Eczema Dermatitis


A common skin condition, atopic dermatitis is frequently described as "the itch that rashes". Intensely itchy patches form. These patches can be widespread or limited to a few areas. Scratching often leads to redness, swelling, cracking, "weeping" of clear fluid, crusting, and scaling of the skin. Constant scratching can cause skin damage, infection, and sleep loss. This is a common skin disease in children. It is so common that people have given it a few names:

  • Eczema (name most people use)
  • Dermatitis
  • Atopic (a-top-ic) eczema
  • Atopic dermatitis

To avoid confusion, we’ll use the medical term atopic dermatitis Ten to 20 percent of children and 1 to 3 percent of adults develop atopic dermatitis, making it the most common type of eczema. For 60 percent or more, atopic dermatitis begins during the first year of life, and at least 80 percent have the condition before age 5. While rare, atopic dermatitis can first appear at puberty or later.

Infantile Eczema

When atopic dermatitis begins during infancy, it often is called infantile eczema. In infants, itchy patches tend to develop on the scalp, forehead, and face, especially on the cheeks. For some children, the condition completely resolves by age two. If the condition does not resolve, the childhood phase of atopic dermatitis begins. During the childhood phase, itchy patches usually form on the back of the knee and the inside of the elbow. When atopic dermatitis develops in an infant or young child, the child tends to get better with time.

Eczema Later in Life

Atopic dermatitis also can be a lifelong condition. Fortunately, for many it tends to become less severe with age. During the teenage and young-adult years, the itchy patches often develop on the elbows and knees. Other common sites for these patches are the hands, feet, ankles, wrists, face, neck, and upper chest. Patches are not limited to these areas; they can appear anywhere on the body, including around the eyes and on the eyelids.

In teen and adults, patches of atopic dermatitis are typically dry, may look discolored, and also may be scaly or have thickened skin.

Hand Eczema

Atopic dermatitis increases the risk of developing hand eczema. Some people who see their atopic dermatitis clear during adolescence develop hand eczema as adults. More than 50 percent of those who develop atopic dermatitis continue to experience skin rashes as adults, often in the form of hand eczema. Hand eczema has many causes. Overexposure to irritant chemical trauma, such as soap and water or other solvents, and physical trauma such as digging in the garden with bare hands or handling large quantities of paper, can cause hand eczema or make pre-existing hand eczema worse. Persons with atopic dermatitis have sensitive skin often making them predisposed to other skin problems. Without proper diagnosis and treatment, hand eczema can become chronic (long lasting), interfering with everyday activities and on-the-job tasks. Hand eczema can be stubborn. It may take months for the patches of red, scaly, and inflamed skin to heal. For hand eczema to resolve, patients must continue using the medication as directed, possibly change their daily hygiene and work habits, get light therapy, keep appointments with their dermatologist, and not get discouraged.

Diagnosis

Effective treatment requires a correct diagnosis; however, it is not always easy to distinguish one type of eczema from another or from similar skin conditions. Your doctor has the medical training and experience needed to determine if eczema is present, and if present, which type. To diagnose eczema, your doctor examines the skin and asks about:

  • When the skin condition first appeared
  • Signs and symptoms, such as long-term pruritus (itching) or recurring dermatitis (inflammation of the skin)
  • Certain circumstances that may aggravate the condition, such as excessively dry air or emotional stress
  • Family medical history, including questions about close blood relatives who have asthma, hay fever, or eczema
  • Personal medical history
  • In some cases, a skin biopsy may be performed to rule out other causes.

Treatment

Once eczema is diagnosed, a treatment plan will be made based on:

  • Type and severity of the eczema present
  • Age, health, and medical history (including presence of other conditions)

The primary goal of treatment is to relieve discomfort by controlling the signs and symptoms. Since eczema is usually dry and itchy, most treatment plans involve applying creams or ointments to keep the skin as moist as possible. We recommend that lotions should not be used in treatment of eczema. The treatment plan also may require lifestyle modifications and using medication as directed. A topical (applied to the skin) medication may be prescribed to help relieve itching and inflammation.

Another way to treat the itch is with a non-sedating antihistamine. If itching is severe, a sedative antihistamine may be recommended. Certain types of severe eczema may be treated with phototherapy (sun lamp treatments). Oral medications to suppress the immune system, such as corticosteroids and cyclosporine, may be prescribed to treat severe eczema that has been unresponsive to other treatments. Since so many factors affect why a person develops eczema, and since there are different types of eczemas, a treatment plan that works for one person may not effectively control eczema in another person. Sometimes it takes "trial and error" to find an effective treatment plan.

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