Eczema
Atopic dermatitis (eczema) is a condition that causes dry, itchy and inflamed skin. It’s common in young children but can occur at any age. Atopic dermatitis is long lasting (chronic) and tends to flare sometimes. It can be irritating but it’s not contagious.
People with atopic dermatitis are at risk of developing food allergies, hay fever and asthma.
In some people, atopic dermatitis is related to a gene variation that affects the skin’s ability to provide protection. With a weak barrier function, the skin is less able to retain moisture and protect against bacteria, irritants, allergens and environmental factors — such as tobacco smoke.
In other people, atopic dermatitis is caused by too much of the bacteria Staphylococcus aureus on the skin. This displaces helpful bacteria and disrupts the skin’s barrier function.
A weak skin barrier function might also trigger an immune system response that causes the inflamed skin and other symptoms.
Atopic dermatitis (eczema) is one of several types of dermatitis. Other common types are contact dermatitis and seborrheic dermatitis (dandruff). Dermatitis isn’t contagious.
Atopic dermatitis (eczema) symptoms can appear anywhere on the body and vary widely from person to person. They may include:
- Dry, cracked skin.
- Itchiness (pruritus).
- Rash on swollen skin that varies in color depending on your skin color.
- Small, raised bumps, on brown or Black skin.
- Oozing and crusting.
- Thickened skin.
- Darkening of the skin around the eyes.
- Raw, sensitive skin from scratching.
Treatment for eczema in babies (infantile eczema) includes:
- Identifying and avoiding skin irritants
- Avoiding extreme temperatures
- Giving your baby a short bath in warm water and applying a cream or ointment while the skin is still damp
See your baby’s health care provider if these steps don’t improve the rash or it looks infected. Your baby might need a prescription medication to control the rash or treat an infection. Your health care provider might also recommend an oral antihistamine to help lessen the itch and cause drowsiness, which may be helpful for nighttime itching and discomfort. The type of antihistamine that causes drowsiness may negatively affect the school performance of some children.
Medicated products applied to the skin. Many options are available to help control itching and repair the skin. Products are available in various strengths and as creams, gels and ointments. Talk with your health care provider about the options and your preferences. Whatever you use, apply it as directed (often twice a day), before you moisturize. Overuse of a corticosteroid product applied to the skin may cause side effects, such as thinning skin.
Creams or ointments with a calcineurin inhibitor might be a good option for those over age 2. Examples include tacrolimus (Protopic) and pimecrolimus (Elidel). Apply it as directed, before you moisturize. Avoid strong sunlight when using these products.
The Food and Drug Administration requires that these products have a black box warning about the risk of lymphoma. This warning is based on rare cases of lymphoma among people using topical calcineurin inhibitors. After 10 years of study, no causal relationship between these products and lymphoma and no increased risk of cancer have been found.
- Drugs to fight infection. Your health care provider may prescribe antibiotic pills to treat an infection.
- Pills that control inflammation. For more-severe eczema, your health care provider may prescribe pills to help control your symptoms. Options might include cyclosporine, methotrexate, prednisone, mycophenolate and azathioprine. These pills are effective but can’t be used long term because of potential serious side effects.
- Other options for severe eczema. The injectable biologics (monoclonal antibodies) dupilumab (Dupixent) and tralokinumab (Adbry) might be options for people with moderate to severe disease who don’t respond well to other treatment. Studies show that it’s safe and effective in easing the symptoms of atopic dermatitis. Dupilumab is for people over age 6. Tralokinumab is for adults.
- Wet dressings. An effective, intensive treatment for severe eczema involves applying a corticosteroid ointment and sealing in the medication with a wrap of wet gauze topped with a layer of dry gauze. Sometimes this is done in a hospital for people with widespread lesions because it’s labor intensive and requires nursing expertise. Or ask your health care provider about learning how to use this technique at home safely.
Light therapy. This treatment is used for people who either don’t get better with topical treatments or rapidly flare again after treatment. The simplest form of light therapy (phototherapy) involves exposing the affected area to controlled amounts of natural sunlight. Other forms use artificial ultraviolet A (UVA) and narrow band ultraviolet B (UVB) alone or with drugs.
Though effective, long-term light therapy has harmful effects, including premature skin aging, changes in skin color (hyperpigmentation) and an increased risk of skin cancer. For these reasons, phototherapy is less commonly used in young children and is not given to infants. Talk with your health care provider about the pros and cons of light therapy.
- Counseling. If you’re embarrassed or frustrated by your skin condition, it can help to talk with a therapist or other counselor.
- Relaxation, behavior modification and biofeedback. These approaches may help people who scratch out of habit.
Many people with atopic dermatitis have tried alternative (integrative) medicine approaches to easing their symptoms. Some approaches are supported by clinical studies.
- Cannabinoids. When applied to skin, creams containing cannabinoids have been shown to ease itching and skin thickening. Several studies over more than 10 years showed some benefit.
- Natural oils. When added to bathwater, natural oils might help improve dry skin. Examples of such oils are soybean oil and mineral oil. Use caution with oils in a bathtub as they can make the tub slippery.
- Manuka honey. When applied to the skin, manuka honey has been shown to calm reactions on the skin. It has been used for centuries as an antimicrobial. Don’t use in it on children under 1 year of age, as it carries the risk of infantile botulism.
- Acupuncture and acupressure. Several studies show that acupuncture and acupressure can reduce the itchiness of atopic dermatitis.
If you’re considering alternative therapies, talk with your health care provider about their pros and cons.
Complications of atopic dermatitis (eczema) may include:
- Asthma and hay fever. Many people with atopic dermatitis develop asthma and hay fever. This can happen before or after developing atopic dermatitis.
- Food allergies. People with atopic dermatitis often develop food allergies. One of the main symptoms of this condition is hives (urticaria).
- Chronic itchy, scaly skin. A skin condition called neurodermatitis (lichen simplex chronicus) starts with a patch of itchy skin. You scratch the area, which provides only temporary relief. Scratching actually makes the skin itchier because it activates the nerve fibers in your skin. Over time, you may scratch out of habit. This condition can cause the affected skin to become discolored, thick and leathery.
- Patches of skin that’s darker or lighter than the surrounding area. This complication after the rash has healed is called post-inflammatory hyperpigmentation or hypopigmentation. It’s more common in people with brown or Black skin. It might take several months for the discoloration to fade.
- Skin infections. Repeated scratching that breaks the skin can cause open sores and cracks. These increase the risk of infection from bacteria and viruses. These skin infections can spread and become life-threatening.
- Irritant hand dermatitis. This especially affects people whose hands are often wet and exposed to harsh soaps, detergents and disinfectant at work.
- Allergic contact dermatitis. This condition is common in people with atopic dermatitis. Allergic contact dermatitis is an itchy rash caused by touching substances you’re allergic to. The color of the rash varies depending on your skin color.
- Sleep problems. The itchiness of atopic dermatitis can interfere with sleep.
- Mental health conditions. Atopic dermatitis is associated with depression and anxiety. This may be related to the constant itching and sleep problems common among people with atopic dermatitis.
The main risk factor for atopic dermatitis is having had eczema, allergies, hay fever or asthma in the past. Having family members with these conditions also increases your risk.
Talk with a health care provider if you or your child:
- Has symptoms of atopic dermatitis
- Is so uncomfortable that the condition is affecting sleep and daily activities
- Has a skin infection — look for new streaks, pus, yellow scabs
- Has symptoms even after trying self-care steps
Developing a basic skin care routine may help prevent eczema flares. The following tips may help reduce the drying effects of bathing:
Moisturize your skin at least twice a day. Creams, ointments, shea butter and lotions seal in moisture. Choose a product or products that work well for you. Ideally, the best one for you will be safe, effective, affordable and unscented.
Using petroleum jelly on your baby’s skin may help prevent development of atopic dermatitis.
- Take a daily bath or shower. Use warm, rather than hot, water and limit your bath or shower to about 10 minutes.
- Use a gentle, nonsoap cleanser. Choose a cleanser that’s free of dyes, alcohols and fragrance. For young children, you usually need only warm water to get them clean — no soap or bubble bath needed. Soap can be especially irritating to the skin of young children. For people of any age, deodorant soaps and antibacterial soaps can remove too much of the skin’s natural oils and dry the skin. Don’t scrub the skin with a washcloth or loofah.
- Pat dry. After bathing, gently pat the skin with a soft towel. Apply moisturizer while your skin is still damp (within three minutes).
The triggers for atopic dermatitis vary widely from person to person. Try to identify and avoid irritants that trigger your eczema. In general, avoid anything that causes an itch because scratching often triggers a flare.
Common triggers for atopic dermatitis include:
- Rough wool fabric
- Dry skin
- Skin infection
- Heat and sweat
- Stress
- Cleaning products
- Dust mites and pet dander
- Mold
- Pollen
- Smoke from tobacco
- Cold and dry air
- Fragrances
- Other irritating chemicals
Infants and children may have flares triggered by eating certain foods, such as eggs and cow’s milk. Talk with your child’s health care provider about identifying potential food allergies.
References
- AskMayoExpert. Atopic dermatitis. Mayo Clinic; 2021.
- Chan LS, et al., eds. Complementary and alternative approaches II. In: Atopic Dermatitis: Inside Out or Outside In? Elsevier; 2023. https://www.clinicalkey.com. Accessed May 10, 2022.
- Eichenfield LF, et al. Current guidelines for the evaluation and management of atopic dermatitis: A comparison of the Joint Task Force Practice Parameter and American Academy of Dermatology guidelines. Journal of Allergy and Clinical Immunology; 2017; doi:10.1016/j.jaci.2017.01.009.
- Stander S. Atopic dermatitis. The New England Journal of Medicine. 2021; doi:10.1056/NEJMra2023911.
- American Academy of Dermatology Guidelines: Awareness of comorbidities associated with atopic dermatitis in adults. Journal of the American Academy of Dermatology. 2022; doi:10.1016/j.jaad.2022.01.009.
- Goldsmith LA, et al., eds. Atopic dermatitis. In: Fitzpatrick’s Dermatology in General Medicine. 9th ed. McGraw-Hill Education; 2019. https://accessmedicine.mhmedical.com. Accessed May 9, 2022.
- Ash S, et al. Comparison of bleach, acetic acid, and other topical anti-infective treatments in pediatric atopic dermatitis: A retrospective cohort study on antibiotic exposure. Pediatric Dermatology. 2019; doi:10.1111/pde.13663.
- Eczema and bathing. National Eczema Association. https://nationaleczema.org/eczema/treatment/bathing. Accessed May 9, 2022.
- Lebwohl MG, et al. Atopic dermatitis. In: Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 6th ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed May 9, 2022.
- Eczema in skin of color: What you need to know. https://nationaleczema.org/eczema-in-skin-of-color. Accessed May 9, 2019.
- Kelly AP, et al. Atopic dermatitis and other eczemas. In: Taylor and Kelly’s Dermatology for Skin of Color. 2nd ed. McGraw Hill; 2016. https://accessmedicine.mhmedical.com. Accessed May 9, 2022.
- Kelly AP, et al. Pediatrics. In: Taylor and Kelly’s Dermatology for Skin of Color. 2nd ed. McGraw-Hill Education; 2016. https://accessmedicine.mhmedical.com. Accessed May 9, 2022.
- Chan LS, et al., eds. Complementary and alternative approaches I. In: Atopic Dermatitis: Inside Out or Outside In? Elsevier; 2023. https://www.clinicalkey.com. Accessed May 10, 2022.
- Chan LS, et al., eds. Topical therapies. In: Atopic Dermatitis: Inside Out or Outside In? Elsevier; 2023. https://www.clinicalkey.com. Accessed May 10, 2022.
- Schmitt BD. Eczema follow-up call. In: Pediatric Telephone Protocols: Office Version. 17th ed. American Academy of Pediatrics; 2021.
- Waldman RA, et al. Atopic dermatitis — Face. In: Dermatology for the Primary Care Provider. Elsevier; 2022. https://www.clinicalkey.com. Accessed May 9, 2022.
- Chan LS, et al., eds. Therapeutic guideline overview. In: Atopic Dermatitis: Inside Out or Outside In? Elsevier; 2023. https://www.clinicalkey.com. Accessed May 10, 2022.
- Chan LS, et al., eds. Clinical evidence: External factors. In: Atopic Dermatitis: Inside Out or Outside In? Elsevier; 2023. https://www.clinicalkey.com. Accessed May 10, 2022.
- Medical review (expert opinion). Mayo Clinic. May 16, 2022.
- New drug for atopic dermatitis. AJN. 2022;122:18.
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