All About Eczema

 

What is Eczema?

Atopic dermatitis, a form of eczema, is a chronic inflammatory skin disease that causes:

  • red patches on the skin that itch;
  • dry and scaly skin;
  • thickened skin;
  • and open, oozing, crusty sores.

Eczema symptoms often appear on the following parts of the body:

  • face
  • neck
  • hands
  • wrists
  • elbows
  • knees
  • ankles
  • feet

Eczema symptoms come and go, but even when skin appears clear, there may be inflammation under the surface of the skin, waiting to flare.

Infographic of the cycle of itch and scratch that keeps eczema going

What causes eczema?

The cause of eczema is unknown, but doctors believe that it is related to genetics, an immune system that is sensitive to allergens and irritants and a defective skin barrier that allows moisture to escape and allergens and bacteria to invade. Approximately 70% of people with eczema report a family history of the condition.

Exposure to allergens and irritants start a chain reaction in the body. The immune cells release histamines, cytokines and other chemicals to get rid of the irritants. The resulting inflammation causes the skin to itch, and itch and itch.

Too much scratching can lead to infection if the surface of the skin is broken. Signs of an infection include yellowish, crusty skin (often on top of the eczema), red, swollen bumps and pus-filled blisters.

Some people with eczema may lack a specific type of protein, called filaggrin, in their skin. This protein serves as a protective barrier from allergens, irritants and infections. When filaggrin is lacking, it weakens the skin barrier function of the skin. Some people with eczema also have high blood levels of Immunoglobulin E, or IgE, which are antibodies produced by the immune system that set off allergy symptoms.

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Photo of baby with eczema on their ankle

What triggers eczema?

An important part of an eczema treatment plan is preventing exposure to allergens and irritants that set off skin problems. First things first – you must identify what is triggering your eczema symptoms.

Triggers and symptoms for eczema are different for everyone.

What makes identifying them so challenging is sometimes a flare-up can occur hours after the initial exposure. Some people may experience symptoms in certain areas of the body or only at certain times of the year.

Trigger avoidance is essential in managing eczema, but it’s important to remember that, since eczema is a systemic condition, it is not a cure. Following are common eczema triggers.

Contact Allergies

Eczema is sometimes set off by something a person is in contact with on a regular basis. It could be a piece of jewelry that contains nickel, rubber or chemicals used in cosmetics, disinfectants and skin products.

An allergist can do a patch test to identify the specific allergens causing the problem.

Other potential skin allergens include:

  • Antibacterial ointments such as neomycin and bacitracin
  • Formaldehyde, which is found in some household cleaning products.

Dry Skin

When your skin is dry, it can lead to eczema symptoms. Some people have a genetic condition associated with a skin protein called filaggrin that causes their skin to lose moisture and allow allergens and bacteria to enter the skin more easily.

The best way to prevent an eczema flare is to keep your skin well moisturized. Recent research suggests that moisturizing a baby’s skin from birth may help prevent eczema from developing.

photo of a dust mite

Dust Mites

These tiny insects live in mattresses, pillows, upholstered furniture – anywhere they can find moisture along with their favorite food, tiny bits of shed human skin.

Eczema patients may be allergic to dust mites. Allergens from their droppings and dead bodies collect in bedding, furnishings and house dust, then irritate skin, airways and eyes on contact.

When eczema is already flaring, dust mite allergens can worsen the problem. Encase your bed’s pillows and mattress with allergen-proof covers to put a barrier between you and the dust mites. Wash linens weekly and vacuum carpets, floors and furnishings with a HEPA vacuum.

Environmental Allergies

People with eczema may experience symptoms after exposure to certain grass, tree or ragweed pollen and/or indoor or outdoor mold.

It’s best to treat symptoms that arise from environmental allergens with aggressive moisturizing, along with antihistamines and topical corticosteroids if necessary.

Skin prick or blood testing for environmental allergies will help identify specific allergens to avoid.

Some patients may do well with allergen immunotherapy (allergy shots or tablets), in which a patient is given a gradually increasing amount of an allergen to build tolerance and reduce symptoms.

Food Allergies

Food allergens can play a role in the onset of eczema symptoms, particularly for infants and young children. Between 35 and 60 percent of young children with moderate to severe eczema also have food allergies.

It’s believed the breakdown of the skin barrier contributes to an allergic response when a food allergen is consumed.

Among children under the age of 2, eczema is most often related to milk or egg allergy, but it can occur with any food. Other common food allergens include peanut, tree nuts, fish, shellfish, soy and wheat.

Consult with a board-certified allergist for a diagnosis and then develop a plan to avoid the food allergen. Food-allergic patients are also at risk for anaphylaxis, a severe allergic reaction. Always carry two epinephrine auto-injectors, the treatment for anaphylaxis, if you have a severe food allergy.

Pet Allergies

Pet dander (dead skin cells), saliva or urine are normally harmless proteins, but for people with eczema they can trigger skin symptoms leading to respiratory problems. Early exposure to pet dander may contribute to the development of eczema in children who are prone to the condition.

Finding a new home for the furry pet is the most effective way to reduce levels of pet allergens in the home, but if that’s not a consideration, bathe your pet at least once a week and set up no-pet zones, including the bedroom.

Hormones

In women, hormone fluctuations may trigger or worsen eczema symptoms. Hormone changes occur just before and during menstruation, during pregnancy, after pregnancy, or when transitioning to menopause.

Outdoor Temperatures

Whether because it dries out skin or causes sweating, heat is a common eczema trigger. Sweat, in particular, can collect in your armpits or inner part of your elbow, leading to skin irritation.

Meanwhile, in winter months, humidity that provides moisture in the air decreases, resulting in dry skin.

In addition, a sudden rise or drop in temperature can trigger an eczema flare.

Strategies to keep comfortable in hot and cold weather include:

Hot Weather

Wear appropriate clothing: light, breathable clothes in the summer.
Avoid going outside during peak heat times during the day, usually between 10 a.m. and 3 p.m. If you do go outside, keep a small towel with you to wipe away excess sweat.
Stay hydrated to moisturize from the inside out.

Cold Weather

Wear gloves in the winter (since hands are particularly sensitive and often exposed to cold).
Consider a humidifier to moisturize the indoor air.

Skin Irritants

While they are not true allergens, some soaps, shampoos, detergents, fragrances and wool or synthetic clothing can significantly irritate sensitive skin.

Heavy or tight clothing that rubs against the skin can also cause symptoms. Use gentle, nonirritating products and stick with them.

Natural fiber clothing such as cotton or silk is usually most comfortable. Once an area gets irritated, it can take a long time for it to calm down.

Stress

An increase in stress may either cause an eczema flare or worsen an existing one. Some patients may scratch more often when they’re feeling pressure. Managing stress effectively can reduce flares.

Coping strategies such as meditation or yoga, regular exercise, getting enough sleep, and connecting with family and friends are great ways to take your mind off your worries.

Tobacco Smoke

Cigarette smoke, including secondhand smoke, can irritate skin in addition to the lungs and eyes. Set a no-smoking policy both inside and outside your home; smoking is a major health issue for everyone.

Viral and Bacterial Infections

The common cold can cause an eczema flare. In addition, the herpes virus, which can cause cold sores in and around the mouth, can lead to flares – including a potentially serious infection that can spread cold sores to other areas of the body.

Exposure to bacteria can cause harmful toxins to secrete into the skin, prompting an immune reaction and causing skin inflammation. One of the more common bacteria is Staphylococcus aureus, which can not only worsen eczema but also slow skin healing.

How is eczema diagnosed?

Patients can undergo testing to find out what allergens and irritants are worsening their symptoms. Know what triggers your eczema puts you one step closer to reducing symptoms, whether through avoidance, medication or other treatments.

Skin Prick Tests

Droplets of suspected allergens are placed on or just under the skin surface. Raised bumps (about the size of a mosquito bite) strongly indicate an allergy to the substance. Skin prick testing is commonly used by allergists because of its accuracy, ease of use and immediate results. Results are typically known within 20 minutes.

Blood Test

After a blood sample is drawn, it is analyzed to detect IgE antibodies directed at specific allergens. Tests may measure specific or overall levels of IgE Some may also break down common allergens and measure IgE to specific components. Lab results may take several days. Consult with your doctor to ensure that the blood test is interpreted correctly. Eczema typically results in very high IgE levels and may falsely elevate results.

Patch Test

Chambers containing chemicals of potential triggers on adhesive strips are placed on the patient’s back. After 2-3 days, the patches are removed by the doctor and the skin is evaluated for reactions. If symptoms appear, then it’s confirmation of an allergy. Patch testing is commonly used for contact allergies to fragrances, detergents, metal and other chemical substances.

Oral Food Challenge

If it’s believed that a food allergy is causing symptoms, the doctor may want to perform an oral food challenge. In this test, the patient is asked to eat a tiny amount of a suspected allergen, and then gradually larger amounts, to determine if there’s an allergic reaction. The challenge should only be conducted by a doctor and at a medical facility that has access to epinephrine and other emergency treatments.

Photo of doctor greeting a young woman patient for an exam

Other tests helpful in diagnosing eczema

Buccal swabs

Buccal swabs, or cheek swabs, are used to detect mutations in the filaggrin gene, the protein that helps protect the body from allergens and bacteria; a lack of filaggrin weakens the skin barrier, leading to eczema.

Skin biopsy

A skin biopsy, where a tiny piece of skin is removed and analyzed under a microscope, can rule out other skin diseases such as skin cancer or psoriasis.

After testing, your doctor will compile all of the evidence together – test results, your personal and family health history, physical exam, home and work environments, activities that might expose you to allergens – to reach a diagnosis.

How common is eczema?

Eczema is a skin condition that affects 31.6 million people in the United States. Atopic dermatitis is the most common form of eczema; 16.5 million adults and 9.6 million children under the age of 18 have atopic dermatitis. Among children, 3.2 million have moderate-to-severe symptoms. Eczema often develops in early childhood, appearing within the first 6 months or within the first 5 years.

What treatments are used for eczema?

Early diagnosis and treatment are essential to avoid skin complications and improve quality of life.

Treatments include:

  • moisturizers
  • wet wrap therapy
  • medications
  • phototherapy
Photo of person applying moisturizer to their hand

How do I cope with the challenges of eczema?

If you have eczema, you know that it can greatly affect your quality of life and well-being. The itching, scratching, loss of sleep and more greatly impact day-to-day living. It can also take an emotional toll on both patient and family. Although there’s no cure, there are now better treatments available that can help manage eczema.

In addition to treatments, managing the itch-scratch cycle is the best thing to do to help cope with eczema and reduce symptoms. Also, be sure to practice good self-care and seek out the support you need and deserve with this difficult condition.

Are there other conditions that may look like eczema but are not eczema?

There are other conditions that are different than eczema, but the symptoms, diagnosis and treatment vary depending upon the condition. Here are some of them.

Hereditary Angioedema

Psoriasis

Chronic Idiopathic Urticaria (CIU)

Cold Urticaria

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