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Keratosis pilaris - close-up
Keratosis pilaris - close-up


Atopic dermatitis
Atopic dermatitis


Atopy on the ankles
Atopy on the ankles


Dermatitis, atopic on the arms
Dermatitis, atopic on the arms


Dermatitis, atopic in an infant
Dermatitis, atopic in an infant


Hyperlinearity in atopic dermatitis, on the palm
Hyperlinearity in atopic dermatitis, on the palm


Eczema, atopic - close-up
Eczema, atopic - close-up


Dermatitis, atopic on a young girl's face
Dermatitis, atopic on a young girl's face


Keratosis pilaris on the cheek
Keratosis pilaris on the cheek


Dermatitis, atopic on the legs
Dermatitis, atopic on the legs


Hyperlinearity in atopic dermatitis
Hyperlinearity in atopic dermatitis


Definition:

Eczema is a chronic skin disorder that involves scaly and itchy rashes.



Alternative Names:

Infantile eczema; Atopic dermatitis; Dermatitis - atopic



Causes, incidence, and risk factors:

Eczema is due to a hypersensitivity reaction (similar to an allergy ) in the skin, which leads to long-term inflammation. The inflammation causes the skin to become itchy and scaly. Long-term irritation and scratching can cause the skin to thicken and have a leather-like texture.

Eczema is most common in infants. The condition tends to run in families.

People with eczema often have a family history of allergic conditions such as asthma , hay fever , or eczema.

The following can make eczema symptoms worse:

  • Dry skin
  • Exposure to environmental irritants
  • Exposure to water
  • Stress
  • Temperature changes


Symptoms:

Signs and tests:

Diagnosis is primarily based on the appearance of the skin and on personal and family history. The health care provider should examine the lesions to rule out other possible causes. A skin lesion biopsy may be performed, but is not always required to make the diagnosis.



Treatment:

Treatment can vary depending on the appearance (stage) of the lesions. "Weeping" lesions, dry scaly lesions, or chronic dry, thickened lesions are each treated differently.

  • Avoid anything that makes your symptoms worse. This may include food allergens and irritants such as wool and lanolin.
  • When washing or bathing, keep water contact as brief as possible and use less soap than usual. After bathing, it is important to trap the moisture in the skin by applying lubricating cream on the skin while it is damp. Dry skin often makes the condition worse. Temperature changes and stress may cause sweating and aggravate the condition.
  • Treat weeping lesions with soothing moisturizers, mild soaps, or wet dressings.
  • Use mild anti-itch lotions or topical corticosteroids to soothe less severe or healing areas, or dry scaly lesions.
  • You can treat chronic thickened areas with ointments or creams that contain tar compounds, powerful anti-inflammatory medicines, and ingredients that lubricate or soften the skin.
  • Your health care provider may prescribe oral corticosteroids to reduce inflammation if the condition is severe.
  • Medicines called topical immunomodulators (TIMs) may be prescribed in some cases. TIMs include tacrolimus (Protopic) and pimecrolimus (Elidel). These medications do not contain corticosteroids.


Support Groups:



Expectations (prognosis):

Eczema is a chronic condition, but you can control it with treatment and by avoiding irritants. In children, it often clears up by early adulthood. In adults, it is generally a long-term or recurring condition.



Complications:
  • Bacterial infections of the skin
  • Permanent scars


Calling your health care provider:

Call for an appointment with your health care provider if:

  • Eczema does not respond to moisturizers or avoiding allergens
  • Symptoms worsen or treatment is ineffective
  • You have signs of infection (such as fever, redness, pain)


Prevention:

Studies have shown that children who are breast-fed are less likely to get eczema. This is also true when the nursing mother has avoided cow's milk in her diet. Other dietary restrictions may include eggs, fish, peanuts, and soy.

Eczema tends to run in families. Controlling stress , nervousness, anxiety , and depression can help in some cases.



References:

Habif TP. Clinical Dermatology. 4th ed. St. Louis, Mo: Mosby; 2004:41.

Goldman L, Ausiello D. Cecil Textbook of Medicine, 22nd ed. Philadelphia, Pa: WB Saunders; 2004:2458-2460.

Lewis-Jones S, Mugglestone MA; Guideline Development Group. Management of atopic eczema in children aged up to 12 years: summary of NICE guidance. BMJ. 2007;335:1263-1264.

Ascroft DM, Chen LC, Garside R, Stein K, Williams HC. Topical pimecrolimus for eczema. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005500.




Review Date: 10/28/2008
Reviewed By: Michael Lehrer, MD, Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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