Eczema, also referred to as atopic dermatitis, is an inflammatory skin rash. The skin will get dry, red, and very itchy. Approximately 31 million people in American have eczema. It is the most common chronic skin disease in young children with 10-20% of all children having eczema. Eczema is most common in infants and children usually showing up by age 5, but it can present in adolescents and adults. However, it is unusual to develop eczema after age 60. Eczema is part of the “atopic march”. The atopic march refers to the diagnosis of eczema during infancy, followed by the development of food allergies, then allergic rhinitis (often referred to as hay fever), and finally asthma. Studies have shown that up to 80% of children with eczema develop allergic rhinitis and/or asthma later in childhood.
Why do people get eczema?
Eczema is thought to be caused by a defective skin barrier. The causes of eczema are multifactorial. Genes and environment are both thought to play a role, with genetics playing a larger part. There is not just one gene involved in eczema. One of the most important genes found to play a role in eczema is related to a protein called filaggrin. This is a protein that helps hold moisture in your skin. Many people with eczema do not have enough of this protein or the protein does not work correctly. Eczema is not contagious, meaning you cannot catch it from someone else. It is often hereditary. If your parents have allergies or asthma, you are at increased risk to develop eczema. Environmental factors that are thought to possibly play a role in the development of eczema include climate, growing up in a rural vs. urban setting, exposure to non-pathogenic microorganisms (non-harmful), and water hardness. There have been studies that show increased number of siblings, early daycare exposure, exposure to farm animals, and pet dogs reduce the likelihood of developing eczema. These studies support the theory called the “hygiene hypothesis”. This theory states that exposure to certain germs and infections helps the immune system to develop and teaches to not overreact to harmless substances that cause allergies such as grass, dogs, trees, etc.
What are the symptoms of eczema?
The 2 main symptoms of eczema or severe itching and dry skin. Eczema has a waxing and waning course. You will have times where your skin is clear or much better and then times where your skin is flaring. When flaring, the skin will be extremely itchy with red bumps, flakiness, or blisters. Sometimes there can be weeping or crusting. In darker skin, the skin may be less red or more a deep brown or purply-red color. In chronic eczema, the skin can appear dry and scaly. The skin can crack and bleed. People can often develop secondary infections from scratching the skin. The itch from eczema can be described as unbearable affecting sleep and school/work performance.
How do you treat eczema?
The good news is that most children with eczema will outgrow it. There is no cure for eczema but there are treatments. The most important part of eczema treatment is MOISTURIZE, MOISTURIZE, MOISTURIZE. I always tell my parents/patients that eczema treatment can be time consuming, but it works. Moisturize several times a day if possible. A petrolatum-based moisturizer is the best like Aquaphor or Vaseline. These can be greasy so if you cannot stand the greasiness, you can reserve this for before bed and use a more lotion-like consistency moisturizer during the day. It is important to try to limit baths or showers to 10 minutes or less and use lukewarm water. Pat dry when you get out. The best time to moisturize is right
when you get out of the shower. The next step is usually to use a steroid cream when you have flares. There are a few topical medications that are not steroid-based that also work in eczema. There is a biologic therapy called Dupixent that is approved for moderate-to-severe atopic dermatitis that is not controlled with steroid creams. This should be a conversation between you and your healthcare provider to decide what it the best treatment for you.
There are other factors that can exacerbate eczema. Irritants can make eczema worse. Make sure to avoid fragrances in any moisturizers as well as your soaps and all personal hygiene products. Also, avoid other irritants such as fabric softeners, dryer sheets, bubble baths. Try to use a free and clear detergent. Irritants can also be dryness in the air or extreme heat or cold. Exposure to allergens can also worsen eczema. This can be allergens in the air such as dust or pollens. People often ask me about the role of food allergens. As we said earlier, children with eczema are at increased risk for other allergic conditions including food allergies. There are some children with eczema who will have certain foods which may not cause the stereotypical anaphylactic reaction but could flare their eczema. Milk, egg, wheat, and soy are the most common foods implicated in flaring eczema. We tend to try to not completely remove these foods from their diet unless eczema is severe due to the risk of developing a life-threatening anaphylactic food allergy after removing the food. It is best to speak with an allergic and discuss food allergy testing in this scenario. It is not recommended to test all children with eczema for food allergies as there is a very high false positive rate. This leads to misdiagnosis of and unnecessary food avoidance. Again, this is a very important discussion to have with your allergist.
In summary, it is important to discuss eczema with your healthcare provider and see an allergist for moderate-to-severe eczema. There are many treatment options. It is important to develop a plan that works for you and helps you live your life without eczema getting in the way.