What is eczema?
Eczema is also known as atopic dermatitis (AD). It is a common inflammatory skin disease that affects up to 13% of children and 10% of adults in the US. Eczema is a systemic and chronic disease meaning it is often a life-long condition that comes and goes and tends to flare with triggers. There is no cure for eczema. It presents with red, itchy and inflamed patches that appear anywhere on the body. Scratching leads to inflammation, swelling and eventually cracking and weeping of the skin. This can lead to subsequent skin infections. It is not contagious, but has a considerable impact on quality of life.
95% of people develop eczema before age 5. In infancy, eczema appears as itchy, red, scaly patches on the baby’s face or chest. Usually the condition goes away as the child grows, but not always. Even when the red, itchy patches resolve, the child can be left with easily irritated, dry, sensitive skin.
What causes eczema?
Many factors contribute to the development of eczema including genetic susceptibility, environmental factors, microbiome and immune system dysregulation. A family history of allergic diseases like hay fever or asthma is an important risk factor.
What are the symptoms?
Infant eczema is usually acute, with lesions on the face, body and limbs. Children that are 1 year old and above often manifest red patches around the mouth, on the neck, behind the knees and inside the elbows. Adolescents and adults present with thickened or scratched lesions behind the knees and inside of the elbows, on the wrists, ankles and eyelids, around the mouth and on the hands. Eczema may be mild, moderate or severe. Despite the various manifestations the condition is treated as a single disease.
Complications include skin infections from constant scratching that creates open sores, and contact dermatitis from harsh soaps, detergents and disinfectants. The itch-scratch cycle can interfere with sleep, and the more the itch is scratched, the more it itches. Triggers include sweat, stress, heat, itchy fabrics, fragrances, pet dander, environmental allergies, soaps, detergents, dust and pollen, and hot dry air. Some food allergies can also trigger flares.
How is eczema diagnosed?
There is no objective test to confirm a diagnosis of atopic dermatitis. Medical dermatologist Dr. Rachel White will diagnose the disease based upon the clinical features and medical history. Diagnosis requires exclusion of other skin conditions with similar appearance including infections and other inflammatory skin conditions. It may also include performing a patch test where a small amount of an allergen is placed on the skin and is checked for skin reactions.
How is eczema treated?
The goal is to manage eczema in an effort to prevent worsening of the disease, calm the skin, control itching, and prevent infections and skin thickening. Traditional treatments involve topical and oral medications. Moisturizers are essential to maintain the integrity of the skin barrier. The skin barrier keeps out bacteria, allergens and irritants that aggravate AD. Topical anti-inflammatory medications reduce inflammation, itching, and redness.
Treatments for adults with stubborn or severe disease include phototherapy, immunosuppressants and short courses of steroids. Long-term topical treatment is frequently needed. Newer therapies include crisaborole (Eucrisaâ) ointment for mild to moderate AD, and dupilumab (Dupixentâ) for moderate to severe AD.
RW Dermatology provides board certified medical dermatology to Buckingham Township and the surrounding suburbs of Philadelphia. When you are concerned about red, itchy patches of skin on your child’s face or body or you suffer with chronic skin irritations, schedule an appointment today. From diagnosis to treatment and management, Dr. White can help.