If you or someone you love has ever dealt with frequent dry, red or itchy patches of skin, you likely know how frustrating eczema can be. The condition can impact confidence, comfort and daily routine for anyone; but for parents especially, it can be particularly heartbreaking to watch a child enduring sleepless nights and one painful flare-up after another.
Eczema is also surprisingly common. According to the National Institute of Allergy and Infectious Diseases, it affects up to 20% of children and up to 10% of adults. “It’s one of the most common skin conditions I see in the office,” says Dr. Dustin Portela, a board-certified dermatologist at Treasure Valley Dermatology in Idaho.
Here’s what eczema is, what causes it and how it can be treated and managed if it affects you or someone you love.
What is eczema?
Eczema, formally known as atopic dermatitis, is a chronic inflammatory skin condition “that occurs because the skin’s natural barrier is defective, which causes the skin to be more sensitive to products and environmental factors,” says Dr. Debra Jaliman, a board-certified dermatologist and assistant clinical professor of dermatology at Mt. Sinai School of Medicine in New York City.
The condition is marked by dry, red, scaly patches of skin, “and the hallmark symptom is itching,” says Portela. In fact, “many people say the itch is worse than the rash itself.” In more severe cases, the skin may crack, ooze, scab or become raw and extremely uncomfortable. “In chronic cases, the skin can also look thickened or leathery from repeated scratching,” adds Jaliman.
In children, eczema often appears on the face, elbows or behind the knees. As kids grow, it may shift to skin folds around the neck, elbows and knees. In adults, the hands, feet and areas prone to friction or sweating are often most affected.
Diagnosis of the condition typically begins with a dermatologist reviewing when symptoms started, possible triggers and establishing a family history of allergies or eczema. Patch testing may also be used to identify contact allergens, and in some cases, a skin biopsy can help rule out other conditions.
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What causes eczema?
While the exact cause of eczema isn’t fully understood, it’s believed to arise from a mix of genetic, immune and environmental factors. “Genetics play a role because if one or both parents have eczema,” says Portela, “there’s a higher chance a child will too.” One explanation for this is that “many people with eczema have a variation in the filaggrin gene, which helps maintain the skin’s protective barrier,” explains Jaliman.
An overactive immune system also contributes. In susceptible people, the immune system reacts too strongly to minor exposures, creating chronic inflammation.
Environmental triggers play a big role as well. “Everyday things like soaps, detergents, rough fabrics, pet dander, dust, pollen, dry air, stress or even sweat can trigger a flare,” says Portela. Some children may also experience food-related flare-ups, adds Jaliman.
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How to prevent or treat eczema
While eczema isn’t usually curable, Portela notes that some children outgrow it by age 5 or 6. Still, flare-up prevention and daily management can make a world of difference in preventing flare-ups. “Moisturize like it’s your job,” advises Portela. He recommends thick creams or ointments and taking warm, short showers (instead of hot, long ones) and choosing gentle cleansers without added fragrance or dyes. “Harsh soaps strip the skin barrier and make flares worse,” he adds.
Treatment usually requires a layered approach. As with prevention, daily skin care is foundational, with regular moisturizing needed to restore the protective barrier. “A humidifier may also be helpful,” Jaliman notes. For mild flare-ups, hydrocortisone cream can reduce itching and irritation. “But if you’ve used hydrocortisone for one to two weeks along with daily moisturizer and things aren’t improving, you should see a board-certified dermatologist,” advises Portela.
Indeed, when symptoms are more persistent, prescription therapies may be necessary. “Your dermatologist may prescribe medicated creams, stronger topical or oral medications or newer injectable therapies if over-the-counter treatments aren’t enough,” says Jaliman.
Options may include topical corticosteroids or nonsteroidal immunomodulators, which are often used on sensitive areas or for long-term control. Other approaches such as phototherapy with controlled ultraviolet light, and wet wrap therapy (where medicated ointment is sealed under damp bandages), may also be recommended. Because stress can worsen flares, stress management and psychological support can play an important supportive role as well.
“Eczema can be frustrating, but the good news is that the condition is usually very treatable,” says Portela. “With the right combination of daily care and medical treatment, most people get their symptoms under excellent control.”
This article originally appeared on USA TODAY: What does eczema look like? Dermatologists explain.
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