What is eczema?

Eczema is a skin problem that causes itching, dryness, fine scales or flaking, and sometimes mild redness.

Eczema can be a brief, mild skin irritation that does not need medical treatment. Sometimes, however, it causes relentless itching and scratching. The skin may become scaly, raw, or thickened from constant or repeated bouts of eczema. This more severe form of eczema is called atopic dermatitis and is a chronic (long-lasting) condition. Atopic dermatitis usually appears first in childhood or early adulthood.

How does it occur?

Mild eczema is usually a temporary reaction to something that irritates the skin, such as a fabric, chemical, or metal. Sometimes a change in the weather or humidity causes eczema. Also, you may get eczema when you eat certain foods or take some medicines.

The tendency for severe eczema generally seems to be inherited along with asthma or hay fever.

What are the symptoms?

The main symptom of mild eczema is a small area of fine, dry scales, often on the arms or legs. The skin may or may not itch.

Severe eczema causes intense itching. The most common areas of itching are the fronts of the elbows, backs of the knees, and face. However, any area of skin may be affected. The skin is usually very sensitive to being touched. Even a light touch may cause itching. Many people who have severe eczema are quite sensitive to scratchy fabrics, especially wool. Eczema often becomes worse in the winter, when indoor air is very dry.

How is it diagnosed?

Your health care provider will examine the area of skin that is affected. He or she will ask about your history and your family's history of rashes and other problems such as allergy or asthma.

How is it treated?

Mild eczema sometimes does not need any treatment, or it will go away if you rub 1% hydrocortisone cream (no prescription needed) on the area a few times a day.

More severe eczema can be more difficult and frustrating to treat. Medicines are used to help control and prevent the itching. It's also important to keep the skin well lubricated.

The itching of severe eczema can usually be prevented with oral antihistamine medications. Many antihistamines cause drowsiness, so you may want to take the medicine only at bedtime. (It is important to prevent scratching during sleep.) Some antihistamines are available that do not cause drowsiness. These nonsedating antihistamines are more expensive, but they can be taken at any time of day to prevent itching.

Steroid creams or ointments can help control the itching and rash caused by atopic dermatitis. Use these medications exactly as directed by your health care provider for the best results. Steroid creams or ointments come in many different strengths. Some should be applied just once a day, and some need to be used four times a day. Do not use them more often than recommended. Serious complications can develop from overuse of steroid medications.

To keep the skin well lubricated and prevent excessive dryness, avoid exposing your skin to a lot of water. This seems surprising, but in fact, when skin becomes wet, evaporation of water from the skin dries the skin even more. For this reason, if you have severe eczema you should avoid frequent baths or showers. Take sponge baths between baths or showers. Use moisturizing creams or ointments, rather than water-based lotions, regularly (several times a day, if possible).

Recent research has suggested that people who are allergic to dust mites may be more likely to have atopic dermatitis. Thus, some health care providers may decide to test just for an allergy to dust mites. If test results clearly show you are allergic to dust mites, your provider may recommend that you try to eliminate dust mites from your home.

Before you decide to have allergy tests, you might first want to see if your symptoms improve if you do everything possible to eliminate dust mites from your home.

To reduce the population of dust mites in your home you must dust all surfaces often. You also need to eliminate the surfaces from which dust mites can never be completely removed. These surfaces include wall-to-wall carpets and draperies with horizontal folds, which catch dust and cannot be wet-wiped or laundered.

In some situations, allergy shots for dust mites may be helpful. You should consider this treatment only after seeing a dermatologist (a skin specialist) and an allergist (an allergy specialist).

What can be done to prevent eczema?

To prevent mild eczema, try to avoid letting your skin come into contact with substances that irritate it. You may also need to avoid eating certain foods or taking certain medicines, when possible.

Because severe eczema is an inherited disorder, there is no known way to prevent it. However, as with many medical conditions, there seems to be a relationship between flares of atopic dermatitis and stress. When you can, avoid or minimize stressful situations. Since this is not always possible, it may help to know that your worsening of symptoms during times of stress is only temporary.