Treatment
Eczema is the name for a group of conditions that cause the skin to become red, itchy, and inflamed. It’s common — over 30 million Americans have some form of eczema — but it’s not well understood. For those with eczema, it’s an itchy, red, dry irritation that can come and go for life.
What is eczema?
Typically, eczema causes a person’s skin to become itchy, red, and red. In extreme outbreaks, the skin can become leathery and develop cracks. Eczema is common in infants, but it usually resolves before adulthood. For adults with eczema, it can be a chronic condition that can appear on any part of the body. There are a number of different forms, with atopic dermatitis being the most common.
Atopic dermatitis is the most common form of eczema, so its symptoms are also the most common. These symptoms vary widely between patients:
- Dry skin
- Itching, which can be severe
- Red to brownish-grey patches that occur on the hands, feet, ankles, wrists, neck, upper chest,
- eyelids, inside the bend of the elbows and knees, and on the face and scalp of infants
- Thickened, cracked, scaly skin
- Raw, sensitive, swollen skin, usually from scratching
- Possibly blistering or sore formation on dry patches
What causes eczema?
Normal, healthy skin works to retain moisture. This provides protection from bacteria, irritants, and allergens. It is thought that eczema develops due to a gene variation that affects the skin’s ability to retain moisture and then loses the corresponding protection from the moisture. This allows the skin to be affected by environmental factors, irritants, and allergens. Further proof of the possibility of a genetic link is that eczema seems to fun in families.
Beyond the genetic possibilities, some scientists believe those with eczema have a skin defect that allows moisture to leave through the skin, opening the door for germs to make their way in. An overactive immune system, similar to how the body reacts when a person has an allergy, is thought to also play a role in eczema.
Regardless of how the process occurs, when an irritant or an allergen causes the immune system to react, this produces the skin inflammation common to all forms of eczema.
These are some potential triggers of an eczema breakout:
- Contact with irritating substances such as wool, synthetic fabrics, and soaps
- Heat and sweat
- Cold, dry climates
- Dry skin
How To Treat Eczema
After checking your skin, discussing your symptoms, your health history, and your family history of eczema or allergies, Dr. Shah will be able to tell if it’s eczema. From there, treatment options may depend on the severity of your inflammation, and what type of eczema you have.
Changing your skin care regimen is a start. It’s important to use mild soaps that don’t dry your skin. Moisturizing your skin is also important. Avoiding hot showers or hot baths is a good idea, as they can dry out your skin. Using a humidifier in the dry winter months is helpful. Limiting stress is key.
Different Types of Eczema
There are several different types of eczema. Unfortunate patients may have more than one type at a time. Here are the main types of eczema with a description of their characteristics.
- Atopic Dermatitis – The most common form of eczema, atopic dermatitis is chronic and inflammatory. Atopic dermatitis is related to asthma and hay fever, but it is not an allergy. Still, the immune system overreacting to irritants, whether inside or outside the body, is behind the chronic flare-ups. The symptoms listed above are for atopic dermatitis.
- Contact Dermatitis – When a person with contact dermatitis touches irritating substances or allergens, his or her skin becomes inflamed, causing it to burn, itch, and become red. Irritant contact dermatitis and allergic contact dermatitis are the most common forms. Symptoms include redness and rash, burning or swelling, and blisters that may weep or crust over. These occur on the area where contact was made. Irritants may include these items: solvents, chemicals, detergents, paints, bleach, wool, soaps and fragrances, tobacco smoke, and allergens such as pollen.
- Dyshidrotic Eczema – This form of eczema produces small, itchy blisters on the edges of the fingers, toes, palms, and soles of the feet. Twice as prevalent in women as men, dyshidrotic eczema may be triggered by stress, allergies, moist hands and feet, or exposure to nickel in jewelry, cobalt in metal objects and some paints, or chromium salts in cement, leather, paint, and other products.
- Neurodermatitis – This form of eczema starts with an itchy patch of skin. These occur in commonly scratched areas, and scratching then makes the areas more irritated and itchy. This itch-scratch cycle causes the affected skin to become thick and leathery. Neurodermatitis occurs in areas that can be reached and scratched: the head, neck, wrists, forearms, ankles, vulva, scrotum, and anus. Treatment success depends on the patient being able to resist the urge to rub or itch the affected areas, but this can be difficult as the itching can be intense.
- Nummular Dermatitis – This form of eczema looks much different than other more common forms. Patients with nummular dermatitis develop coin-shaped spots on their skin. These spots can be very itchy and difficult to treat. It is thought that nummular dermatitis can be triggered by insect bites, reactions to skin inflammation, or dry skin in the winter.
- Seborrheic Dermatitis – Another chronic form of eczema, seborrheic dermatitis appears on areas of the body where there are a lot of oil-producing sebaceous glands, such as the upper back, scalp, and the nose. This form of eczema is common in infants and is known colloquially as “cradle cap.” In adults, it also commonly appears on the scalp. Symptoms may range from dry flakes (dandruff) to yellow, greasy scales with reddened skin. It’s thought that hormones play a role in this form of eczema.
- Stasis Dermatitis – Also known as venous eczema, this occurs when the patient has a problem with blood flow in the veins and pressure develops. This pressure can cause fluid to leak out of the veins and into the skin, resulting in stasis dermatitis. This usually occurs in the lower legs. Symptoms include swelling around the ankles, redness, scaling, itching, and pain.
If your eczema is more severe and stubborn, the above probably won’t be enough. Dr. Shah will likely prescribe these any of these possible medications:
- Hydrocortisone — These creams or ointments calm the skin inflammation.
- Antihistamines — These help calm your immune reaction.
- Corticosteroids — These anti-inflammatory drugs target serious outbreaks.
- Immune system drugs — There are a number of drugs, and prescription creams and ointments that control the inflammation and reduce immune system reactions.
- Injectables — Dupilumab (brand name Dupixent) is an injectable medicine for severe atopic dermatitis. Typically given every two weeks as an injection, it controls the body’s inflammatory respond.
- Prescription-strength moisturizers — These support the skin’s barrier against irritants and allergens.
- Ultraviolet light therapy — This can help to calm the inflammation on the skin.
Intense pulsed light — These short duration pulses of wavelengths of high-intensity light can also calm inflammation.