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Eczema:  How to Find Relief

By Phoebe E. Rabbin, MD, FAAD

Eczema is a term that refers to a group of skin conditions characterized by an itchy, red and scaly rash on the body. In general, it is used to refer to atopic dermatitis, one of the most common skin disorders in the world. According to the American Academy of Dermatology, up to 20% of children and 3% of adults will have this condition.

Symptoms

The primary symptom of atopic dermatitis is itching, and this is accompanied by an eruption that can appear on the face, neck, trunk and extremities. It can resemble small bumps as well as large red patches and can be weeping. People with eczema have periods of remission and exacerbation of their itching and appearance of their eruption. Dry skin, or xerosis, is a common characteristic as well. Of note, 50-80% of people with atopic dermatitis will also have asthma and /or environmental allergies.

Causes

Factors that are known to cause atopic dermatitis include genetic predisposition, skin barrier dysfunction, an impaired immune system and the environment (cold, heat, emotional stress, etc.). While many people with atopic dermatitis have food and environmental allergies, the role of allergy in exacerbation of eczema remains controversial. Because of the tendency to scratch the eruption, patients with eczema do have an increased risk of bacterial and viral skin infections, which in turn can cause a flare of the rash.

Treatment

Atopic dermatitis has many treatments, and they are focused on short term management of flares of the itching and eruption, and long term management to control the itching and dry skin between flares. Luke-warm baths, mild cleansers and emollients/moisturizers after bathing are part of the general gentle skin care guidelines. Use of cotton and silk fabric clothing are suggested to help to decrease irritation and avoid triggering a flare of the itching and eruption. Anti-pruritic (anti-itch) lotions and creams, as well as use of oral antihistamines, can be very helpful in the management of symptoms. Over-the-counter hydrocortisone products for short term treatment can be tried if the other non-prescription products are not helpful.

When to See a Doctor

If these do not help to control the symptoms or eruption, a visit to a dermatologist would be the appropriate next step. The dermatologist can evaluate the patient for possible concomittant bacterial or viral infection, and prescribe the appropriate topical and oral medications including antibiotics, antivirals and/or stronger corticosteroids. Phototherapy using ultraviolet light has been used for years to treatment eczema that does not respond well to medication. Other, newer options for the treatment of recalcitrant atopic dermatitis include topical and oral medications called immunomodulators. Allergen testing can also be performed if the dermatologist decides to evaluate the patient for possible food and/or environmental allergen triggers. Early and consistent management of the eruption of eczema and its symptoms can decrease the frequency of flares.