Eczema: The itch that rashes
Eczema, formally known as atopic dermatitis, is a chronic skin disease that often arises in infancy and early childhood but can arise later in life as well. Rachel J. McAndrew, MD, a dermatologist on the medical staff at Baylor Scott & White Specialty Clinic – Lakeway, shares her top tips for understanding and managing eczema.
Common eczema symptoms
“Itching is a prominent component of this condition,” she said. “People with eczema are often caught in an ‘itch-scratch cycle.’ The more you scratch the skin, the more it itches; the more it itches, the more you scratch it. Treatment is aimed at breaking this cycle.”
Along with scratching, other symptoms include:
- Scaling of the skin
- Cracking of the skin
- Weeping or oozing of clear fluid from the rash
- Formation of crusts on the surface of the skin
- Lichenification, or leather-like areas that develop after long-term itching and scratching
Who is most at risk for developing eczema?
“The origin of eczema is complex,” Dr. McAndrew said. “A genetic predisposition to the condition, a defective skin barrier and inflammation in the skin all play a role.”
Eczema is most common in people who have a family history of allergies or asthma. It is commonly seen in people of all ages but often develops initially in infants and young children.
In infants, the itchy areas are most prevalent on the face, scalp, arms and legs. It is unusual for the diaper area to be involved with eczema (although other types of rashes are frequent in this area). In children, the most common areas to find eczema are the inside of the elbows and the back of the knees.
Eczema may also involve the face with dry patches on the checks, forehead and eyelids, or other areas on the trunk and extremities such as the wrists, hands, feet, ankles, forearms, chest or back.
Will eczema go away?
Eczema may improve with time for some children, Dr. McAndrew said, but many cases of eczema will become chronic. It is not uncommon for the severity of eczema to ebb and flow over the course of life with periods of quiet and then episodes of intermittent flares.
“Without proper medical diagnosis and treatment, eczema can negatively impact the quality of life of affected individuals,” Dr. McAndrew said. “Treatment of eczema takes time and effort, it but can have a profoundly positive impact on your life.”
Treatment is directed at restoring the normal skin barrier and decreasing inflammation and itching.
Tips for managing eczema
Because eczema is a chronic condition, treatment and prevention go hand in hand. A combination of drug therapy and behavior modification are used to break the cycle of skin irritation.
Follow these tips to manage your eczema:
- Moisturize affected areas several times daily
- Bathe in water that is warm, not hot, and then apply moisturizer (and medicated ointments, if prescribed by your physician) within three minutes of getting out of the shower or tub
- Use mild soap or cleanser in the shower or bath with no fragrance, and avoid bubble baths
- Avoid fragrance in all of your hygiene products
- Topical steroid creams or ointments may be prescribed by your physician to calm the redness, itching and rash
- Antihistamines such as Benadryl (at night) or Zyrtec (during the day) may be used with your physician’s approval to help with the itching
- Rinse with water after swimming in a pool or lake and immediately apply moisturizer afterward
- Wear gloves to protect against household cleansers, chemicals and when washing dishes
- Wear gloves in cold weather to prevent dry, chapped or scaly skin
- Avoid very dry air, using an air humidifier during winter
- Avoid wearing wool or synthetic fabrics, such as polyester
“If your eczema is severe and not responding to the strategies noted above, there are several other treatment options that you may want to discuss with your dermatologist, including light therapy, pills and injectable medications that are FDA approved for the treatment of eczema,” Dr. McAndrew said.
What products to use and avoid
“Ointment will typically provide the most improvement for dry skin, followed by cream and then lotion,” Dr. McAndrew said. “I typically recommend avoiding lotions as they are often alcohol based and can cause burning and stinging upon application.”
She also said the following products should not be used if you have eczema:
- Fabric softener
- Dryer sheets
- All skin-care products with heavy amounts of color or fragrance
If you think you may have eczema, it’s a good idea to see your dermatologist or primary care physician to have your skin evaluated. Together, you can address your concerns and keep eczema from slowing you down.
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