How to Eliminate Eczema

What is eczema?

Also known as atopic dermatitis, eczema is a chronic inflammatory skin condition that typically affects children but can also affect adults. Approximately 10% to 20% of children and 1% to 3% of adults have the condition. Over the past 3 decades, however, eczema has become even more common.¹

Eczema is characterized by itching (pruritus), skin dryness (xerosis), redness (erythema), and skin oozing, crusting, thickening, and discoloration. Its exact cause is unknown, but research suggests that a combination of factors, including genetics, dysfunction in the skin’s natural barrier, an impaired immune response, and environmental triggers, are at play.²

What are the key features of eczema?

Several types of eczema exist, with symptoms ranging from mild to severe. The appearance of eczema can range from mildly dry, itchy skin to severely dehydrated skin that is painfully inflamed, red, cracked, and/or bumpy. The inflammation can become so severe that the skin cracks and bleeds. Over time, repeated skin irritation can lead to skin thickening, known as lichenification, and darkening of the skin, known as hyperpigmentation.

Symptoms of eczema usually manifest at an early age. Approximately 60% of affected patients will have their first presentation within the first year of life, and 90% will have an eruption by age 5. About 10% to 30% of patients will continue to have eczema throughout adulthood. Many patients with eczema have a personal or family history of allergies, eczema, or asthma. Itching (pruritus) and dry skin (xerosis) are important symptoms.³

The itch of eczema can be extremely bothersome to patients. Up to 60% of children will experience sleep disruption as a result. Antihistamines can be particularly helpful for managing itch and other allergic symptoms and may help with the disruption of sleep.^3,4

How is eczema diagnosed?

Eczema is generally diagnosed by physical examination and patient history. Numerous scales are used to measure disease severity. These scales tend to focus on the rash characteristics and the impact of eczema on the patient’s quality of life. The health care provider may ask the patient questions about how the eczema impacts sleep, daily activities, and school as well as questions about the persistence of symptoms.^3,4

The distribution of rashes and timing of rash development can tell the health care provider a lot about the potential diagnosis. The rash of eczema generally appears in the following distribution patterns^1-3:

• Infants and toddlers:Cheeks, forehead, scalp, and extensor surfaces
• Older children and adolescents:Flexural areas of the neck, elbows, wrists, and ankles
• Adults:Lichenification in flexural regions and involvement of the hands, wrists, ankles, feet, and face (particularly the forehead and around the eyes)
• Any age group:Flexural regions and sparing the groin and axillary regions

How is eczema treated?

No cure exists for eczema. It is a chronic condition that may wax and wane, and the mainstay of treatment is preventing flare-ups and minimizing symptoms.

To prevent flare-ups, one must take measures to avoid triggers. This can be done by keeping a journal to track exacerbations and determine what treatments work best. Eczema triggers and stress should also be avoided as much as possible.

• Journaling:With any chronic health condition, it is always a great idea to start a journal and keep track of flares. The patient may learn that particular foods, places, chemicals, body washes, clothes, or activities lead to flares. Individual responses to certain products or medications may vary.
• Triggers:General triggers should be avoided, such as low humidity, high heat, prolonged baths or showers, fragrances, and topical preservatives.
• Stress:Too much physical or emotional stress can lead to eczema flares. Affected individuals should identify stressors in their life and learn therapeutic coping mechanisms.

For all stages of eczema, keeping the skin well hydrated is imperative. Mild to moderate eczema may be treated with topical medications, such as corticosteroids. In more severe cases, oral prescription medications and possibly phototherapy may be required. The goal of treating is eczema is not to cure the disease but to prevent flare-ups, minimize symptoms, and prevent secondary infections.

Sara Marlowis a licensed and board-certified family nurse practitioner, public health nurse, and adjunct assistant professor of health policy. She was the spring 2015 health policy fellow at the American Association of Nurse Practitioners’ government affairs office in Washington, DC, and is the current co-chair of the Health Policy and Practice Committee of the California Association for Nurse Practitioners.

References

1. Atopic dermatitis. American Academy of Dermatology website. aad.org/public/diseases/eczema/atopic-dermatitis. Accessed April 18, 2016.
2. Learning module: Atopic dermatitis. American Academy of Dermatology website. aad.org/education/basic-derm-curriculum/suggested-order-of-modules/atopic-dermatitis. Accessed April 18, 2016.
3. Eichenfield L F, Tom W, Berger T et al. Guidelines of care for the management of atopic dermatitis.Journal of the American Academy of Dermatology. 2014;71(6):116-127. doi:10.1016/j.jaad.2014.08.038.
4. Weston WL, Howe W. Treatment of atopic dermatitis (eczema). In: Post T, ed.UpToDate. Waltham, Mass.: UpToDate; 2016.uptodate.com. Accessed March 20, 2016.