Patient education: Eczema (atopic dermatitis) (The Basics)

What is eczema? — Eczema is a skin condition that makes your skin itchy and flaky. Doctors do not know what causes it. Eczema often happens in people who have allergies. It can also run in families. Another term for eczema is "atopic dermatitis."

What are the symptoms of eczema? — The symptoms of eczema can include:

●Intense itching

●Color changes – In people with light skin, areas with eczema might look red or pink. In people with dark skin, they might appear dark brown, purple, or gray. Sometimes, there is a patch of skin that looks lighter than the skin around it.

●Small bumps – These might look like dots or goosebumps (picture 1).

●Skin that flakes off or forms scales (picture 2)

Most people with eczema have their first symptoms before they turn 5. But eczema can look different in people of different ages:

●In babies and children younger than 2 years old, eczema tends to affect the front of the arms and legs, cheeks, or scalp (picture 3). (The diaper area is not usually affected.)

●In older children and adults, eczema often affects the sides of the neck, the elbow creases, and the backs of the knees (picture 4). Adults can also get it on their wrists, hands, forearms, and face (picture 5).

●In older children and adults, the skin can become thicker over time (picture 6), and can even form scars from too much scratching.

Is there a test for eczema? — No, there is no test. But doctors and nurses can tell if you have eczema by looking at your skin and by asking you questions.

What can I do to reduce my symptoms? — You can use unscented, thick moisturizing creams and ointments to keep the skin from getting too dry.

If possible, try to avoid or limit things that can make eczema worse. These include:

●Being too hot or sweating too much

●Being in very dry air

●Stress or worry

●Sudden temperature changes

●Harsh soaps or cleaning products

●Perfumes

●Wool or synthetic fabrics (like polyester)

How is eczema treated? — There are treatments that can relieve the symptoms of eczema. But the condition cannot be cured. Even so, about half of children with eczema grow out of it by the time they become adults. Treatments for eczema include:

●Moisturizing creams or ointments – These products help keep your skin moist. In some cases, your doctor or nurse might suggest using a moist dressing over special creams or medicines. It helps to put on your cream or ointment right after a bath or shower. Some people also try products that you put in the bathtub, such as oil or oatmeal. But these have been found not to help with eczema symptoms.

●Steroid creams and ointments – These can help with itching and swelling. In severe cases, you might need steroids in pills. But your doctor or nurse will want you to stop taking steroid pills as soon as possible. Even though these medicines help, they can also cause problems of their own.

●Antihistamine pills – Antihistamines are medicines that people often take for allergies. Some people with eczema find that antihistamines relieve itching. Others do not think that the medicines help with itching. Many people with eczema find that itching is worst at night. That can make it hard to sleep. If you have this problem, talk with your doctor or nurse about it. They might recommend an antihistamine that can also help you sleep.

●Light therapy – Another treatment option is something called "light therapy," but doctors do not use it much. During light therapy, your skin is exposed to a special kind of light called ultraviolet light. This therapy is usually done in a doctor's office.

Doctors usually recommend light therapy for people who do not get better with other treatments.

●Medicines that change the way that the immune system works – These medicines are only for people who do not get better with moisturizers and steroid creams or ointments.

Can eczema be prevented? — Experts don't know if there is a way to prevent eczema. Babies who have a parent or sibling with eczema have a higher risk of getting it. For these babies, good skin care might be helpful, especially in cold or dry areas. Good skin care includes using moisturizing creams or ointments. But doctors don't yet know if this actually helps prevent eczema from happening later.

If you use cream or ointment on your newborn, wash your hands first. This helps lower the risk of getting germs on the baby's skin that could cause infection. Try to use products that come in a tube instead of a jar that you dip your fingers in.

When should I call the doctor? — Call for emergency help right away (in the US and Canada, call 9-1-1) if:

●You have signs of a very bad allergic reaction called "anaphylaxis." These include:

•Hives – Raised, inflamed, red patches of skin that are very itchy.

•Angioedema – A condition that causes puffiness, usually of the face, eyelids, ears, mouth, hands, or feet.

•Redness or itching of the skin on most of the body (without hives)

•Swelling or itching of the eyes

•Runny nose or swelling of the tongue

•Trouble breathing, wheezing, or voice changes

•Vomiting or diarrhea

•Feeling dizzy or passing out

Call for advice if:

●You have signs of an infection – These include a fever of 100.4°F (38°C) or higher, or chills.

●Your eczema is making you feel anxious or depressed – There are treatments that can help with this.

●You have trouble sleeping because you are itching.

●Your eczema:

•Has pus or yellow scabs on it

•Gets worse or is covering most of your body

•Is on your eyes or lips, or if you notice a rash or blisters in your mouth

•Gets worse after you were around someone with cold sores or fever blisters

More on this topic

Patient education: Contact dermatitis (The Basics)
Patient education: Giving your child over-the-counter medicines (The Basics)
Patient education: Topical corticosteroid medicines (The Basics)

Patient education: Eczema (atopic dermatitis) (Beyond the Basics)