| Eczema (Atopic Dermatitis) What is eczema? Eczema is a 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. How does it occur? Sometimes a change in the weather or humidity causes eczema. Also, you may get eczema when you eat certain foods or take certain medicines. Often the tendency for severe eczema seems to be inherited along with asthma or hay fever. What are the symptoms? The main symptom of mild eczema is an area of fine, dry scaling, 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 the air is very dry. How is it diagnosed? Your health care 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. How is it treated? Mild eczema sometimes does not need any treatment. Or it may go away if you put 1% hydrocortisone cream on the area a few 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. Many antihistamines cause drowsiness, so you may want to take the medicine only at bedtime. (It is important to prevent scratching during sleep.) Some antihistamines are available that do not cause drowsiness. These nonsedating antihistamines are more expensive, but they can be taken day or night to prevent itching. Your health care provider may recommend that you take antihistamines daily, or you may need to take them only as you need them. Steroid creams or ointments can help control the itching and rash caused by severe eczema. Use these medications exactly as prescribed by your health care provider for the best results. Steroid creams and ointments come in many different strengths. Some should be used just once a day, some four times a day. Do not use them more often than recommended. Serious complications can develop from overuse of steroid medications. 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 tub baths or showers less often. Take sponge baths between baths or showers. Use moisturizing creams or ointments, rather than water-based lotions, regularly (several times a day, if possible). Recent research has suggested that people who are allergic to dust mites may be more likely to have severe eczema. Some health care providers may decide to test for an allergy to dust mites. If test results clearly show you are allergic to dust mites, your provider may recommend that you try to rid dust mites from your home. Before you have allergy tests, you might first see if your symptoms improve if you do everything you can to eliminate dust mites from your home. To reduce the population of dust mites in your home, you must dust all surfaces often. 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 wet-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). What can be done to prevent eczema? To prevent mild eczema, you may need to avoid certain foods or medicines when possible. 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 your worsening of symptoms during times of stress is only temporary. Courtesy of MoonFamilyPractice
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