Vrinda Kumar, M.D.
Eczema is a general term used to describe an inflammation of the skin with can cause itching, oozing, weeping, crusting or scaling. Even though there are several different kinds of eczema, in a pediatrician’s office, you will often hear the terms “eczema” and “atopic dermatitis” used interchangeably. The symptoms of eczema are caused by a combination of inflammation, as well as a defect in the layers of the skin that are supposed to protect the skin from irritants/bacteria and keep skin moisturized. The result is VERY ITCHY SKIN!
Signs and symptoms of eczema generally show up in infancy or toddlerhood. It also tends to run in families. Most people outgrow it by age 10, but a certain percentage of people will continue to have flares throughout adulthood. It tends to be a chronic issue for most people, which means it can come and go for several years.
The most common places on the body to get eczema in infants is on the cheeks and scalp. For toddlers and older children, it tends to affect the creases behind the elbow, behind the knee, legs, and neck. It can look red, dry, dark brown, “goose-bumpy”, scaly, and can cause skin darkening or even skin lightening in some people. People with atopic dermatitis are at higher likelihood of having allergies (food and environmental) and asthma.
There are some things that can trigger eczema flares or make them worse, and these things should be avoided by people with eczema. These include:
- Skin irritants such as dyes and fragrances in skin products
- Certain foods like dairy, nuts, eggs, soy, wheat, especially if the person has an allergy to these foods
- Extremes of temperature and humidity
- Stress
- Hormones (especially in women)
- Illnesses (for example, colds and respiratory infections)
There is no specific test to diagnose eczema, nor is there a cure. The key to managing eczema is to keep the skin well moisturized, keep the itching at bay for the comfort of the patient, and decreasing the inflammation of the skin. Also, skin that is affected by eczema is more prone to getting infected with bacteria, so it is important to watch for signs of infection.
The mainstays of managing eczema and avoiding flares include:
- Avoiding irritants or known allergens that may trigger flares (use unscented, dye-free skin products, soaps, lotions, laundry detergents)
- Keeping the skin well moisturized with a thick emollient, and applying it when the skin is still damp (like after a bath)
- Using over-the-counter or prescription anti-inflammatory creams (as recommended by your doctor!), such as hydrocortisone, Desonide, Triamcinolone, or other anti-inflammatory creams/ointments that may be given by
your physician depending on the severity of the eczema - Trying to control the itch by either cool compresses or an oral antihistamine (also, only if recommended by your physician!)
- Antibiotics if the skin gets infected.
- Wear natural, soft fibers such as cotton (avoid itchy wool!)
Interesting fact: some recent studies have shown that introducing fish into a child’s diet before age 12 months can reduce the risk that the child will develop eczema or wheezing in later months!
Eczema can usually be diagnosed by a physician by simply looking at the rash in the office. Sometimes, allergy testing is performed in children to figure out potential allergic triggers that may be exacerbating the eczema. In more serious cases of eczema, your physician may choose to refer you to a specialist for further treatment (dermatologist or an allergist).