Eczema

Overview

Atopic dermatitis, the most common kind of eczema, makes the skin extremely itchy. Scratching leads to more redness, swelling, cracking, oozing of clear fluid, crusting, and scaling. It usually comes in flares, when it's worse, and times when the skin gets better or clears.

People with eczema often have a weaker skin barrier, so their skin loses moisture and gets irritated more easily. Genes, the immune system, and the environment all play a role. Many people with eczema also have asthma, hay fever, or food allergies.

Symptoms

Where the rash shows up depends on age.

• Itching, which can be severe and may start before the rash
• Dry, scaly skin
• Red or darker patches of rash
• Rashes that ooze, weep clear fluid, or crust when scratched

Less common

• Thick, leathery skin from long-term scratching
• Lighter or darker skin in the affected areas
• Small bumps or blisters

How it usually goes

• Babies: Rash often on the face, scalp, and around the joints; rarely in the diaper area.
• Children: Rash often in the bends of the elbows and knees, the neck, and the ankles.
• Teens and adults: Rash on the hands, neck, around the eyes, and in the bends of the elbows and knees.

When to get medical care

Causes

No one knows exactly what causes eczema. Changes in the skin's protective layer let moisture escape, which dries the skin and leads to inflammation and itching. Genes, the immune system, and the environment all play a role.

Common triggers include dry or cold air, hot showers, sweating, harsh soaps and detergents, perfumes and dyes, wool, stress, colds, and allergens like dust mites, pollen, and pets.

Does it spread or run in families?

• It isn't contagious. You can't catch it from someone else.
• It can run in families. Tell your doctor if a parent, brother, or sister has it.

Who is more likely to get it

• Babies and children
• Family history of eczema, asthma, or hay fever
• Asthma or allergies

Possible complications

• Skin infections: Bacteria or viruses can infect scratched skin
• Asthma: Children with eczema are more likely to develop it
• Hay fever: Often goes along with eczema
• Sleep loss: From night-time itching

Diagnosis

A healthcare professional usually diagnoses eczema by looking at your skin and asking about your symptoms and family history. There's no single test for it.

Questions you may be asked

• Where the rash is and how long you've had it
• How bad the itching is, and whether it keeps you up at night
• What seems to make it worse, like soaps, fabrics, weather, or stress
• Whether you or your family have asthma, hay fever, or food allergies
• Which creams or medicines you've tried

The exam

They'll look at your skin for dry, red, scaly, thickened, or oozing patches and where they are on your body.

Tests

Tests are sometimes used:

• Allergy testing: If allergies might be triggering flares; ask before cutting out foods, especially for children.
• Skin swab: If the skin looks infected.

Treatment

Treatment combines daily skin care to protect the skin barrier with medicine to calm flares.

Self-care

• Moisturize at least twice a day, right after bathing, with an ointment like petroleum jelly or a thick cream
• Take short, lukewarm baths or showers, once a day at most, and pat skin dry
• Use mild, unscented soap or a non-soap cleanser, and unscented laundry detergent
• Avoid rough fabrics like wool, and wear soft cotton
• Keep nails short, and wear light gloves at night if scratching is a problem
• Use a humidifier in dry weather

Medicines

Moisturizers are the base of treatment. Ask your healthcare professional which medicines are right for you or your child.

Medicine names link to drug information from the U.S. National Library of Medicine (MedlinePlus). OwieClear doesn't give doses: follow the label or your healthcare professional.

Your healthcare professional may prescribe a steroid cream or ointment for flares, or other creams that calm the skin. For severe eczema, options include light therapy and newer medicines. Infected skin may need antibiotics.

How it compares

Prevention

Daily care helps prevent flares:

• Moisturize every day, even when skin looks clear
• Use gentle, unscented products
• Avoid very hot showers and long baths
• Learn and avoid your triggers
• Manage stress

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to a dermatologist (skin doctor).

Living with it

• Moisturize at least twice a day.
• Use gentle, fragrance-free products.
• Long-term illness can affect mood. Tell your doctor if you feel down or anxious.

Support groups and helplines

• Asthma and Allergy Foundation of America: Education and online support for asthma, allergies, and eczema.
• National Eczema Association: Tips, product guide, and community for eczema.

Back to school, work, or sports

• Most people can keep working or going to school.
• Ask about changes that help, like extra breaks or a flexible schedule. Workers may be covered by the ADA. Students may get a 504 plan.

Children, pregnancy, and older adults

• Babies and children: Eczema is most common in young children, and many outgrow it. Talk with your child's doctor before cutting foods out of their diet.
• Darker skin tones: Eczema may look purple, brown, or gray instead of red, and can leave lighter or darker spots that fade over time.
• Adults: Eczema on the hands is common, especially with frequent handwashing or wet work. Use gloves and moisturize after washing.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Some skin medicines, like isotretinoin and retinoid creams, aren't safe in pregnancy.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

For caregivers

• Go to visits when you can and take notes.
• Keep a list of medicines, allergies, and doctors in one place.
• Learn the warning signs that need fast care.
• Take breaks and ask for help. Caregivers need care too.

Outlook

Eczema can last a long time, but most people can control it with daily skin care and treatment. Many children's eczema gets better as they grow.

Myths and facts

Getting ready for your visit

A little preparation helps.

What to bring

• Photos of flares if the rash comes and goes
• A list of products you use on your skin and laundry
• What seems to trigger flares
• Medicines and creams you've tried

Questions to ask

• Which moisturizer should I use, and how often?
• How long can I use a steroid cream safely?
• Should I or my child be tested for allergies?
• What should I do during a bad flare?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Eczema