Eczema (atopic dermatitis)

Eczema, also known as atopic dermatitis, is a chronic skin problem that causes dry, itchy, scaly, red skin on various areas of the body.

It is sometimes accompanied by a secondary bacterial infection, darkening of the skin around the eyes and/or an extra fold of skin under the eye. In more severe cases, blisters and fissures may develop, and the skin may become thicker from repeated scratching.

Eczema usually begins during childhood, often improves with age, and appears to have a genetic component.

Causes and triggers

In most cases, eczema is caused by an abnormality in the skin's protective barrier. As a result, the skin becomes dehydrated more easily, and lacks adequate protection from allergens, microbes and irritants, causing itching. As for the visible skin lesions, they are a direct result of itching.

Individuals with eczema are often genetically predisposed to the condition and tend to suffer from atopy, a syndrome that causes allergies (food and/or environmental), asthma and chronic conjunctivitis, among other things. However, contrary to popular belief, eczema flares in children are rarely associated with food allergies.

Certain factors may trigger eczema flares, including:

  • Cold or dry air
  • Sweating
  • Stress or anxiety
  • Rapid temperature changes
  • Exposure to certain chemical products (soap, detergents, perfumes, etc.)
  • Wearing garments made of wool or synthetic fibers such as polyester
  • Allergens

Treatment

Since eczema is a chronic condition, symptoms may worsen then improve periodically. While some people can go years without having any symptoms, eczema is not curable. To decrease the itch intensity and prevent new flares, it is important to keep the skin hydrated. Here are a few tips:

  • Avoid triggers.
  • Keep fingernails short and clean and wear cotton gloves as needed to prevent scratching and secondary infections.
  • To relieve itching, take short, lukewarm baths and use mild soap (e.g., Cetaphil) sparingly.
    • Bath products (oils and others) have not been found to relieve symptoms.
    • Long or hot baths should be avoided since they tend to dry out the skin.
    • Bath salts should also be avoided.
  • Apply a thick moisturizing cream (e.g., Eucerin) or ointment (e.g., Vaseline) liberally over the entire body at least twice daily, ideally immediately after bathing.
  • Apply a steroid cream (e.g., hydrocortisone 1%) on irritated skin or take oral antihistamines (e.g., Benadryl).
    • It should be noted that certain steroid creams and oral antihistamines are sold over-the-counter, while others must be prescribed by a medical professional.
  • Apply a dampened cotton dressing (e.g., gauze) to the affected area for a few days and change to a fresh dressing every eight hours.

Babies who have a parent, brother, or sister with eczema have a higher risk of developing eczema. Applying moisturizing creams or ointments (see above) on the baby's skin daily from the first week of life may prevent eczema during the child's first year. However, it is uncertain whether this is effective at preventing eczema later in life.

When should I see a medical professional?

  • If the condition does not improve with treatment.
  • If the face or skin folds are affected.
  • If you believe another condition may be responsible for the symptoms.

For more information:

Canadian Dermatology Association
www.dermatology.ca

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