Eczema (atopic dermatitis): triggers, skin care and treatment

Eczema is a very common cause of itchy skin, especially in children. It tends to come and go, and most people can keep it under control with a steady skin-care routine and, when needed, medical treatment. This article explains the condition using information from the NHS and MedlinePlus.

1. Introduction

Eczema, also called dermatitis, is a term for several types of skin swelling, also called inflammation ^[2]. The most common type is atopic eczema, also called atopic dermatitis. The NHS says it is a common condition that causes itchy skin, most often in young children, though it can affect all ages ^[1]. MedlinePlus, a health information service of the US National Institutes of Health, notes that it is often long lasting and may improve or worsen over time ^[2]. Eczema is not contagious ^{[1, 2]}.

2. Signs and symptoms

The main symptom is itchy skin. The NHS describes skin that may be dry, cracked, scaly, crusty or thickened, and sometimes blistered or bleeding. The colour change depends on skin tone and can look red, purple, grey, white or lighter or darker than the skin around it ^[1].

Common areas include the elbows, knees and hands. In babies and toddlers, the face is often affected ^[1]. MedlinePlus notes that in older children and adults it is more often found on the inner elbows, behind the knees, on the neck, hands and feet, and in some adults it affects only the hands or eyelids ^[3]. Itching can begin before the rash appears, and scratching makes the skin redder, more swollen and itchier ^{[2, 3]}.

Symptoms often start in babies and young children, and many people improve as they grow older. MedlinePlus says many people outgrow it by early adulthood, although flare-ups are common and in adults it is usually long term or recurring ^{[1, 3]}. Periods when the skin is worse are called flare-ups.

3. Causes and triggers

The exact cause is not known. MedlinePlus says it is likely to be a mix of genetic and environmental factors ^[2]. People with atopic eczema often have a family history of eczema, asthma or hay fever ^{[1, 3]}. The encyclopedia entry explains that affected people may lack certain skin proteins that help skin hold water, which makes it dry and sensitive ^[3].

Triggers vary from person to person. Sources list ^{[1, 3]}:

• Soaps, detergents, perfumes and dyes in lotions
• Rough fabrics such as wool
• Dust mites, pollen, pets and mould
• Heat, cold, dry weather and sudden temperature changes
• Colds, flu and skin infections
• Stress and, in some women, hormone changes such as pregnancy

4. Diagnosis

Doctors usually diagnose eczema from how the skin looks and from your personal and family history ^[3]. MedlinePlus says a skin sample (biopsy) may be needed to rule out other causes of itchy skin, allergy skin tests may help in hard-to-manage cases, and skin swabs may be taken because people with eczema are more prone to infection ^[3].

5. Self-care and daily skin care

Daily skin care can reduce the need for medicine ^[3]. The NHS and MedlinePlus suggest ^{[1, 3]}:

1. Apply an emollient, which is a moisturiser, at least twice a day and keep using it even when the skin looks better.
2. Use an emollient instead of soap for washing, and take short, cool baths with gentle cleansers.
3. Pat on moisturiser while the skin is still damp.
4. Avoid known triggers.
5. Keep nails short and, for babies, consider anti-scratch mittens.
6. Keep cool, because heat can increase itching.

Safety points from the NHS: do not share emollients, use a spoon or pump instead of dipping fingers into a tub, and avoid smoking or naked flames when your clothes or bedding have emollient on them, because they can catch fire more easily ^[1]. The NHS also advises not changing your diet unless a doctor recommends it ^[1], and MedlinePlus says certain foods in very young children should be discussed with a provider first ^[3].

6. Treatment options

For mild eczema a pharmacist can advise ^[1]. If you need more, a doctor may prescribe treatments from these groups ^{[1, 3]}:

• Emollients, as creams, ointments or washes
• Topical corticosteroids, which are steroid creams or ointments put on the skin, starting with a mild one
• Other skin treatments that calm the immune system, in older children and adults
• Antihistamine tablets, which may ease itching for some people
• Light therapy, or stronger medicines for severe eczema, under specialist care

Your doctor decides the right product, strength and length of use. Using steroid or other medicines exactly as advised and telling your doctor about everything you use helps avoid side effects.

7. Infection and special groups

Eczema skin is more likely to become infected. The NHS warns that blistering, crusting, weeping fluid, pus-filled spots, pain, swelling, warmth, fever or feeling unwell can signal infection or a more serious condition called eczema herpeticum, and advises an urgent appointment or urgent medical advice ^[1].

For babies, MedlinePlus says breastfeeding until about 4 months may lower the risk of eczema ^[3]. In children, eczema often eases around ages 5 to 6 ^[3].

8. When to see a doctor

The NHS advises seeing a doctor if you or your child have symptoms of eczema, or if treatments are not helping ^[1]. Get an urgent appointment, or urgent medical advice, if the eczema ^[1]:

• is blistered, crusty, leaking fluid or has pus-filled spots
• is painful, swollen or warm
• suddenly gets worse or spreads
• comes with a high temperature or feeling generally unwell

MedlinePlus also suggests seeing a provider if symptoms worsen or signs of infection appear ^[3].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

Eczema is a common, non-contagious skin condition that is often long term and goes through flare-ups. A routine of regular moisturising, avoiding triggers and getting medical advice early can keep symptoms under control, and urgent help is needed if infection is suspected. Your doctor decides which treatments suit you or your child.