Overview

Atopic dermatitis, also called eczema, is a hereditary and chronic skin disorder that mostly affects infants or very young children. Most children who suffer eczema symptoms — more than half — are often over the condition by the time they reach puberty. Some children however may experience eczema until they reach adulthood.

Eczema actually refers to a number of different skin conditions that present with similar symptoms, primarily with red and irritated skin that is itchy and often flaky. In some cases the condition can result in small, fluid-filled bumps with the potential to ooze.

Eczema is known as atopic dermatitis because the word atopic refers to conditions which occur when a patient is overly sensitive to allergens in their environments. This can include pollens, molds, dust, pet dander and foods.

Symptoms

The distribution of eczema symptoms (how eczema presents itself on the body) may change with age. In infants and young children, eczema is usually located on the face, outside of the elbows and on the knees. In older children and adults, eczema tends to be on the hands and feet, the arms, and on the back of the knees. While symptoms can vary with each patient, the following are the most common eczema symptoms.

  • Dry, scaly skin
  • Small bumps that open and weep when scratched
  • Redness and swelling of the skin
  • A thickening of the skin (with chronic eczema)

Patients, especially children, often try to relieve the itching of eczema by rubbing the affected areas or by scratching with the fingernails (or anything within reach.) Unfortunately scratching and rubbing can not only tear the skin (potentially leading to infection of the eczema site) but it can also produce thickening and browning of the skin.

Because eczema can go into remission randomly, and eczema symptoms can vary, it can often resemble other skin conditions. If you experience changes in your skin including chronic itching and redness you should always consult with your physician for diagnosis and appropriate treatment.

Diagnosis

Eczema is very common. The American Academy of Dermatology estimates that, worldwide, 10 to 20 percent of children have eczema. In addition to a complete medical history and physical examination, diagnostic procedures for eczema may include the following:

  • Family history – Children born to a mother or father who has eczema, asthma, or hay fever are more prone to eczema.
  • Personal history of allergies or asthma
  • Blood tests
  • Patch test – This is used to find allergies by placing small amounts of allergy-causing substances on the skin and monitoring the response. 

Causes

Research has led scientists to believe that eczema and eczema symptoms are inherited, so parents with eczema are more likely to have children who will suffer eczema symptoms. While it is believed to be genetic, specific triggers can potentially make the condition worse. It's important to note that harsh flare-ups of eczema can be better controlled by avoiding the most obvious eczema causes such as:

  • Excessive heat and sweating
  • Stress
  • Certain foods (dairy, acidic foods, etc. — the sensitivity depends on the individual)
  • Skin care products (alcohol based products)
  • Wool or coarse textiles
  • Harsh detergents or soaps
  • Dry skin
  • Pet dander
  • Dust
  • Mold
  • Pollen
  • Dry air environments (seasonal dry air)

Of children who have eczema, most will show eczema symptoms in the first year of life and 90 percent will show signs of eczema within the first five years. Consulting with a dermatologist can often help determine the cause of the flare up or the primary trigger for eczema symptoms.

Treatments

Specific treatment for eczema will be determined by your doctor based on:

  • Your age, overall health, and medical history
  • Extent of the reaction
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the reaction
  • Your opinion or preference

There is no cure for eczema. The goals of treatment are to reduce itching and inflammation of the skin, moisturize the skin, and prevent infection.

Management of eczema symptoms

The following are suggestions for the management of eczema:

  • Avoid contact with irritants, as determined by your doctor.
  • Take brief baths or showers using lukewarm water.
  • Practice good skin care techniques.
  • Prevent infections.
  • Do not use harsh soaps. Ask your doctor to recommend a brand.
  • Dress in light clothes--sweating can make eczema worse.
  • Use lubricating lotions at least once a day. Ask your doctor to recommend a brand.
  • Avoid scratching the affected area.
  • Minimize stress.
  • Implement lifestyle changes that prevent flare-ups. 

Your doctor may also prescribe medications in severe cases. The following medications are most commonly used to treat eczema:

  • Antihistamines – These medications may help to decrease the amount of itching. Some examples include diphenhydramine (Benadryl) or hydroxyzine (Atarax). These medications may cause drowsiness, which can help with sleep. This is considered one of the primary benefits of antihistamines as proper sleep is necessary for skin healing. Some new antihistamines are also available that do not cause drowsiness. Consult your doctor for more information.
  • Steroid creams – These topical medications help to decrease the inflammation in the skin, thus decreasing the itching and swelling. Topical steroids are among the most commonly used medications to reduce the signs and symptoms of eczema. Many topical steroids in various strengths are available. Steroids, if overused, are potentially damaging to the skin. Consult your doctor for more information.
  • Systemic corticosteroids – These medications given internally provide a potent reduction in inflammation, which can relieve itching. They are reserved for only severe cases and can come in the form of a pill or liquid, or given as a shot. There are significant side effects associated with the long term use of systemic corticosteroids so they are only used for a limited time. 
  • Oral antibiotics – These medications kill bacteria known to cause infections in the setting of eczema. Scratching the affected skin is a common way to introduce bacteria to the area leading to infection. A sample from the body part thought to be infected may be taken and cultured in a lab to determine what type of antibiotic to use for the most effective treatment. It is important to take the antibiotic exactly as prescribed including the duration. Early discontinuation of antibiotic therapy increases the risk for resistant bacteria to develop. 
  • Oral cyclosporine – This medication has been used for years to treat cases of eczema that do not respond to other therapies. It is used primarily to prevent rejection after organ transplantation. It suppresses the immune system, stopping it from overreacting and thus preventing eczema from flaring. It is available in capsule or liquid form. It has many potential side effects that should be considered carefully. Consult your doctor as needed.
  • Phototherapy – Two types are used to treat eczema including ultraviolet (UV) light therapy and PUVA (chemophototherapy). Light therapy uses UV light of specific wavelengths to target the immune system and prevent exaggerated responses that lead to inflammation. Phototherapy will likely be used in combination with other therapies in select patients. There are risks and benefits of light therapy that should be weighed carefully with your doctor. 
  • Topical immunomodulator – Topical immunomodulators are a new class of drugs for the treatment of eczema. These drugs are applied directly to the skin to alter the immune response.

There may be other appropriate treatment options available that can be discussed with your doctor.