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Eczema: Causes, Treatment And Prevention

Eczema: Causes, treatment and Prevention
Submitted and Medically Reviewed By: Dr. Mavra Farrukh

Overview

Eczema (atopic dermatitis) is a prevalent and uncomfortable skin condition that can affect your quality of life. However, 15% to 20% of people have eczema or a form of dermatitis, so you are not alone. Eczema can be managed if you have sufficient knowledge about the disease, and this article aims to provide that. 

What is eczema?

Eczema is a skin condition, one of many types of dermatitis. In true meaning, “dermatitis” means “inflammation of the skin.” While “derm” means “skin” and “itis” means “inflammation.” “Eczema” has its root in the Greek word “ekzein” which means to “break out.”

An eczema skin rash can present as dry, itchy, red, and bumpy skin. Eczema damages the skin barrier. Resultantly, the loss of barrier function makes the skin more sensitive and prone to infection.

Eczema is not a contagious condition, and it does not cause any harm to the body. In addition, some treatments can help manage your symptoms. 

What are the causes of eczema?

The skin serves as a barrier against physical threats in the environment such as liquids, gases, infections, and temperature changes. However, external components such as pollution can breach that barrier—the likelihood increase when the skin barrier is already compromised.

A mixture of environmental factors and genetics have been identified that cause one to develop eczema. For example, an individual with an overactive immune system may have a genetic predisposition and exposure to external irritants like smoke or chemicals in the environment can trigger an eczema flare.

So a combination of the following can result in an eczema outbreak:

  • Immune system:  If you are diagnosed with eczema, your immune system overreacts to environmental allergens, resulting in skin inflammation. 
  • Genetics: You’re more prone to develop eczema if there is a history of dermatitis in your family. The risk further increases if there’s a history of asthma or hay fever as well. A change in your genes that controls a specific protein that helps your body regulate healthy skin may be one underlying factor contributing to your body initiating such a response in the skin.   
  • Your environment: Allergens include substances like pet hair, pollen or foods that can trigger an allergic reaction. Other environmental factors that can trigger or worsen eczema include tobacco smoke, harsh soaps, fabrics such as wool, detergents, and some skin care products. Changes in temperature or low humidity/dry air can cause your skin to become dry and itchy. Heat and high humidity can worsen a current eczema flare-up.
  • Your stress: Stress levels contribute significantly to developing or worsening your eczema breakout. There are mental signs of stress and physical signs of stress. Some of these include:

Mental signs:

  • Depression.
  • A negative opinion of yourself.
  • Anxiety.
  • Feeling overwhelmed.
  • Difficulty concentrating.
  • Irritability.
  • Mood swings
  • Use of alcohol, tobacco or other drugs.

Physical signs:

  • Nausea
  • Dizziness.
  • Loss of libido.
  • Sleeping a lot.
  • Inability to sleep.
  • Diarrhoea.
  • Constipation.
  • Muscle tension.
  • Body aches.

Who is at risk of getting eczema?

Eczema usually begins in childhood that is referred to as a baby’s eczema. But it isn’t age-specific, and you may develop adult eczema at any age. The following factors increase your risk:

  • Being a female.
  • Belonging to African American descent.
  • Having asthma or hayfever. 
  • Having a family of dermatitis or asthma.

Eczema flare-up causes

An eczema flare-up occurs when such symptoms appear on the skin. External and internal factors can contribute to eczema flares. Some reasons for eczema flare-up include:

  • cigarette smoke
  • allergens such as pollens, dust, dust mites or mould
  • scented products
  • chemicals found in cleansers/ detergents
  • scented products
  • synthetic fabrics
  • upper respiratory infections
  • temperature changes
  • stress
  • food allergies
  • animal dander
Do you have a rash? Chat with a doctor to find out the cause

What are the symptoms of eczema?

Eczema/atopic dermatitis symptoms include:

  • Dry skin.
  • Itchy skin.
  • Red rashes.
  • Bumps on the skin.
  • Scaly, leathery patches of skin.
  • Crusting skin.
  • Swelling.

Symptoms can vary according to the kind of eczema that you have. For example, some forms, such as mild discord eczema, result in discharge or fluid from the eczematous patches from the skin, while others simply result in discoloration from eczema.

Eczema is often found to be associated with the following conditions:

What are the 3 stages of eczema?

Eczema’s progression isn’t always linear. The rash can begin at the acute stage and then progress to the subacute and chronic phases. It can start at the subacute stage and remain in that stage or switch to to the acute stage.

The rash can progress or improve and symptoms can halt at any stage as well. 

Acute:

This refers to an eczema rash that has just started, usually when the skin comes into contact with an irritant or allergen. This short-term eczema may last for a few weeks before the skin heals. Intense itching is one of the first signs of acute eczema. Some common presentations include unexplained itching all over the body at night or itchy bumps on elbows or other parts of the body. 

Some characteristic symptoms that indicate an acute stage of eczema include:

  • Intense itching
  • Swelling
  • Tenderness
  • Bumps
  • Redness
  • Fluid-filled blisters that may ooze
  • Pain

Symptoms of eczema are typically intense during this initial phase. This is the reason why this stage is often referred to as a flare-up.

Acute eczema can be caused by direct contact with allergens or can result from a reaction to a primary infection such as a fungal infection, in such case, a skin rash develops at a distant site. Worsening of the existing condition may occur as well.

Some evidence suggests that Staphylococcus aureus colonies growing on the skin may contribute to disease flares up in the case of atopic dermatitis.

Acute Stage Treatment Options:

Some treatment options to manage the acute stage include:

  • Antihistamines
  • Application of cold/wet compresses
  • Topical steroids(Hydrocortisone cream)
  • Oral steroids(if the rash is severe or widespread)
  • Antibiotics(if the rash is infected)

Subacute

This is considered the transitional phase between the acute and chronic stages. Itching is mainly replaced by a stinging or burning sensation in this stage. The borders of the rash lose their distinct margins, and eczema dry patches on the skin appear.

Subacute phase symptoms are less severe than those in the acute stage. 

However, stinging and burning in the subacute stage are more intense. The rash is dry, and typically there isn’t any oozing.

The subacute stage is the “middle” stage of the progression. Although, eczema can begin at this stage as well. Some symptoms that help define this stage include:

  • Flaky or scaly skin
  • Dry skin or cracks in the skin
  • Itching, burning, and stinging
  • Redness that may be less prominent than that of the acute stage

Many acute eczema rashes shift to the subacute phase as they heal. During an eczema flare, subacute rashes can get worse and convert into the acute phase. Moreover, long-lasting subacute rashes can become chronic.

Subacute Stage Treatment Options:

Some treatment options to manage the acute stage include:

  • Moisturisers
  • Coal Tar Products
  • Antihistamines
  • Topical Steriods
  • Topical Calcineurin Inhibitors

Chronic

These eczema flares are long-lasting. It may take a couple of months for symptoms to appear. Chronic eczema is not only defined by a specific time duration. This stage has its own set of characteristic symptoms that sets it apart from the other two phases; eczema discolouration is one such symptom. 

Other symptoms of chronic eczema include:

  • Cracks in the skin
  • Itching
  • Dark, dull, or discoloured skin
  • Deeper skin lines
  • Larger areas of skin breakdown known as excoriations
  • Thickened/ leathery-looking skin or lichenification.

Symptoms during this stage are often severe. Many symptoms result from repeated scratching of the skin due to intense itching.

Chronic Stage Treatment Options:

  • Moisturisers
  • Topical steroids(more effective when the area is wrapped)
Dry,red and itchy skin can be due to eczema. Chat with a doctor for treatment options.

How is eczema diagnosed?

In order to diagnose eczema, your doctor will examine your skin. First, they will look for signs of eczema, including a rash, redness or dryness. Furthermore, your doctor may enquire further about the symptoms that you’re experiencing.

Usually, your doctor can diagnose eczema after examining your skin. However, for confirmation, the following tests may be done:

  • An allergy skin test.
  • Blood tests to check for other underlying causes.
  • A skin biopsy helps differentiate one form of dermatitis from another.

Treatment and Prevention of Eczema

Treating eczema (atopic dermatitis) can be quite challenging, and simply resorting to using Aveeno eczema therapy might not cut it for you. However, you can not do much regarding the genetic component but can control or manage the environmental exposure and reduce your stress levels. In addition, figuring out what triggers or worsens your eczema can help prevent it. The goal of treatment is to reduce discomfort and itching and to avoid infection and flare-ups.

Medications used to treat the symptoms of eczema, include:

  • Topical corticosteroid creams/ointments: These are common eczema creams prescribed by doctors. These are anti-inflammatory medications and usually help relieve inflammation and itchiness. Patients are instructed to apply them directly over the affected area. In severe cases, prescription-strength topical steroids are prescribed.
  • Oral medications: If topical treatments do not work for you, your doctor may prescribe oral medications. These include systemic corticosteroids or immunosuppressants. These medications are available as injections or oral tablets and are given for short periods. The symptoms may worsen after stopping or coming off such medications. 
  • Antibiotics: Antibiotics are prescribed if a bacterial skin infection accompanies eczema.
  • Antihistamines: This help combats the itching and can help reduce itching/scratching at night as they cause drowsiness.
  • Topical calcineurin inhibitors: This drug suppresses the immune system, resulting in decreased inflammation and helping prevent flares.
  • Barrier repair moisturisers: These reduce water loss and help to repair the skin.
  • Phototherapy: This involves exposure to UVA or UVB waves. This form of treatment is beneficial for treating moderate cases. Throughout the treatment, you will be closely monitored by your doctor. 
  • Injected biologic drugs: These medications target specific proteins in the immune system, helping to suppress or modify your immune system’s response.

Even though there isn’t a specific cure for the condition, a person must consult with a doctor to get a proper treatment plan.

Even after the affected area of skin has healed, you must take the right steps to care for it.

Tips to prevent flare-ups 

  • Reduce stress.
  • Avoid known triggers.
  • Keep your skin clean.
  • Reduce your shower duration.
  • Avoid taking a scorching shower.
  • Keep your skin moisturised.
  • Avoid using dye and scented products. 
  • Avoiding scratching the skin
  • Use a mild soap for bathing. Gently pat your skin dry, and then apply a moisturising cream immediately after drying your skin to help lock in the moisture. Reapply the cream several times a day.
  • Use a humidifier if dry air makes your skin dry.
  • Use skin products that contain ceramide. 
  • Wear gloves while working if your job requires you to immerse your hands in water. Additionally, you can wear cotton gloves under plastic gloves to absorb sweat. Moreover, wear gloves when going outside during the winter months.
  • Use mild, unscented soaps or body wash.
  • Drink plenty of water each day. Water helps to keep the skin moist.
  • Wear loose clothes made of cotton to avoid synthetic material. 
  • Avoid drastic changes in temperature and humidity.
  • Identify stressors in your life and learn how to manage or avoid those. Regular exercise, activities and stress-management techniques, such as meditation or yoga, might be beneficial.
  • Limit your exposure to allergens.
  • Avoid scratching or rubbing areas of the skin.
  • Consult a psychiatrist for medication and a therapist for counselling if your mental health worsens or is affected. 

Natural Remedies to Manage Eczema

In order to manage symptoms of eczema, alternate remedies can be tried. However, before using a herbal supplement, it is best to consult with a doctor once to rule out any potential side effects. Some home remedies worth trying include:

  • acupuncture
  • aromatherapy
  • drinking green, black, or oolong tea
  • applying coconut or primrose oils
  • practising relaxation techniques, like meditation or yoga

If your child has eczema spots, eczema on the hands or genital eczema, the following measures may help manage the symptoms:

  • Avoid long, hot baths that can lead to dry skin. Using lukewarm water and giving your child sponge baths is a better alternative.  
  • Apply lotion immediately after bathing. This will help trap moisture in the skin.
  • Moisturising regularly is extremely helpful.
  • Try to regulate the room temperature. Changes in room temperature and humidity can contribute to skin dryness.
  • Dress your child in cotton clothes. Wool, silk and polyester can irritate the skin.
  • Use mild laundry soap to prevent irritation.
  • Keep a lookout for signs of skin infections. If you notice any, contact your doctor. 

Complications of Eczema

Some eczema complications include:

  • Sleep disturbances: Eczema can lead to difficulty sleeping and disrupt your sleep schedule.
  • Skin infections: Continous scratching can cause a break in the skin, making it prone to infections.
  • Asthma:  Eczema may lead to the development of asthma in children younger than age 12.
  • Thick and scaly skin. Repeated scratching can cause your skin to thicken over time.
  • Additional types of eczema: Having one type of eczema can increase your risk of developing another type.

Is there a cure for eczema?

There may be no permanent cure for eczema, but there are treatments that help manage the condition or eliminate the symptoms.

Does eczema spread?

Eczema is not contagious. You can’t get eczema by being in close contact, such as skin-to-skin contact with the person. Bacteria, fungus, or viruses do not cause eczema. However, those with a family history of eczema, asthma, or allergies are at higher risk of developing eczema. 

What foods to eat or avoid to reduce my risk of eczema?

The association between eczema and food allergies is unclear. Suppose you have any kind of food allergies, one of the reasons you must avoid that particular food is that it may trigger or worsen dermatitis. Some common food allergies include peanuts, dairy, eggs, sugar, alcohol and gluten. If your condition flares up after eating a particular food, you are probably allergic to it.

However, food will most likely not trigger an outbreak if you don’t have any food allergy. 

Other Conditions Confused with Eczema

Scabies vs Eczema

Scabies is caused by mites, which are invisible to the naked eye. Burrowing into the skin leads to itching, which can often be confused with eczema. Scabies is contagious, and the areas of the body affected by scabies may differ from eczema. The two conditions can still be confused. 

Psoriasis vs Eczema

Psoriasis leads to itchy, red, scaly, silver-coloured patches on the skin. Most commonly, the patches appear on the knees, elbows or scalp, though they can appear elsewhere on the body. Psoriasis can also make the skin crack or bleed. Unlike eczema, it affects the joints and leads to swollen and stiff joints. Since both conditions can result in flare-ups, one could easily mistake psoriasis for eczema.

Mycosis vs Eczema

Mycosis can be confused with eczema on the hands. This condition is caused by a fungus and leads to redness and itching.

Seborrheic dermatitis vs eczema

Seborrheic dermatitis is also called the “cradle cap” in babies. Although, it can affect adults as well. It results in inflammation of the scalp leading to itching.

Seborrheic dermatitis usually affects the face and scalp in adults. However, in infants, it can affect the diaper region as well. 

Eczema vs Ringworm

Ringworm is a fungal infection. The rash can be scaly, dry or itchy. Itching lasts for a short duration. Eczema lasts longer and often flares up in intensity or changes location on the body. 

When to Consult Your Doctor

About 15% to 20% of people experience some form of eczema at some point in their lives. You might have eczema if your skin is dry, itchy and red. It’s a common skin condition but isn’t contagious. There are treatments that manage symptoms. Eczema can take a mental toll as well. It can disrupt your sleeping and make you develop a poor self-image. Talk with our online doctor at Your Doctors Online to discuss your treatment options. 

Do you have an eczema flare-up? Chat with a doctor for treatment options.

FAQs on Eczema Answered by Your Doctors Online

What causes eczema in adults?

A mixture of environmental factors and genetics have been identified that cause one to develop eczema.

What causes eczema in babies?

Some factors responsible for eczema in babies include:
Immune system
Genetics
Skin irritants /allergens: Certain fabrics, soaps and certain foods.

Why is my eczema spreading?

Exposure to chemicals, irritants, temperature changes, stress, and hormonal changes can trigger or worsen your eczema. 

What causes eczema flare-ups?

External and internal factors can contribute to eczema flares. Some reasons for eczema flare-up include:
cigarette smoke
allergens such as pollens, dust, dust mites or mould
scented products
chemicals found in cleansers/ detergents
scented products
synthetic fabrics
upper respiratory infections
temperature changes
stress
food allergies

Does chlorine help eczema?

Some studies indicate that diluted bleach may help reduce bacteria on eczematous skin and consequently help people with eczema. On the other hand, chlorine can dry out the skin, worsening eczema. 

What gets rid of eczema fast?

Corticosteroid creams, topical ointments, and antihistamines are some treatment options that can help relieve itching and reduce inflammation. 

What is the biggest trigger for eczema?

Some common triggers for eczema include soaps, detergents, washing-up liquid, cigarette smoke, dust mites, stress etc.

What gets rid of eczema naturally?

Some things that may help get rid of eczema or calm down a flare-up include:
Coconut oil
Sunflower oil
Colloidal oatmeal
Calendula cream

What foods to avoid if you have eczema?

Avoiding the following food may help prevent an outbreak:
Citrus fruits
Dairy
Tags
Gluten
Dairy
Peanuts
Soy

What foods help eczema?

Consuming anti-inflammatory foods such as fish, foods high in probiotics, and fruits and vegetables, such as apples, broccoli, cherries, spinach, and kale, can help keep a flare-up at bay. 

What vitamins are good for eczema?

Fish oil, Vitamin D, Vitamin E, Zinc and Probiotics have all shown promising results in helping manage eczema. 

How long does it take for eczema flare-up to clear?

The duration of the flare-up is different for everyone. It can depend on the type and severity of the symptoms. Mostly, the rash or symptoms disappear within a few weeks of treatment. 

How to stop eczema itching immediately?

Applying a steroid cream, calamine lotion or taking antihistamines can help manage the itching associated with eczema. 

Why does my skin hurt?

Pain can occur due to irritation, injury or conditions such as diabetes, shingles, or complex regional pain syndrome.

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Dr. Asim Cheema

Internal Medicine

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