Eczema and its most common form, atopic dermatitis, are skin complaints which effect a large sector of the American population. As many as 30% of the U.S. population have experienced atopic dermatitis at some point while the National Eczema Association reports 31.6 million adults in the U.S. have some form of eczema. With such prevalence it is important to understand what the condition is, its most common symptoms and the different types there are. It is also important to have a good understanding of the various treatment methods dependent on the severity of the condition.
Most people first discover an itchy or red patch on their neck, inner elbows or behind their knees. It is especially common to find these patches on young children as many children have eczema that settles down as they age. Once you find an itchy or reddened patch, visiting your doctor is usually the next step and here is when you may first hear the word eczema. Most people have heard of the condition before, but prior to seeking their own treatment, most do not understand what it really means, how many different types there are and how it can be effectively treated. Whether you have the condition yourself or your child has been diagnosed with it, the more you educate yourself, the easier it becomes to manage.
What is Eczema?
Every person experiences eczema in different ways although there are some similar symptoms and indicators of the condition. Eczema is the medical term for a quite varied group of conditions which result in the skin becoming red, inflamed and usually very itchy. There are several different types of eczema which we’ll look at in more depth below but the word itself comes from the Greek for “to boil over”. This is a good way of describing the itching and inflamed nature of patches which appear on the skin during a flare up of the condition. It can be a mild condition, but it can develop into a more severe problem and regular treatment is often necessary to keep the symptoms at bay. There is no cure for eczema, but it is very common and can be treated in almost all cases.
Eczema is a very common condition in babies and young children, when it often appears on the cheeks and the skin. As mentioned, many children grow out of the condition before adulthood and live without any flare ups for the rest of their lives. It is also possible, but rare, for adults to develop eczema even if they did not have it in childhood.
What are the most common symptoms of Eczema?
The symptoms each person with eczema experiences differs and so if you don’t experience all these symptoms, you may still have the condition. It can appear on different parts of the body at different times so keeping all of the symptoms in mind is worthwhile in case it manifests in a different way on a different part of the body.
The main symptom of eczema is usually the itchiness which can become overwhelming. The itch may only be mild or slightly irritating or it might become extremely difficult to manage, leading to the “itch-scratch cycle”. The “itch-scratch cycle” is the process which leads to the itching getting so bad people scratch until it bleeds. This process often leads to the eczema becoming even worse and thus causing the cycle which can be hard to get out of.
Below are some of the most common symptoms of eczema which you can look out for:
- Red, inflamed areas of skin
- Dry, sensitive skin
- Dark coloring to the skin
- Rough, scaly or leather-like patches of skin
- Unmanageable itching
- Swollen areas or patches of skin
- Oozing or crusting
As already mentioned, people may experience only one or two or the above symptoms or all of them. In any instance, with any of the above symptoms a visit to the doctor’s office is recommended. Then you can move towards diagnosis and treatment of the issue.
Is Eczema Contagious?
Eczema can look quite alarming and worrying, especially for parents of young children. It is common to worry that it might not be OK to take children to playgroups or send them to school. However, eczema is never contagious. Currently, there is no exact cause known for the condition, but researchers have discovered that people usually develop eczema due to environmental and genetic factors. Often, an irritant will alert or “switch on” the immune system and the skin cells do not react properly, resulting the eczema flare up.
Different Types of Eczema
There are many different conditions which are categorized as eczema. Some are less common than others and all can be treated in a range of ways to ensure the patient can have some relief from the pain, itching and inflammation the condition causes. Of the several different types of eczema the following are the most well-known:
- Atopic dermatitis
- Contact dermatitis
- Nummular eczema
- Dyshidrotic eczema
- Stasis dermatitis
- Seborrheic dermatitis
Although each condition has distinct features it is possible to have more than one at a time. All types of eczema cause the redness and itching which the condition is known for. Some types may also cause blistering of the skin and peeling, but this isn’t always the case. Understanding the type of eczema, you or your child has can help in getting the right treatment and managing the condition. Below we’re looking more closely at each type of eczema and the characteristics which typify it.
Atopic dermatitis is one of the most severe types of the condition. It is chronic and inflammatory and can become very painful. The cause of this type of eczema is not known but it happens when the immune system goes into overdrive in reaction to an allergen or irritant. This can be either inside or outside of the body. Atopic dermatitis usually begins in early childhood, often before a child is even six months old. The condition tends to improve over time but this is not always the case and most people with atopic dermatitis will experience flare ups where the condition gets considerably worse.
Atopic dermatitis is closely linked to allergies. It is part of what is known as the atopic triad alongside hay fever and asthmas. Research shows that people who come with a family with a history of any of these three conditions are more likely to develop atopic dermatitis. The most common symptoms of this condition include:
- Erythema (redness)
- Dry, scaly skin in many different areas of the body
- Cracked skin behind the ears
- Rashes on the cheeks, arms and legs
- Crusted, open and weeping sores
- Constant or regular itching
Contact dermatitis occurs when someone’s skin touches an irritating substance or an allergen. This contact causes the skin to become inflamed, itch and can cause a burning sensation. There are many different kinds of contact dermatitis, but allergic contact dermatitis and irritant contact dermatitis are the most common. The most common irritants include things such as solvents, detergents, industrial chemicals, paint, bleach and acidic foods. This not an exhaustive list and different people react to different irritants too. The burning sensation and subsequent swelling are the most common symptoms of contact dermatitis as well as redness and a rash. Blisters may develop in severe reactions too.
Nummular eczema is also known as nummular dermatitis or discoid eczema. It is a common type of the condition which can develop at any age. People with nummular eczema develop coin-shaped spots on their skin which can be extremely itchy. It is usually triggered by particular incidents such as insect bites, skin inflammation reactions and the dry skin that often develops in the winter.
The main symptoms of nummular eczema are:
- Dry, scaly skin
- Wet, open and crusting sores
- Constant itching
- Round coin-shaped spots of sore skin
Dyshidrotic eczema causes the development of small, itchy blisters. They usually appear on the edges of the fingers, toes, palms and the soles of the feet. As with other forms of eczema there is no definitive known cause. However, common triggers of dyshidrotic eczema include stress, allergies, moist hands and feet, exposure to nickel, especially in metal plated jewelry and exposure to other elements such as cobalt and chromium salts. Dyshidrotic eczema is up to twice as more common in women as it is in men.
The most common symptoms of dyshidrotic eczema are:
- Scaly skin
- Cracked, sore skin
- Small fluid-filled blisters on the edges of the fingers, hands and feet
- Redness and inflammation
Stasis dermatitis is also known as gravitational dermatitis or venous eczema. It happens when there is a problem with the blood flow in the veins and pressure develops in the area. It usually occurs in the lower legs. The pressure that builds up can cause fluid to leak out of the veins and into the skin, which is stasis dermatitis.
The most common symptoms include:
- Swollen ankles
- Scaling and itching of the skin
- Infection of the affected area
- Cracking and large ulcers
Some of these symptoms are more severe than others but all can be treated.
Seborrheic dermatitis is a chronic form of eczema which affects areas of the body where a lot of oil-producing glands are situated. This includes area such as the upper back, nose and most commonly, the scalp. Unlike most other forms of eczema, seborrheic dermatitis is not the result of an allergy.
In infants, seborrheic dermatitis is known as cradle cap and it is often confused with dandruff for people experiencing it the first time. Seborrheic dermatitis is more common in people with particular conditions such as HIV or AIDs and it can affect people with nervous system conditions such as Parkinson’s Disease more frequently than the general population. Seborrheic dermatitis most commonly affects the scalp and it can form in large scales, flakes or greasy reddened patches of the skin.
The most common symptoms of seborrheic dermatitis include:
- Redness of the affected area
- Greasy and swollen skin
- White and yellow crusted flakes
These are the most commonly known and regularly treated forms of eczema. Many people have more than one of these conditions and may seek separate treatment for each specific one.
Treating and Managing Eczema
As mentioned, eczema has no cure. However, all the different types can be treated in a range of ways. Managing your skin on a regular basis can help to avoid flare ups and keep the skin in the best possible condition. Dependent on the age of the person with eczema and the severity of the condition the most common treatments include:
- Over-the-counter remedies
- Prescriptions topical medication
- Biologic drugs
- Natural and complementary therapies
The key to managing eczema effectively is keeping the symptoms as under control as possible. If you can keep the itching under control, then you can avoid the itch-scratch cycle and the condition is much more manageable in general.
The basics of managing eczema include:
- Know your triggers – if particular irritants or allergens cause flare ups, do all you can avoid them
- Implement a structured bathing and moisturizing routine
- Use your over-the-counter or prescription topical creams consistently and exactly as prescribed
- Look out for any changes in symptoms such as signs of infections, changing in the skin or any lumps or bumps that weren’t previously there.
Despite following these rules, you may still find you experience flare ups. Eczema is a very unpredictable condition and there are many unknowns in its causes and triggers. People with the condition can also consider the following to help manage their condition:
- Look more in-depth at triggers: recognizing stressful situations and events can be key to managing flare ups of the condition.
- Find others who know what it’s like – many parent and baby groups and community groups exist where you can discuss your symptoms. You can also access resources from national and local organizations
- Try not to scratch irritated skin. This could sound like both common sense and absolutely impossible if you live with eczema. Scratching the skin exacerbates the condition and can make it even harder to manage
Common Eczema Treatments
Below are the most common eczema treatments looked at in a little more depth:
Over-the-counter treatments are medications which you can buy without a prescription. The most common OTC treatments are used for moisturizing the skin and keeping dry patches at bay, so they don’t become itchy and scratching becomes an urge. Some OTC products can also be used for gently cleansing the skin to stop any risk of infection.
An exact routine when it comes to bathing can help alleviate the symptoms of eczema. Soaking regularly in a warm bath or taking regular showers is key to getting rid of dead skin and once bathing is complete, moisturizing is essential. Certain natural remedies such as vinegar, salt and/or oatmeal to a bath can help manage certain symptoms such as itching and inflammation.
Moisturization is perhaps the most important tool in managing eczema. When the skin gets too dry and itchy, eczema can flare. Wind, cold temperatures and harsh soaps can exacerbate dry skin and make it worse. Similarly, bathing without immediate moisturizing can further irritate the skin and cause more dryness. It is common for people with eczema to have drier skin than the average person, which makes it particularly important to find the right moisturizing treatments. Your doctor and healthcare team should be able to advise which types of moisturizer to use and when.
Prescription topical medications include steroids (corticosteroids), topical calcineurin inhibitors, PDE4 inhibitors and skin barrier creams. Barrier creams can be particularly useful as they help to keep the skin protected against irritants. Available through your doctor, prescription medications are almost always creams or gels which are applied directly to the affected area. Most of them help to ease the redness, dryness and itching.
Phototherapy is usually carried out a clinic or hospital. It involves sitting under a special machine which emits UVB (narrowband ultraviolet B) light onto the skin. It can help to reduce itching and inflammation. It also increases vitamin D production in the skin and helps the skin develop the bacteria-fighting systems it requires.
Biologic drugs specifically focus in on a particular element of the immune system’s reaction which contributes to the symptoms of your eczema. Genetically engineered, these drugs utilize proteins taken from human genes. They are injected directly into the skin and target very specific parts of the immune system, with the aim of limiting inflammation.
Immunosuppressants or systemic medications work to control or suppress the immune system. While we do not yet have the exact information needed to understand the cause of eczema, research does link it closely to the immune system. There is thought that immunosuppressants can help to slow down the symptoms of severe eczema.
Complementary therapies can support and help in the management of eczema. Various studies including ‘Complementary therapies for the treatment of eczema’ show that these kinds of treatment can have a positive impact in reducing symptoms. Some supplements such as plant-based topicals have been found to alleviate and minimize symptoms. Some even argue that dietary changes can help to limit the symptoms of atopic dermatitis, with some doctors recommending cutting out dairy and eggs from the diet.
There are constant developments and regular research into the condition to help develop better, more effective treatments. Recently, researchers have discovered allergy shots can alleviate some of the symptoms of the most severe eczema. This is just one of many discoveries helping to revolutionize treatment and attempt to find an effective cure for the condition.
Managing Eczema and Flare Ups
As we have discussed throughout this article, controlling the symptoms of eczema is key to managing the condition. If you can keep the symptoms at bay and minimize scratching, it is possible to live comfortably without too much impact of the condition on your day to day life. Flare ups can and do occur without warning but with the right topical medications, patients can react proactively to any flare ups, switching to a higher strength corticosteroid cream for example.
The flare ups associated with eczema can be distressing and hard to manage, especially if you have had your condition under control and it seems to come from nowhere. Not realizing when you are over-exerting yourself or allowing too much stress into your life can be key reasons that eczema flare ups occur when you don’t expect it. Similarly, product ranges you regularly use may change or update their ingredients, which makes it important to be aware of what products such as detergents and washing powders, you come into contract with on a regular basis. It can seem exhausting to need to remember all these things, but it is worth it to avoid regular flare ups and the unwanted pain and discomfort of constant itching.
Finding the Right Approach to your Eczema
Every individual’s symptoms will present themselves in their own way. This means while you can share your story with others who live with the condition, your experience will be different. Your specific bathing and moisturizing routine will differ from the next person’s and the most effective treatment methods for your condition may not be the same as the next person’s. Most people living with eczema are able to manage it effectively without much intervention from medical professionals. While prescription medications may be necessary, only occasional check-ups are needed to ensure the condition is well-managed and no changes in treatment are required.
Key to managing eczema is educating yourself on the issue. This is especially true for new parents who may or may not have experienced the condition before and want to ensure their children are in as little pain and discomfort as possible. The more you know, the better you can approach managing the disease and finding the right solutions for your particular circumstances.