Treating Eczema (eg-ze-ma)

Eczema, or atopic dermatitis, is the most common form of dermatitis. It affects between 15-20% of children and rarely can persist into, or even start in, adulthood. It often occurs alongside other "atopic" conditions, asthma and allergic rhinitis, or in families with these conditions, but it can exist on its own. Eczema arises from of a complex interaction of genetic and environmental factors. The main genetic defect in eczema relates to impaired barrier function, making the skin highly susceptible to irritation by soap and water, harsh weather and other irritants. This defect essentially translates to having dry skin covered with microscopic cracks that allow the entry of bacteria and the nidus for inflammation and itching.

This chronic, itchy skin condition can affect any part of the body. In infants it often affects the face and hands. As kids grow, it tends to favor arms and legs. Some people with severe eczema can have widespread involvement. Similar to psoriasis, eczema has a tendency to wax and wane. Many people notice worsening or flares of disease during winter months, when their skin is especially dry. Flares can also occur with superinfections, when bacteria, fungi, or viruses grow on the skin's surface.

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What are the types of eczema?

• Dyshidrotic eczema

  This is a distinct form of eczema that presents as tiny fluid filled blisters on the hands and feet. It is more common in adults than children. Dyshidrotic eczema should be a diagnosis of exclusion, after ruling out similar appearing diseases, like fungal infections, scabies infestation, nickel allergy, and allergic contact dermatitis.

• Nummular dermatitis

  This is a variant of eczema that presents as large round (nummular) patches and plaques of dermatitis on the skin, most commonly on the legs and trunk. It is more common in adults than children.

What are the treatments for eczema?

• Barrier repair

  The most important eczema treatment is proper (gentle) skin cares and daily aggressive skin moisturization. Regular emollients (moisturizers) essentially cover up microscopic cracks and supplement the natural skin barrier, restoring a healthy balance. Over-exposure to water and soap should be minimized.

• Topical anti-inflammatories

  Topical steroids are the mainstay of eczema treatment. Ideally, topical steroids are applied regularly in the beginning to clear disease and then infrequently to maintain or prevent recurrence. Calcineurin inhibitors, such as pimecrolimus cream or tacrolimus ointment, may also be used for eczema maintenance.

• Antimicrobials

  Prescription antimicrobials may be used to treat bacterial, fungal, or viral superinfections. Weekly "bleach baths" are also recommended to decrease bacterial colonization of the skin's surface.

• Oral antihistamines

  May be used to help lessen itching and improve sleep.

• Immunosuppressive medicines

  Severe eczema may need treatment with systemic medicines to calm inflammation from the inside-out. Examples include oral steroids (prednisone), steroid injections (Kenalog®), methotrexate, cyclosporine, mycophenolate mofetil, and azathioprine.

• Biologic therapy

  In 2017, a new injectable biologic treatment became available for adults with moderate to severe uncontrolled eczema. Dupixent is the first of its kind and was shown to be effective in three well-controlled clinical studies with approximately 2100 adults suffering with uncontrolled eczema.

Individual results may vary.

For more information about eczema, visit the National Eczema Association website at: http://nationaleczema.org/