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What is eczema?

Eczema is a very common skin condition, which usually presents as a dry, itchy, red area of the skin.  It is also known as dermatitis; therefore, the terms may be used interchangeably.  Dermatitis is inflammation of the skin.  Eczema in brown and black skin patients appears as ashen, grayish, or brown in color.  It is a commonly seen skin disorder in children and infants.

Common Types of Eczema:

Atopic Dermatitis (Atopic Eczema):
Often begins in infancy due to unknown cause.  Skin may have dry, flaky, itchy lesions or small hard blister-like rash.  Can appear anywhere on the body, but is often seen on the hands, feet, wrists, ankles, elbows and knee creases in children.  In adults, it usually presents on the face, neck, hands, feet, and creases of elbows and knees.  Many patients who suffer from asthma and allergic rhinitis commonly have atopic dermatitis as well.

Nummular Dermatitis (Nummular Eczema):
This form of eczema presents as very itchy coin-shaped areas of inflammation and can be crusty or scaly.

Contact Dermatitis:
As the name implies, this type of eczema is a result of excessive contact with an irritant, which results in skin irritation and inflammation.  Common irritants include soaps, detergents, chemicals, and other household products.  Patients exposed to allergens such as poison ivy, metals, fragrances, etc also fall into this type of eczema.

Eczema in patients with skin of color can experience darkening of the skin due to itching and scratching.  This is call post-inflammatory hyperpigmentation, which is caused by trauma to the skin from scratching.  In most cases, this hyperpigmentation can resolve once the inflammation and itching are addressed.  In some cases; however, the hyperpigmentation can last for months to years, and may need to be treated with a cosmetic fading cream to even the tone.

What is the cause of Eczema?
The cause of atopic dermatitis and many forms of eczema is unknown, but many believe there is a genetic component.  Triggers are things that cause the skin to become irritated, inflamed, or dry, and include:  stress, weather changes, irritants, environmental or food allergens, hot water/showers, and low humidity.

How do I know if I have Eczema?
Eczema is usually diagnosed clinically. Direct physical examination and taking of a medical history allow dermatologists to accurately recognize the different forms of eczema. They may also ask about family history of eczema and associated diseases.  A skin biopsy may be obtained for further evaluation in the laboratory.

How is Eczema treated?
There are many helpful, easy ways to treat or soothe eczema. The first step is to avoid irritants or allergens, to which your body may react.  It is critical to moisturize as part of your daily routine.  Gentle skin care is important and may include:

  • Avoid extremely hot or extremely cold showers/baths
  • Avoid excessive exposure to sunlight
  • Avoid exposure to smoke
  • Avoid becoming overheated (exercising) 
  • Avoid fragrances (perfumes, colognes, cleansers, detergent, etc.)
  • Wear looser-fitting clothing
  • Avoid foods known to cause allergies
  • Apply moisturizer right after bathing
  • Avoid scratching – try using a cloth or pat the area gently

A provider may likely prescribe medications to help reduce the inflammation, dryness, and itching of your eczema.  Medications may include a topical corticosteroid, a systemic steroid by mouth, and an antihistamine by mouth.  In some severe cases, your provider may prescribe an antibiotic if a skin infection is suspected.  Additionally, your provider may recommend intralesional steroid injections as an add-on therapy to reduce the inflammation faster.   In some severe and persistent cases, additional medications are recommended.