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Eczema

Alternate Names

  • atopic dermatitis
  • atopic eczema
  • Dyshidrotic eczema

Definition

Eczema is a skin condition that causes patches of dry, scaly, extremely itchy skin.

What is going on in the body?

Eczema usually results from a hypersensitivity, or allergy-like sensitivity, causing inflammation. The inflammation causes the skin to become itchy and scaly. Eczema is not a true allergy. Rather, it is a condition in which the skin may react or become sensitive to allergens, which are allergy-causing substances.

Risks

What are the causes and risks of the condition?

Eczema is usually related to a history of hypersensitivity or reaction in the body similar to an allergy. Although eczema is more common in babies and young children, older children and adults may also experience eczema. It seems to be more evident in those with a history of asthma or hay fever. It is also more common in a person who has a family history of eczema, hay fever, or other respiratory allergies.
Flare-ups of eczema may occur with exposure to environmental factors, such as stress, dry climate or high temperatures, soaps, chlorine, and other irritating substances. Foods that may cause worsening of symptoms include peanut butter, milk, or eggs.

Prevention

What can be done to prevent the condition?

Eczema cannot be prevented, but progression of symptoms may be decreased by avoiding allergens that seem to cause flare-ups. Controlling stress or anxiety-producing situations may also decrease risk of eczema flare-ups.

Diagnosed

How is the condition diagnosed?

The healthcare professional will usually obtain a family and personal history of allergy-related conditions. A thorough exam will usually be done to examine the rash and rule out any other possible causes for it. The professional may take a sample of fluid oozing from a lesion and send it to the laboratory to identify any bacteria that may be present.
Sometimes a biopsy of the lesions may be done. For a skin biopsy, the provider takes a small sample of skin and sends it to the laboratory to rule out other causes. If the rash continues, blood tests may also be helpful to rule out other associated conditions.

Long Term Effects

What are the long-term effects of the condition?

Long-term effects of eczema include infection and scarring. Other long-term effects may include emotional frustration from having to live with the disfiguring skin rashes and scars. Up to 40% of children will outgrow eczema. Long-term effects can usually be reduced with early treatment.

Other Risks

What are the risks to others?

Eczema is not contagious, but if the lesions become infected, the organism causing the infection may be contagious.

Treatments

What are the treatments for the condition?

The main goal of treatment is to minimize and treat symptoms. Treatment may include the following recommendations:
  • Avoid irritants that tend to worsen symptoms.
  • Avoid scratching the lesions.
  • Keep the skin moist with moisturizing creams, lotions and ointments to reduce symptoms.
  • Avoid excessive and lengthy baths. .
  • Don't bathe babies with soap too frequently. Mild neutral soaps are recommended as needed, and bubble baths should be avoided.
  • Keep infants' and children's fingernails cut short to avoid irritating lesions from scratching.
  • Avoid heavy ointments such as petroleum jelly or vegetable shortening. These products can make symptoms worse because they block the sweat glands.
Medications used to treat eczema include the following:
  • topical cream or ointment for lesions that are oozing or extremely itchy, including mild anti-itching lotions or topical steroids
  • an immunomodulator cream, pimecrolimus (i.e., Elidel), reduces inflammation without using steroids
  • coal-tar compound ointments or topical steroids for chronic thickened patches
  • oral steroids, such as prednisone, for severe cases of eczema or inflammation
  • antibiotics for secondary infection
  • antihistamines to reduce inflammation and itching

Side Effects

What are the side effects of the treatments?

Side effects to treatment depend on the treatment used. Topical steroid ointments and oral steroids can cause further irritation of the skin or secondary skin conditions. Antibiotics can cause stomach upset, diarrhea, and allergic reaction . Some antihistamines can cause drowsiness.

After Treatment

What happens after treatment for the condition?

After treatment, a person who has eczema may need to avoid situations or conditions that make the eczema worse.

Monitor

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare professional.

Sources

Mayo Clinic Family Health Book, David E. Larson, 1996 [hyperLink url="http://www.aad.org/pamphlets/eczema.html" linkTitle="www.aad.org/pamphlets/eczema.html"]www.aad.org/pamphlets/eczema.html[/hyperLink]

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