Eczema: Atopic Dermatitis

  • Basics

    Eczema is a long-term inflammation or irritation, of the skin with sudden and often intense flare-ups. People with eczema have patches of dry, red, inflamed, and extremely itchy skin. Figure 01 During an eczema flare, affected areas of the skin become very dry, reddened, and irritated. Repeated scratching can cause the skin to thicken. It can also break the skin and introduce bacteria, causing an infection. When this happens, the skin will look wet, and a crust may form over the surface. Repeated outbreaks can lead to a type of eczema that is characterized by raw, thick, and scaly (lichenified) skin.

    Eczema is a general term that covers many types of skin inflammation. Atopic dermatitis (AD), for example, is a chronic (long-lasting) type of eczema that occurs in people with a genetic predisposition.

    Other types of eczema—such as contact dermatitis—are not long-lasting. These types, triggered by an external irritant, go away once the irritant is removed. However, people with AD will continue to have flares, and their skin can be easily inflamed even when the trigger is no longer present.

    Eczema is similar to other conditions like asthma and seasonal allergies in that it involves a bodily response to the environment. Eczema often flares up as a result of triggers such as sweat, heat, or exposure to irritating chemicals. Often, this type of sensitivity tends to run in families.

    While eczema primarily affects young children, 90% grow out of it by puberty.

    Eczema is a fairly common skin disorder. It affects approximately 7% of all children and typically appears in the first year of life, gradually subsiding as children grow older. If the eczema persists beyond a child's second birthday, he or she is more likely to have lifelong skin allergies. At least 60% of children with eczema will have some form of skin irritation throughout their lives.

    The face, neck, knees, elbows, and wrists are the most common sites of eczema outbreaks in children.

    In very young children, eczema tends to appear on the face, elbows, knees, and wrists because these are the places that rub against bedding. Scratching and rubbing often lead to eczema flare-ups. In adults and older children, eczema will tend to appear in areas where moisture collects—on the insides of elbows, the backs of knees, or the neck.Figure 02

    In most cases, self-care, over-the-counter medications, or prescription drugs can control eczema.

    Click to enlarge: Eczema

    Figure 01. Eczema

    Click to enlarge: Areas where eczema breakouts often occur

    Figure 02. Areas where eczema breakouts often occur

  • Causes

    The cause of eczema remains unclear, but is thought to be a combination of environmental triggers, heredity, and infections.

    Eczema erupts when scratched, rather than being a rash that itches. Therefore, it has been called "the itch that rashes."

    Stimuli or triggers that can cause itching include sweating, high or low humidity, wool, emotional stress, allergens, soaps, and foods. Certain types of bacteria may also contribute to AD. For example, the bacteria Staphylococcus aureus live on the skin of 90% of people with AD. Only 5% of people who do not have AD carry the bacteria.

    Family inheritance is involved in the development of eczema.

    Also, eczema appears to be linked to other familial diseases such as asthma.

    Food allergies may cause flares in some children.

    The following foods may cause an allergic reaction:

    • eggs
    • milk
    • peanuts
    • soy
    • wheat
    • nuts
    • fish

    A doctor can help you address dietary issues or refer you to a pediatrician who specializes in nutrition. In addition, food sensitivities tend to decrease over time. The majority of adults with AD do not have a food allergy.

    People who have eczema should keep their skin moist, as dry skin contributes to eczema flares. Use a moisturizer that does not sting the skin when applied, and that does not contain additives that might cause allergies.

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