Eczema is a common skin problem that causes itching, dryness, fine scales or flaking, and sometimes mild redness.
Eczema can be a mild skin irritation that does not need medical treatment. Sometimes, however, it causes relentless itching and scratching. The skin may become scaly, raw, or thickened from constant or repeated bouts of eczema. This more severe form of eczema, called atopic dermatitis, may always be present or may appear just in certain seasons or with stress. Atopic dermatitis usually appears first in childhood or early adulthood.
Flare-ups of eczema can be caused by:
Often eczema tends to be a problem in families that have other allergy problems, such as asthma or hay fever. The tendency to have eczema may be inherited. Eczema is not contagious, but if the skin gets infected, the infection may be contagious.
The main symptom of mild eczema is an area of fine, dry scaling on the skin, often on the arms or legs. The skin may or may not itch.
Severe eczema causes intense itching. The most common areas of itching are the fronts of the elbows, backs of the knees, and face. However, any area of skin may be affected. The skin is usually very sensitive to being touched. Even a light touch may cause itching. Many people who have severe eczema are quite sensitive to scratchy fabrics, especially wool. Eczema often becomes worse in the winter when indoor air can be very dry.
Your healthcare provider will examine your skin. He or she will ask about your history and your family's history of rashes and about other problems such as allergies or asthma.
Mild eczema sometimes does not need any treatment. It may help to use a nonirritating moisturizer. Or it may go away if you put 1% hydrocortisone cream on the area up to 4 times a day. No prescription is needed for this cream.
More severe eczema can be more difficult to treat. However, medicines such as antihistamines and steroid creams can help prevent or control the itching.
Antihistamine pills can usually prevent the itching of severe eczema. Some antihistamines, such as diphenhydramine, cause drowsiness, so you may want to take the medicine only at bedtime. (It is important to prevent scratching during sleep to try to avoid infections.) Some antihistamines, however, do not cause drowsiness. These nonsedating antihistamines can be taken day or night to prevent itching. Some antihistamines require a prescription and some can be bought without a prescription. Your healthcare provider may recommend that you take antihistamines daily to prevent itching. Or you may be able to take them just when you need them.
Prescription steroid creams or ointments can help control the itching and rash caused by severe eczema. Use these medicines exactly as prescribed by your healthcare provider for the best results. Steroid creams and ointments come in many different strengths. Some should be used just once a day. Using a steroid for a long time can have serious side effects. Use steroid medicine exactly as your healthcare provider prescribes. Don’t use more or less of it than prescribed by your provider and don’t use it longer than prescribed. Don’t stop using a steroid without your provider's approval. You may have to lower your dosage slowly before stopping it. Don’t put steroid medicine on your face or around your eyes unless your provider tells you to.
Keep your skin well lubricated. To prevent your skin from becoming too dry, avoid exposing your skin to a lot of water. This seems surprising, but in fact, every time the skin gets wet, evaporation of water from the skin dries the skin even more. For this reason, if you have severe eczema you should take baths or showers less often. Keep them brief and use lukewarm (not hot) water. Take sponge baths between baths or showers. Use moisturizing creams or ointments, rather than water-based lotions, regularly (several times a day, if possible).
Some healthcare providers may recommend testing for an allergy to dust mites. If test results clearly show that you are allergic to dust mites, your provider may recommend that you try to get rid of any dust mites in your home. Before you have allergy tests, you might first see if your symptoms get better if you do everything you can to eliminate dust mites from your home. Dermatologists have noted that eliminating dust mite sources is usually helpful only to children.
To reduce the population of dust mites in your home, all surfaces must be dusted often. Bed pillows and mattresses should have anti-allergy covers to minimize exposure to the mites. Bedding should be washed often (every week or two) to keep the mite population down.
If possible, you also need to eliminate the surfaces from which dust mites can never be completely removed. These surfaces include wall-to-wall carpets and draperies with horizontal folds, which catch dust and cannot be damp-wiped or laundered.
In some cases, allergy shots for dust mites may be helpful. You should consider this treatment only after seeing a dermatologist (a skin specialist) or an allergist (an allergy specialist).
Eczema that begins in childhood may improve or even go away by adulthood. However, in many cases it may be a lifelong problem.
For mild eczema, you may need to try to avoid certain foods or medicines if they seem to make the eczema worse. Keep your skin well lubricated and avoid irritating substances such as scratchy fabrics or chemicals such as laundry detergent residue.
Because severe eczema is usually an inherited disorder, there is no known way to prevent it. However, as with many medical conditions, there seems to be a relationship between flare-ups of atopic dermatitis and stress. When you can, avoid or minimize stressful situations. Since this is not always possible, it may help to know that a worsening of symptoms during times of stress is only temporary.
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