Eczema

The Facts

Eczema, also known as dermatitis, refers to a group of skin conditions that cause inflammation of the skin. Eczema is not caused by an infection. The condition may be temporary or chronic, mild or, in rare instances, very serious.

Serious cases usually occur when:

it is severe enough to cause complications, such as skin infections
an affected person also contracts the herpes simplex virus
an affected person has a violent allergic reaction caused by contact dermatitis

Atopic dermatitis is the prevalent form of chronic eczema. It is a genetically inherited condition that tends to run in families who also suffer from hay fever and asthma. Atopic dermatitis will affect about 17% of Canadians at some point in their lives.

Contact dermatitis is a skin reaction caused by exposure to an allergen or irritant.

Dyshidrotic eczema occurs on the palms of the hands, sides of the fingers, and the soles of the feet, and it is associated with itching and blisters.

Nummular dermatitis is a type of eczema that normally affects older adults. Round patches of scaly, inflamed skin may appear anywhere on the body, most commonly on the legs. Winter is the peak period for this condition. It tends to strike dry skin.

Stasis dermatitis (or gravitational eczema) affects the lower legs of older adults. It is basically a poor circulation problem, usually due to blood not being able to get out of the legs well.

The Causes

Genetic inheritance plays a major role in most forms of eczema.

Atopic dermatitis is an inherited oversensitivity of the immune system. Genes play a role in allergies too, though it usually takes prolonged exposure to a given allergen before it becomes a nuisance.
Of course, there are some chemicals that will irritate any skin. Harsh irritants can give anyone a temporary bout of contact dermatitis. Contact dermatitis may be caused by irritants or allergens.

Stasis dermatitis is caused by poor circulation in the lower extremities. Fluid builds up in the capillaries due to raised blood pressure. This causes inflammation of the skin.

Symptoms And Complications

Atopic dermatitis appears as red, itchy, dry skin. It tends to first appear in childhood, and may disappear completely before adulthood. It most often affects the area behind the knees and around the elbows, as well as the face. In infants, it often appears on the chest, face, scalp, and neck. Atopic people who contract the herpes simplex virus can be struck by eczema herpeticum, a serious secondary infection of the inflamed skin that causes a worsened rash and fever.

Contact dermatitis often causes a dry and intensely itchy, red rash. Depending on the trigger to the reaction, the rash may actually be painful, forming blisters that ooze before crusting over. Other reactions caused by irritants cause swelling at the affected area. The area involved may be a clue what allergen or irritant is responsible. The worst forms of allergic contact dermatitis, such as severe latex reactions, can be associated with the potentially fatal allergic reaction called anaphylaxis, which is a body-wide response to the allergen.

Dyshidrotic eczema can cause blisters on the palms of the hands, sides of the fingers, and soles of the feet. The skin will feel itchy or you may feel a burning sensation, and it can crack or peel.

Nummular eczema appears as itchy, red, coin-shaped areas with discharge on the limbs and torso.

Stasis dermatitis appears as inflamed, scaly skin around the lower legs and ankles. Over time, it may turn dark brown.

Making A Diagnosis

To make a diagnosis of eczema, your doctor will examine your skin, and ask you questions about your symptoms. If you get inflamed skin, it's important to tell your doctor about any allergies you have and any unfamiliar substances you have recently come in contact with.

Looking at the skin itself will often allow a physician to distinguish particular types of eczema, although sometimes a skin biopsy or other testing is necessary.

Treatment And Prevention

Your doctor will recommend a treatment plan for your eczema that will take into consideration the type of eczema you have, the severity of the eczema, as well as other factors. For most people, a combination of therapies is needed to manage eczema.

Treatment options for most types of eczema can include moisturizers and topical corticosteroids (e.g., betamethasone*, desonide, hydrocortisone, prednicarbate). Other topical medications (e.g., tacrolimus, pimecrolimus, crisaborole) may also be used to treat atopic dermatitis. The most important step in both treating and preventing eczema flare-ups is frequent moisturizing.

In more severe cases, biologic agents (e.g., abrocitinib, dupilumab) that work on specific proteins involved in immune responses may be prescribed. Biologics are typically given as injections or by mouth, depending on the medication.

For some people with more severe eczema, oral corticosteroids may be needed to control symptoms. Antihistamines that cause drowsiness may be recommended for some types of eczema to help with itching and sleep. When skin infections occur, topical or oral antibiotics may be prescribed.

Stasis dermatitis can be helped by keeping in good physical shape so that blood flows freely through the legs. Support stockings can also assist in pumping the blood up out of the leg. Elevating your legs also increases circulation.

Susceptibility to most forms of eczema is genetic and unavoidable. Knowing what allergens and irritants to avoid can help you get through life without being too inconvenienced by eczema.

Other tips to help you deal with eczema include:

Bathe in cool or tepid water with gentle soap. Minimize the use of soap when possible.
Use moisturizers immediately after you bathe to keep the moisture locked in. Avoid moisturizers with perfumes, as they may worsen the condition.
Avoid scratching affected areas. Some people wear cotton gloves at night to prevent scratching in their sleep.
Keep your fingernails short.
Don't let sweat stay on your skin.
Avoid clothes that don't let the skin breathe.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.