The exact cause of eczema is unknown. It seems to be a combination of dry, irritable skin, an abnormal immune response, and an impaired skin barrier. It is genetic and often associated with certain changes in the skin genome.
Factors That Worsen EczemaStaphylococcus aureus bacteria is usually on the skin of people with eczema. Scratching can break the skin's barrier to infection. The wounds ooze liquid, making eczema worse and provoking infection. This is particularly common in children. Other factors which can worsen eczema include:
- Dry skin
- Long, hot baths and showers
- Low humidity
- Rapid changes in temperature
- Soaps, detergents, various cleaners
- Wool and synthetic fabrics or clothing
- Cigarette smoke
- Severe air pollution
Signs And Symptoms
- Patchy areas of red to brownish-gray discoloration of the skin
- Itching, which can be severe and interrupt sleep
- Small, raised bumps, which may leak fluid and crust over when scratched
- Thickened, cracked or scaly skin
- Raw, sensitive skin
Patches of eczema can occur anywhere, but are most often on the hands and feet, ankles and behind the knees, the front at the bend of the elbow, wrists, face, neck and upper chest. It can affect the skin around the eye and the eyelids. Scratching around the eyes can cause redness and swelling. Here's some more information about the different types of eczema
ComplicationsComplications of eczema include:
- Neurodermatitis. Prolonged scratching causes more itching which causes more and more intense scratching, which causes more and more intense itching. It can lead to neurodermatitis, also called lichen simplex chronicus. The areas become thick and leathery. They can be raw, red, brown, or just darker than the surrounding skin. The areas can be permanently scarred and/or discolored.
- Skin infections. Scratching can break the skin, causing open sores and fissures that can become infected with bacteria usually present on the skin.
- Eye complications. As described above, including inflammation of the eyelid, called blepharitis, and the lining of the eyelid, cause conjunctivitis. See your doctor if this occurs.
PreventionAvoiding dry skin can help to prevent recurrent episodes of more severe dermatitis. Bathing can be very drying. These tips can be helpful:
- Bathe less frequently. Try going a day or two without a shower or bath. Use warm or tepid, not hot, water. A bath oil may help. Limit it to 10-15 minutes.
- Use mild soaps which don't excessively remove natural oils. Antibacterial and deodorant soaps are especially drying. Try using soap only on the face, genitals, underarms, hands and feet. Use clear water on other areas.
- Dry your skin carefully and thoroughly, patting gently.
- Moisturize your skin. Moisturizers can create a barrier over your skin, helping to retain moisture. Thick moisturizers work well, such as Eucerin, Cetaphil, and Vanicream. Cosmetics containing moisturizers may be helpful. Avoid potentially harmful chemicals. An oil, such as baby oil, applied after bathing helps retain moisture and lasts longer on the skin than water-based products.
- Look into using an all-natural body moisturizer with clean ingredients.
TreatmentsTreatment for eczema is directed at reducing inflammation, relieving itching and preventing future flare-ups. Over-the-counter anti-itch creams and other self-care methods can help control mild eczema. Although eczema is associated with allergies, eliminating allergens rarely helps. It's virtually impossible to eliminate all dust and allergens. Feather pillows and mattresses, down comforters, carpets and curtains are traps for dust and allergens which cannot be entirely eliminated and can make eczema worse. Allergy desensitization shots don't usually improve eczema. Medications may be of benefit:
- Corticosteroid creams or ointments: These may be prescribed in moderate to high-potency concentrations, to relieve itching and ease scaling. Low-potency corticosteroid creams or ointments are available without a prescription, but talk to your doctor before you use any corticosteroid products. There may be long-term effects such as skin irritation or discoloration, thinning of the skin, infections and stretch marks.
- Antibiotics: These may be needed if breaks in the skin allow bacteria to infect the wound. Sometimes antibiotics are used to lower the number of bacteria usually present on skin, in order to reduce the risk of infection.
- Oral antihistamines: may be useful when itching is severe. Diphenhydramine (Benadryl and others) can cause drowsiness and may be helpful at bedtime.
- Oral or injected corticosteroids: These may may be used sparingly in severe cases, such as prednisone or injected corticosteroids to reduce inflammation and relieve itching. The medications are very effective but cannot be used long-term because of the side effects which can be serious, such as cataracts, loss of bone strength (osteoporosis), muscle weakening, decreased resistance to infection, and high blood pressure and thinning of the skin.
- Immunomodulators: Immunomodulators are a class of medications, such as tacrolimus (Protopic) and pimecrolimus (Elidel) with effects on the immune system that help to maintain normal skin texture and reduce flare-ups. They are prescription drugs that are approved for people older than two years.
- Light Therapy (phototherapy) uses natural and artificial light. Natural sunlight, artificial ultraviolet A (UVA) or ultraviolate B (UVB) light therapy are effective, but there are long-term harmful effects, such as premature aging of the skin and an increased risk of skin cancer. Consult your doctor before using light treatment.
Lifestyle And Home Remedies
- Use anti-itch cream such as over-the-counter hydrocortisone creams.
- Identify and avoid triggers.
- Avoid scratching, keep nails trimmed and wear gloves to bed.
- Avoid potentially irritating substances found in cosmetic products.
- Apply cool, wet compresses to areas of intense itching.
- Take a warm bath. Sprinkle the water with baking soda, uncooked oatmeal or colloidal oatmeal, which is a finely ground oatmeal used for baths (Aveeno and others).
- Use mild soaps without artificial dyes or fragrances. Take care to rinse off all the soap. Moisturize your skin by applying a natural ointment after a bath when skin is still moist.
- Use a humidifier. Keep it clean to prevent the growth of bacteria and fungi.
- Wear smooth-textured cotton clothing. Rough, scratchy fabric and wool cause skin irritation.
Claims have been made that chamomile, evening-primrose oil, witch hazel extract, hemp products, and borage-seed oil may be of benefit as eczema treatments, but there is no evidence that these alternative methods are effective. Consult with your doctor about these and any other alternative substances or dietary supplements before you use them.
Your Questions About Eczema Answered
Can I infect other people with eczema? No, because eczema is not an infection.
My face is oily but my eczema is dry. What's going on? It is not uncommon for a person with eczema to have other types of skin problems. Your doctor can help you with managing multiple skin problems.
What can I do to cure this for good? Eczema is not curable. Be careful about taking good care of your skin and following your doctor's instructions to minimize active disease.
There's yellow, crusty stuff on some of my patches of eczema. What is it? When vigorous scratching causes breaks in the skin, bacteria can set up an infection. You may need antibiotics. Gentle cleansing of the area along with moisturizer can be helpful if this persists, consult a physician for treatment.
Can people "grow out of" eczema? Eczema present in childhood may improve with age, but there is still risk of flare-ups.
What soap should I use? A mild soap should be used, either as bars or liquid. Purpose, Dove, and Aveeno are nonirritating. Avoid deodorant and antibacterial soaps, or products with artificial colors and fragrances.
I'm diabetic. Does that make eczema worse? No, but people with diabetes must be very careful about not breaking the skin, which increases the risk of infection. Any sign of infection should be seen by a physician.
Does my eczema mean I have allergies? Allergies and hay fever can be associated with eczema. Be aware of, and avoid, foods and substances that irritate your skin or cause other symptoms.
Does having eczema put me at higher risk for skin cancer? No association between eczema and skin cancer has been identified.
Article Written By Sheila M. Krishna M.D., FAAD
Dr. Krishna is a board-certified dermatologist. She received her undergraduate degree at the Massachusetts Institute of Technology where she double majored in biology and foreign languages and graduated with Phi Beta Kappa honors. She is fluent in both English and Spanish. Dr. Krishna received her medical degree at the David Geffen School of Medicine at the University of California, Los Angeles, where she was a member of the Alpha Omega Alpha Medical Honor Society. She completed her dermatology residency at the Virginia Commonwealth University in Richmond, Virginia, and she served as Chief Resident in the Department of Dermatology. She completed an additional research year at UCLA with Dr. Lloyd Miller, where she gained expertise in research methods and protocol design and execution. Dr. Krishna is a Fellow of both the American Academy of Dermatology (AAD) and the American Society for Mohs Surgery (ASMS). Dr. Krishna practices in San Diego, California where she treats adults and children for skin conditions. Dr. Krishna was selected as a Top Doctor by her peers in San Diego in 2017. Website - https://www.sheilakrishnamd.com/
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2) Mayo Clinic