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Eczema (Atopic Dermatitis)
Eczema (atopic dermatitis) is an intensely itchy rash that appears as dry skin, unable to shield itself from irritants (poor skin barrier function). The intense itching is made worse by scratching. The condition runs in families and often occurs along with asthma and hay fever. There is no cure for eczema, and it is not contagious.
- Eczema is a condition primarily affecting people who have allergies.
- Heat, humidity, detergents/soaps, abrasive clothing (eg, very scratchy wools), chemicals, smoke, and stress may trigger eczema.
- Scratching increases the chances of developing an infection in the affected areas (superimposed infection) because scratching creates breaks in the skin that can allow bacteria to get in.
Who's At Risk?
Infants and children are most frequently affected by eczema, but this condition may continue into adulthood. In the US, 7–17% of children are affected, and a small number continue to have symptoms as adults.
Signs & Symptoms
The most common locations for eczema are:
- Front of the elbows
- Behind the knees
- Arms and legs (extremities)
Thickened, scaly, pink-to-red elevated areas (papules) and sheets of skin (plaques) are seen in these areas. The condition may be rated as:
- Mild – few, scattered areas that are easily treated with self-care measures
- Moderate – more extensive areas that are more difficult to control with self-care measures and may require prescription therapy
- Severe – widespread (diffuse) affected areas that are difficult to treat even with prescription therapy
Children with eczema may have prominent affected areas on the arms and legs (extremities), particularly in front of the elbows and behind the knees.
Areas with infection in the affected areas (superimposed infection) can develop thick crusts.
Dark-skinned individuals with eczema often have extensive accentuation of the hair follicles and shiny skin without obvious thickened, raised areas.
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Maintaining adequate moisture in the skin is very important.
Self-care measures include the following:
- Use non-soap cleansers such as Cetaphil®, or moisturizing soaps such as Dove®.
- Apply thick moisturizers such as petroleum jelly (Vaseline®), Aquaphor® ointment, Eucerin® cream, CeraVe® cream, and Cetaphil cream to damp skin after daily bathing.
- Try to reduce exposure to heat, humidity, detergents/soaps, abrasive clothing, chemicals, smoke, and stress.
- Use fragrance-free laundry detergent.
- Keep your home air from getting too dry by using a humidifier or by setting out bowls of water, especially in the bedroom.
- Treat areas with redness and itching with over-the-counter hydrocortisone cream or ointment, 0.5–1%, twice daily. Avoid using steroid cream on the eyelid area for more than a few days, as it may increase the risk for cataract formation.
- Apply lotions containing menthol or phenol (such as Sarna® lotion) for itching.
Topical or oral (systemic) medications can include:
- Topical steroid creams or ointments to treat areas of limited (localized) eczema. Use lower-strength steroids on the face and medium-to-high-strength steroids on the trunk and on the arms and legs.
- Be careful when using topical steroids in skin folds and blocked (occluded) areas because of the risk of thinning of the skin (atrophy).
- Medications that allow you to reduce steroid exposure (steroid-sparing agents), such as topical tacrolimus or pimecrolimus, may be used for milder disease or for treating sensitive areas, such as the face. These medications are not approved for use with children under the age of 2. These medications have a warning that their use may have a small risk of causing cancer.
- Oral antihistamines to reduce itching.
- For more extensive disease, light therapy may be recommended. People whose condition does not improve with other treatments may take oral medications (such as cyclosporine and tacrolimus) to hold back (suppress) the immune system, preventing allergic reactions.
- If an infection in the affected area (superimposed infection) may be present, topical or oral antibiotics may be prescribed.
- In patients who have multiple areas of broken skin or a history of bacterial skin infections, dilute bleach baths may be prescribed.
See your child’s doctor for evaluation if you see no improvement with self-care measures or the eczema gets worse.
Also see the doctor if you see areas of pus or large numbers of crusty areas (scabs), as this might be caused by infection with bacteria.
Bolognia, Jean L., ed. Dermatology, pp.1999-2414. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick’s Dermatology in General Medicine. 6th ed, pp.1180, 1188-1189. New York: McGraw-Hill, 2003.