Dry Skin (Eczema)
ECZEMA OVERVIEWEczema, also known as atopic dermatitis, is a skin problem that causes dry, itchy, scaly, red skin. It can affect infants, children, and adults and seems more common in certain families. Eczema can be treated with moisturizers and prescription ointments.
ECZEMA CAUSESAlthough the cause of eczema is not completely understood, genetics appear to play a strong role, and people with a family history of eczema are at increased risk of developing the condition. In most people with eczema, there is a genetic abnormality in the outermost layer of the skin, called the epidermis. The epidermis is the first line of defense between the body and the environment. When the epidermis is intact, it keeps environmental irritants, allergens, and microbes from entering the body and prevents the skin from losing too much water. In people with eczema, this barrier is less strong and more permeable than it should be.
Despite popular belief, in children eczema is rarely linked to food allergies. If you think your child might have a food allergy, you should consult an allergy specialist for evaluation. (See "Patient education: Food allergy symptoms and diagnosis (Beyond the Basics)".)
ECZEMA SYMPTOMSMost people with eczema develop their first symptoms as children, before the age of five. Intense itching of the skin, patches of inflamed skin, small bumps, and skin flaking are common. Scratching can further inflame the skin and worsen the itching. The itchiness may be more noticeable at nighttime.
Eczema symptoms vary from one person to another and can change over time. Although eczema is usually limited to specific areas of the body, it may affect multiple areas in severe cases:
●In infants, there may be inflamed, scaly, and crusted areas on the front of the arms and legs, cheeks, or scalp. The diaper area is not usually affected.
●In children and adults, eczema commonly affects the back of the neck, the elbow creases, and the backs of the knees. Other affected areas may include the face, trunk, wrists, and forearms. The skin may become thickened and darkened, or even scarred, from repeated scratching. Scratching can also lead to infection of the skin. Signs of infection include painful red bumps that sometimes contain pus; if you think you might have an infection, consult your doctor or nurse, as you may need treatment.
Other findings in people with eczema can include:
●Dry, scaly skin ●Plugged hair follicles causing small bumps, usually on the face, upper arms, and thighs. ●Increased skin creasing on the palms and/or an extra fold of skin under the eye ●Darkening of the skin around the eyes
ECZEMA DIAGNOSIS: There is no specific test used to diagnose eczema. The diagnosis is usually based upon your medical history, symptoms, and physical examination.
Factors that strongly suggest eczema include long-term and recurrent itching, symptoms that began at a young age, and a personal or family history of certain allergic conditions (including asthma and seasonal allergies as well as eczema). Another factor to consider is symptoms that get worse after exposure to certain triggers. (See 'Identifying triggers' below.)
ECZEMA TREATMENT: Eczema is a chronic condition; it typically improves and then flares (gets worse) periodically. Some people have no symptoms for several years. Eczema is not curable, although it is possible to control your symptoms with a variety of self-care measures and medications.
Who treats eczema? — Many people with eczema can initially be treated by their primary care provider. However, you may need to see a dermatologist (skin specialist) in certain situations, such as if your condition does not improve with treatment, if certain areas of your body are affected (face or skin folds), or if another condition could be causing symptoms.
Identifying triggers — Eliminating factors that aggravate your eczema symptoms can help to control the symptoms. Possible triggers may include:
●Cold or dry environments ●Sweating ●Emotional stress or anxiety ●Rapid temperature changes ●Exposure to certain chemicals or cleaning solutions, including soaps and detergents, perfumes and cosmetics, wool or synthetic fibers, dust, sand, and cigarette smoke
Keeping your skin hydrated
Emollients — Emollients are creams and ointments that moisturize the skin and prevent it from drying out. The best emollients for people with eczema are thick creams (such as Eucerin, Cetaphil, and Nutraderm) or ointments (such as petroleum jelly, Aquaphor, and Vaseline), which contain little to no water. Emollients are most effective when applied immediately after bathing. Emollients can be applied twice a day or more often if needed. Lotions contain more water than creams and ointments and are less effective for moisturizing the skin.
Amlactin foot repair foot cream therapy – several Alpha hydroxy acids to exfoliate plus glycerin petroleum and mineral oil
Aveeno eczema therapy and Aveeno eczema baby (Johnson & Johnson)
CeraVe Itch relief moisturizing lotion
CeraVe Psoriasis moisturizing cream: contains salicylic acid, urea, ceramide, and niacin
Curel foot therapy contains Shea butter coconut milk and vitamin E
Eucerin roughness relief spot treatment (contained urea ceramide and is ideal for local foot calluses
Gold Bond ultimate diabetic dry skin relief: contains aloe vitamin ACE and a list of 7 emollients/humectants
La Roche Posay Lipikar AP balm: Is usable for children as young as 2 weeks old contains thermal water Shea butter and glycerin.
Bathing — It is not clear if showers or baths are better for keeping the skin hydrated. Lukewarm baths or showers can hydrate and cool the skin, temporarily relieving itching from eczema. An unscented, mild soap or non-soap cleanser (such as Cetaphil) should be used sparingly. Apply an emollient immediately after bathing or showering to prevent your skin from drying out as a result of water evaporation. Emollient bath additives (products you add to the bath water) have not been found to help relieve symptoms.
Hot or long baths (more than 10 to 15 minutes) and showers should be avoided since they can dry out the skin.
In some cases, health care providers may recommend dilute bleach baths for people with eczema. These baths help to decrease the number of bacteria on the skin that can cause infections or worsen symptoms. To prepare a bleach bath, one-fourth to one-half cup of bleach is placed in a full bathtub (about 40 gallons) of water. Bleach baths are usually taken for 5 to 10 minutes twice per week and should be followed by application of an emollient.
Treating skin irritation
Topical steroids — Your doctor may suggest a steroid (also called "corticosteroid") cream or ointment if you have mild to moderate eczema. Steroid creams and ointments are available in different strengths; the least potent are available without a prescription (eg, hydrocortisone 1% cream). Stronger versions require a prescription.
Steroid creams or ointments are usually applied to the skin once or twice per day. These help to reduce symptoms and moisturize your skin. As the skin improves, you can switch to a non-medicated emollient. Strong topical steroids may be needed to control severe flares of eczema; however, these should be used for only short periods of time to prevent thinning of the skin that can result from long-term use.
Other skin treatments — Newer skin treatments for eczema include tacrolimus ointment (brand name: Protopic) and pimecrolimus cream (brand name: Elidel). These are effective in controlling eczema, although they do not work as quickly as topical steroids. They are useful in sensitive areas such as the face and groin, and can be used in children over age two. Due to concerns about the long-term safety of these medications, it's important to carefully follow your health care provider's instructions about how and how long to use them.
Oral steroids — Oral steroids (eg, prednisone) occasionally are used for a short period of time to treat a severe flare of eczema, although this treatment is not usually recommended on a regular basis or for prolonged periods of time because of potential side effects.
Ultraviolet light therapy (phototherapy) — Ultraviolet light therapy (also called phototherapy) can effectively control eczema. However, this therapy is expensive and may increase your risk of skin cancer, and is therefore recommended only for people with severe eczema whose symptoms do not respond to other treatments.
Injectable medications — The injectable "biologic" medication dupilumab (brand name: Dupixent) may be beneficial for treating eczema. Due to its high cost and potential side effects, this drug is reserved for adults with moderate to severe eczema that has not responded to other treatments.
Immunosuppressive drugs — Drugs that weaken the immune system may be recommended for people with severe eczema who do not improve with other treatments. However, treatment with these drugs can cause serious side effects, including an increased risk for infection. They are not recommended for use in infants or young children.
Relieving itching
Oral antihistamines — Oral antihistamines sometimes help relieve the itching of eczema. The over-the-counter antihistamine diphenhydramine (sample brand name: Benadryl) and prescription antihistamines, such as hydroxyzine (sample brand names: Vistaril, Atarax) and cyproheptadine, cause drowsiness; these may be especially beneficial for people who have trouble sleeping due to itching.
The nonsedating antihistamines such as cetirizine (brand name: Zyrtec) and loratadine (sample brand names: Alavert, Claritin) may relieve itching; both are available without a prescription in the United States and cause less drowsiness.
Wet dressings — Wet dressings (wet wraps) help soothe and hydrate the skin, reduce itching and redness, loosen crusted areas, and prevent skin injury due to scratching. Dampened cotton garments (eg, gauze) may be worn over the affected area and covered with a dry garment. You can wear these dressings for a few days, overnight, or during the day (change to a fresh dressing every eight hours).
Mood problems — Talk to your health care provider if your eczema is making you feel anxious or depressed. There are treatments that can help with this.
Can eczema be prevented? — Babies who have a parent, brother, or sister with eczema have a high risk of developing eczema. If you have a baby at high risk, using moisturizing creams or ointments on your baby's skin daily from the first week of life may prevent eczema during his or her first year. However, it is uncertain whether this is effective in preventing eczema later in life.
References:
Up-to-date.com
Podiatry today October 2020 by Dr.Vlahovic DPM
ECZEMA CAUSESAlthough the cause of eczema is not completely understood, genetics appear to play a strong role, and people with a family history of eczema are at increased risk of developing the condition. In most people with eczema, there is a genetic abnormality in the outermost layer of the skin, called the epidermis. The epidermis is the first line of defense between the body and the environment. When the epidermis is intact, it keeps environmental irritants, allergens, and microbes from entering the body and prevents the skin from losing too much water. In people with eczema, this barrier is less strong and more permeable than it should be.
Despite popular belief, in children eczema is rarely linked to food allergies. If you think your child might have a food allergy, you should consult an allergy specialist for evaluation. (See "Patient education: Food allergy symptoms and diagnosis (Beyond the Basics)".)
ECZEMA SYMPTOMSMost people with eczema develop their first symptoms as children, before the age of five. Intense itching of the skin, patches of inflamed skin, small bumps, and skin flaking are common. Scratching can further inflame the skin and worsen the itching. The itchiness may be more noticeable at nighttime.
Eczema symptoms vary from one person to another and can change over time. Although eczema is usually limited to specific areas of the body, it may affect multiple areas in severe cases:
●In infants, there may be inflamed, scaly, and crusted areas on the front of the arms and legs, cheeks, or scalp. The diaper area is not usually affected.
●In children and adults, eczema commonly affects the back of the neck, the elbow creases, and the backs of the knees. Other affected areas may include the face, trunk, wrists, and forearms. The skin may become thickened and darkened, or even scarred, from repeated scratching. Scratching can also lead to infection of the skin. Signs of infection include painful red bumps that sometimes contain pus; if you think you might have an infection, consult your doctor or nurse, as you may need treatment.
Other findings in people with eczema can include:
●Dry, scaly skin ●Plugged hair follicles causing small bumps, usually on the face, upper arms, and thighs. ●Increased skin creasing on the palms and/or an extra fold of skin under the eye ●Darkening of the skin around the eyes
ECZEMA DIAGNOSIS: There is no specific test used to diagnose eczema. The diagnosis is usually based upon your medical history, symptoms, and physical examination.
Factors that strongly suggest eczema include long-term and recurrent itching, symptoms that began at a young age, and a personal or family history of certain allergic conditions (including asthma and seasonal allergies as well as eczema). Another factor to consider is symptoms that get worse after exposure to certain triggers. (See 'Identifying triggers' below.)
ECZEMA TREATMENT: Eczema is a chronic condition; it typically improves and then flares (gets worse) periodically. Some people have no symptoms for several years. Eczema is not curable, although it is possible to control your symptoms with a variety of self-care measures and medications.
Who treats eczema? — Many people with eczema can initially be treated by their primary care provider. However, you may need to see a dermatologist (skin specialist) in certain situations, such as if your condition does not improve with treatment, if certain areas of your body are affected (face or skin folds), or if another condition could be causing symptoms.
Identifying triggers — Eliminating factors that aggravate your eczema symptoms can help to control the symptoms. Possible triggers may include:
●Cold or dry environments ●Sweating ●Emotional stress or anxiety ●Rapid temperature changes ●Exposure to certain chemicals or cleaning solutions, including soaps and detergents, perfumes and cosmetics, wool or synthetic fibers, dust, sand, and cigarette smoke
Keeping your skin hydrated
Emollients — Emollients are creams and ointments that moisturize the skin and prevent it from drying out. The best emollients for people with eczema are thick creams (such as Eucerin, Cetaphil, and Nutraderm) or ointments (such as petroleum jelly, Aquaphor, and Vaseline), which contain little to no water. Emollients are most effective when applied immediately after bathing. Emollients can be applied twice a day or more often if needed. Lotions contain more water than creams and ointments and are less effective for moisturizing the skin.
Amlactin foot repair foot cream therapy – several Alpha hydroxy acids to exfoliate plus glycerin petroleum and mineral oil
Aveeno eczema therapy and Aveeno eczema baby (Johnson & Johnson)
CeraVe Itch relief moisturizing lotion
CeraVe Psoriasis moisturizing cream: contains salicylic acid, urea, ceramide, and niacin
Curel foot therapy contains Shea butter coconut milk and vitamin E
Eucerin roughness relief spot treatment (contained urea ceramide and is ideal for local foot calluses
Gold Bond ultimate diabetic dry skin relief: contains aloe vitamin ACE and a list of 7 emollients/humectants
La Roche Posay Lipikar AP balm: Is usable for children as young as 2 weeks old contains thermal water Shea butter and glycerin.
Bathing — It is not clear if showers or baths are better for keeping the skin hydrated. Lukewarm baths or showers can hydrate and cool the skin, temporarily relieving itching from eczema. An unscented, mild soap or non-soap cleanser (such as Cetaphil) should be used sparingly. Apply an emollient immediately after bathing or showering to prevent your skin from drying out as a result of water evaporation. Emollient bath additives (products you add to the bath water) have not been found to help relieve symptoms.
Hot or long baths (more than 10 to 15 minutes) and showers should be avoided since they can dry out the skin.
In some cases, health care providers may recommend dilute bleach baths for people with eczema. These baths help to decrease the number of bacteria on the skin that can cause infections or worsen symptoms. To prepare a bleach bath, one-fourth to one-half cup of bleach is placed in a full bathtub (about 40 gallons) of water. Bleach baths are usually taken for 5 to 10 minutes twice per week and should be followed by application of an emollient.
Treating skin irritation
Topical steroids — Your doctor may suggest a steroid (also called "corticosteroid") cream or ointment if you have mild to moderate eczema. Steroid creams and ointments are available in different strengths; the least potent are available without a prescription (eg, hydrocortisone 1% cream). Stronger versions require a prescription.
Steroid creams or ointments are usually applied to the skin once or twice per day. These help to reduce symptoms and moisturize your skin. As the skin improves, you can switch to a non-medicated emollient. Strong topical steroids may be needed to control severe flares of eczema; however, these should be used for only short periods of time to prevent thinning of the skin that can result from long-term use.
Other skin treatments — Newer skin treatments for eczema include tacrolimus ointment (brand name: Protopic) and pimecrolimus cream (brand name: Elidel). These are effective in controlling eczema, although they do not work as quickly as topical steroids. They are useful in sensitive areas such as the face and groin, and can be used in children over age two. Due to concerns about the long-term safety of these medications, it's important to carefully follow your health care provider's instructions about how and how long to use them.
Oral steroids — Oral steroids (eg, prednisone) occasionally are used for a short period of time to treat a severe flare of eczema, although this treatment is not usually recommended on a regular basis or for prolonged periods of time because of potential side effects.
Ultraviolet light therapy (phototherapy) — Ultraviolet light therapy (also called phototherapy) can effectively control eczema. However, this therapy is expensive and may increase your risk of skin cancer, and is therefore recommended only for people with severe eczema whose symptoms do not respond to other treatments.
Injectable medications — The injectable "biologic" medication dupilumab (brand name: Dupixent) may be beneficial for treating eczema. Due to its high cost and potential side effects, this drug is reserved for adults with moderate to severe eczema that has not responded to other treatments.
Immunosuppressive drugs — Drugs that weaken the immune system may be recommended for people with severe eczema who do not improve with other treatments. However, treatment with these drugs can cause serious side effects, including an increased risk for infection. They are not recommended for use in infants or young children.
Relieving itching
Oral antihistamines — Oral antihistamines sometimes help relieve the itching of eczema. The over-the-counter antihistamine diphenhydramine (sample brand name: Benadryl) and prescription antihistamines, such as hydroxyzine (sample brand names: Vistaril, Atarax) and cyproheptadine, cause drowsiness; these may be especially beneficial for people who have trouble sleeping due to itching.
The nonsedating antihistamines such as cetirizine (brand name: Zyrtec) and loratadine (sample brand names: Alavert, Claritin) may relieve itching; both are available without a prescription in the United States and cause less drowsiness.
Wet dressings — Wet dressings (wet wraps) help soothe and hydrate the skin, reduce itching and redness, loosen crusted areas, and prevent skin injury due to scratching. Dampened cotton garments (eg, gauze) may be worn over the affected area and covered with a dry garment. You can wear these dressings for a few days, overnight, or during the day (change to a fresh dressing every eight hours).
Mood problems — Talk to your health care provider if your eczema is making you feel anxious or depressed. There are treatments that can help with this.
Can eczema be prevented? — Babies who have a parent, brother, or sister with eczema have a high risk of developing eczema. If you have a baby at high risk, using moisturizing creams or ointments on your baby's skin daily from the first week of life may prevent eczema during his or her first year. However, it is uncertain whether this is effective in preventing eczema later in life.
References:
Up-to-date.com
Podiatry today October 2020 by Dr.Vlahovic DPM