Eczema (Atopic Dermatitis): Triggers, Skin Care and When to Be Seen

What it involves

MedlinePlus describes atopic dermatitis, the most common type of eczema, as a long-term skin disorder with scaly, itchy rashes. It is due to a reaction in the skin that causes ongoing itching, swelling, and redness, and people with it may lack specific proteins that keep the skin's water barrier intact. It is most common in infants, and many people outgrow it by early adulthood.

Who this is for

• Patients with a dry, itchy rash that keeps returning, flares in dry weather, or oozes and crusts
• Patients with eczema that is not improving with moisturizer and home care
• Patients who also have asthma or seasonal allergies and notice flares
• Patients with oozing, crusting, or painful skin that may be infected

What to expect

• Questions about where the rash appears, when it flares, and what soaps and products you use
• A look at the skin and a review of your personal and family history of allergies
• A plain skin-care plan with moisturizing steps and what to avoid
• A plan that may include a medicated cream or a referral to a skin specialist

What makes it flare

MedlinePlus lists common triggers for atopic dermatitis:

• Allergies to pollen, mold, dust mites, or animals
• Cold, dry winter air, and getting too hot or too cold
• Dry skin from frequent baths, showers, or swimming
• Contact with irritants, chemicals, wool, or rough materials
• Perfumes or dyes in lotions and soaps
• Colds or the flu, and emotional stress

What eczema looks like

MedlinePlus says skin changes include dry skin, blisters that ooze and crust, raw areas from scratching, redness, color changes, and thick, leathery patches after long irritation. In older children and adults the rash is more often on the inside of the knees and elbows, the neck, hands, and feet, and in adults it may be limited to the hands or eyelids. Itching often starts before the rash does, which is why it is called the itch that rashes.

Daily skin care at home

MedlinePlus says daily care can cut down the need for medicine. It suggests moisturizing with lotions, creams, or ointments such as petroleum jelly two to three times a day, choosing products without alcohol, scents, or dyes, and using a humidifier. For bathing it recommends short, cooler baths, gentle cleansers instead of regular soap, patting rather than scrubbing, and applying moisturizer while the skin is still damp. Keeping fingernails short, and light gloves at night if you scratch in your sleep, can limit damage.

Medicines a provider may use

MedlinePlus says atopic dermatitis is usually treated with medicines applied to the skin, often starting with a mild corticosteroid cream such as hydrocortisone and moving to a stronger one only if needed. It also lists topical immunomodulators for people over age 2, barrier repair creams with ceramides, antihistamines by mouth for itching, and antibiotics if the skin becomes infected. Other options include phototherapy and targeted biologic medicines, which a specialist would manage. The skin conditions guide explains how other rashes are sorted.

Signs it needs a visit

MedlinePlus says to contact your provider if eczema does not get better with home care, if symptoms get worse or treatment does not work, or if there are signs of infection such as fever, redness, or pain. It notes that people with eczema may get skin infections easily, and that complications can include infections caused by bacteria, fungi, or viruses, permanent scars, and side effects from long-term use of strong medicines.

Outlook

MedlinePlus says atopic dermatitis can last a long time and that treating it, avoiding irritants, and keeping skin well moisturized help control symptoms. In children it often starts to go away around age 5 or 6, though flare-ups continue, while in adults it is generally long term or returning. Eczema that begins early, covers a large area, comes with allergies and asthma, or runs in the family can be harder to regulate.

Sources

• MedlinePlus — Atopic dermatitis
• MedlinePlus — Eczema