Eczema is a skin condition caused by inflammation. Atopic dermatitis is the most common of the many types of eczema. While the word "dermatitis" means inflammation of the skin, "atopic" refers to an allergic tendency, which is often inherited. These eczema sufferers have a higher risk of developing other allergic conditions (like asthma or hay fever).
Typically, eczema causes skin to become itchy, red, and dry -- even cracked and leathery. Eczema most frequently appears on the face and extremities, but it can show up in other areas, too.
Like asthma, eczema seems to run in families. Certain genes make some people have extra-sensitive skin, and certain environmental factors -- like stress -- can trigger an episode of eczema.
Eczema is also caused or worsened by contact with irritants in common substances such as:
woolen and synthetic fabrics
soap and other agents that dry skin
heat and sweat
Eczema can also be worsened by dry skin.
Since eczema may in part be an internal response to stress, any emotionally charged event -- from a move to a new job -- may trigger a flare-up.
Almost always, there's an itch before a rash appears in eczema. Typically, eczema shows itself as:
Patches of chronically itchy, dry, thickened skin, usually on the hands, neck, face, and legs. In children, the inner creases of the knees and elbows are often involved.
Scratching can lead to sores with crusts.
Call Your Doctor About Eczema If:
You develop an otherwise unexplained rash and have a family history of eczema or asthma. You should have a medical diagnosis of the condition.
The inflammation does not respond within a week to treatment with over-the-counter hydrocortisone creams. A doctor may suggest more aggressive forms of treatment.
You develop yellowish to light brown crust or pus-filled blisters over existing patches of eczema. This may indicate a bacterial infection that should be treated with an antibiotic.
During a flare-up of eczema, you are exposed to anyone with a viral skin disease such as cold sores or genital herpes. Having eczema puts you at increased risk of contracting the viral disorder.
You develop numerous small, fluid-filled blisters in the areas of eczema. You may have eczema herpeticum, a rare but potentially serious complication caused by the herpes simplex virus.
No matter which part of the skin is affected, eczema is almost always itchy. Sometimes the itching will start before the rash appears, but when it does the rash most commonly occurs on the face, knees, hands, or feet. It may also affect other areas as well.
Affected areas usually appear very dry, thickened, or scaly. In fair-skinned people, these areas may initially appear reddish and then turn brown. Among darker-skinned people, eczema can affect pigmentation, making the affected area lighter or darker.
In infants, the itchy rash can produce an oozing, crusting condition that occurs mainly on the face and scalp, but patches may appear anywhere.
What Causes Eczema?
The exact cause of eczema is unknown, but it's thought to be linked to an overactive response by the body's immune system to unknown triggers.
In addition, eczema is commonly found in families with a history of other allergies or asthma.
Some people may suffer "flare-ups" of the itchy rash in response to certain substances or conditions. For some, coming into contact with rough or coarse materials may cause the skin to become itchy. For others, feeling too hot or too cold, exposure to certain household products like soap or detergent, or coming into contact with animal dander may cause an outbreak. Upper respiratory infections or colds may also be triggers. Stress may cause the condition to worsen.
Although there is no cure, most people can effectively manage their disease with medical treatment and by avoiding irritants. The condition is not contagious and can't be spread from person to person.
How Is Eczema Diagnosed?
Eczema can be diagnosed by a pediatrician, allergist, immunologist, dermatologist or your primary care provider. Since many people with eczema also suffer from allergies, your doctor may perform allergy tests to determine possible irritants or triggers. Children with eczema are especially likely to be tested for allergies.
What Is the Treatment for Eczema?
The goal of treatment for eczema is to relieve and prevent itching, which can lead to infection. Since the disease makes skin dry and itchy, lotions and creams are recommended to keep the skin moist. These solutions are usually applied when the skin is damp, such as after bathing, to help the skin retain moisture. Cold compresses may also be used to relieve itching
Over-the-counter products -- such as hydrocortisone -- or prescription creams and ointments containing stronger corticosteroids are often prescribed to reduce inflammation. For severe cases, your doctor may prescribe short courses of oral corticosteroids. In addition, if the affected area becomes infected, your doctor may prescribe antibiotics to kill the infection-causing bacteria.
Other eczema treatments include antihistamines to reduce severe itching, tar treatments (chemicals designed to reduce itching), phototherapy (therapy using ultraviolet light applied to the skin), and the drug cyclosporine for people whose condition doesn't respond to other treatments.
The FDA has approved two drugs known as topical immunomodulators (TIMs) for the treatment of moderate eczema. The drugs, Elidel and Protopic, are skin creams that work by altering the immune system response to prevent flare-ups.
On March 10, 2005, the FDA warned doctors to prescribe Elidel and Protopic with caution due to concerns over a possible cancer risk associated with their use.
As of January 2006, these two creams carry the FDA's strongest "black box" warning on their packaging to alert doctors and patients to these potential risks. The warning advises doctors to prescribe short-term use of Elidel and Protopic only after other available eczema treatments have failed in adults and children over the age of 2.
How Can Eczema Flare-ups Be Prevented?
Eczema outbreaks can usually be avoided or the severity lessened by following these simple tips.
Avoid sudden changes in temperature or humidity
Avoid sweating or overheating
Avoid scratchy materials, such as wool
Avoid harsh soaps, detergents, and solvents
Avoid environmental factors that trigger allergies (for example, pollen, mold, dust mites, and animal dander)
An important part of diagnosing allergies is a careful evaluation of your symptoms. Your doctor will ask you several questions to rule out other conditions that may cause allergy-like symptoms.
Questions Your Doctor May Ask to Diagnose Allergies
Your doctor will likely ask you a series of questions to help determine if your problem is allergy related. They could include:
What type of symptoms do you have?
How long have you had these symptoms?
When symptoms occur, how long do they last?
Are your symptoms seasonal (come and go throughout the year) or do they last year-round?
Do your symptoms occur when you are outdoors or indoors, such as when you clean your house?
Do your symptoms get worse when you are around pets? Do you have any pets?
Do you smoke? Does anyone in your family smoke?
Are your symptoms interfering with your daily activities or interrupting your sleep?
What makes your symptoms better? What types of treatments have you tried? What allergy drugs are you taking now? Do these medications provide relief? Do they cause unwanted drowsiness?
What other medications are you taking, including prescription and over-the-counter drugs, vitamins, and herbal supplements?
What type of heating system do you have? Do you have central air conditioning?
Do you have any other health conditions, such as asthma or high blood pressure?
Are you having difficulty with your sense of smell or taste?
What makes your symptoms worse?
How much can you modify your lifestyle to reduce your exposure to these allergens?
Physical Examination to Diagnose Allergies
In addition to asking questions, your doctor will perform a complete physical exam. Your skin, eyes, nose, ears, and throat will be examined. Your doctor will look for inflammation (redness or swelling), drainage, or other signs of allergy symptoms.
Other tests may be performed -- based on your doctor's recommendations after the medical history and examination -- to determine which allergens are causing your symptoms. These may include a skin test or blood test.
Questions to Ask Your Doctor About Allergies
You should also ask your doctor questions regarding any of your concerns. Among those you should include are:
What substances are causing my allergies?
What allergy symptoms should I be concerned about? When is it necessary to call the doctor?
What allergy medications or other treatments are available? What are the benefits/side effects of each treatment?
Will I need allergy shots?
What guidelines should I follow if I'm prescribed allergy medication?
Should I take medicine all the time or only when my allergy symptoms become worse?
Should I stop exercising outside if I have allergies?
What types of plants are better to put in my yard if I have allergies?
How can I avoid or reduce exposure to certain allergens?
What can I do around my house to reduce allergies?
Should I avoid going outside during certain times of the year? What can I do to decrease allergy symptoms when I do have to go outside?
How can I tell the difference between allergies and a cold or the flu?
Will changing my diet improve my symptoms?
How often should I come in for follow-up appointments?
There is no cure for allergies, but there are several types of medications available -- both over-the-counter and prescription -- to help ease annoying symptoms like congestion and runny nose. These allergy drugs include antihistamines, decongestants, combination medicines, corticosteroids, and others.
Allergy shots, which gradually increase your ability to tolerate allergens, are also available.
Antihistamines have been used for years to treat allergy symptoms. They can be taken as pills, liquid, nasal spray, or eye drops. Over-the-counter (OTC) antihistamine eye drops can relieve red itchy eyes, while nasal sprays can be used to treat the symptoms of seasonal or year-round allergies.
Examples of antihistamines include:
Over-the-counter: Benadryl, Claritin, Chlor-Trimeton, Dimetane, Zyrtec, and Tavist. Ocu-Hist is an OTC eye drop.
Prescription: Clarinex, Xyzal, and Allegra. Astelin is a prescription nasal spray. Eye drops include Emadine and Livostin.
How Do Antihistamines Work?
When you are exposed to an allergen -- like ragweed pollen -- it triggers your immune system to go into action. Immune system cells known as "mast cells" release a substance called histamine, which attaches to receptors in blood vessels causing them to enlarge. Histamine also binds to other receptors causing redness, swelling, itching, and changes in secretions. By blocking histamine receptors, antihistamines prevent these symptoms.
What Are the Side Effects of Antihistamines?
Many over-the-counter antihistamines cause drowsiness. Non-sedating antihistamines are available by prescription.
Decongestants relieve congestion and are often prescribed along with antihistamines for allergies. They come in nasal spray, eye drop, liquid, or pill form.
Nasal spray and eye drop decongestants can be used for only a few days, since long-term use can actually make symptoms worse. Pills and liquid decongestants may be taken longer safely.
Some examples of decongestants include:
Over-the-counter: Zyrtec-D, Sudafed tablets or liquid, Neo-Synephrine and Afrin nasal sprays, and Visine eye drops.
Prescription: Prescription decongestants include drugs like Claritin-D and Allegra-D that combine a decongestant with another allergy medicine.
How Do Decongestants Work?
During an allergic reaction, tissues in your nose swell in response to contact with the allergen. That swelling produces fluid and mucous. Blood vessels in the eyes also swell, causing redness. Decongestants shrink swollen nasal tissues and blood vessels to relieve the symptoms of nasal swelling, congestion, mucous secretion, and redness.
What Are the Side Effects of Decongestants?
Decongestants may raise blood pressure, so they are not recommended for people who have blood pressure problems or glaucoma. They may also cause insomnia or irritability and restrict urinary flow.
Combination Allergy Drugs
Some allergy drugs contain both an antihistamine and a decongestant to relieve multiple allergy symptoms. There are also other combinations, such as those between an allergy medicine and asthma medicine and an antihistamine eye drop with a mast cell stabilizer drug (see below).
Some examples of combination allergy medicines include:
Over-the-counter: Zyrtec-D , Benadryl Allergy and Sinus, Tylenol Allergy and Sinus.
Prescription: Allegra-D, Claritin-D, and Semprex-D for nasal allergies. Naphcon, Vasocon, Zaditor, Patanol, and Optivar for allergic conjunctivitis