Eczema, in its various forms, is believed to affect 12 - 25 percent of children, and 10 - 15 percent of adults.

See your doctor if:

You're so uncomfortable that you're losing sleep or are distracted from your daily routines
Your skin is painful
You suspect your skin is infected
You've tried self-care steps without success

Eczema occurs in both children and adults, but usually appears during infancy. Although there is no known cause for the disease, it often affects people with a family history of allergies.

Those who are genetically predisposed and then exposed to environmental triggers may develop eczema. Many people who have eczema also suffer from allergic rhinitis and asthma, or have family members who do.

Eczema outbreaks can usually be avoided with some simple precautions. The following suggestions may help to reduce the severity and frequency of flare-ups:

Moisturize frequently

Avoid sudden changes in temperature or humidity

Avoid sweating or overheating

Reduce stress

Avoid scratchy materials (e.g., wool or other irritants)

Avoid harsh soaps, detergents, and solvents

Avoid environmental factors that trigger allergies (e.g., pollens, molds, mites, and animal dander)

Be aware of any foods that may cause an outbreak and avoid those foods

The National Institutes of Health estimates that 15 million people in the United States have some form of eczema. About 10 percent to 20 percent of all infants have eczema; however, in nearly half of these children, the disease will improve greatly by the time they are between five and 15 years of age. Others will have some form of the disease throughout their lives.

Many substances have been identified as itch "triggers" in patients with eczema, and triggers are not the same for every person. Many times it is difficult to identify the exact trigger that causes a flare-up. For some, it seems that rough or coarse materials coming into contact with the skin causes itchiness. For others, feeling too hot and/or sweating will cause an outbreak. Other people find that certain soaps, detergents, disinfectants, contact with juices from fresh fruits and meats, dust mites, and animal saliva and danders may trigger itching. Upper respiratory infections (caused by viruses) may also be triggers. Stress can also sometimes aggravate an existing flare-up.
-skincarephysicians.com

Children are unique patients because it may be difficult for them to resist scratching their eczema, thereby making the condition worse. Fortunately, for mild to moderate cases, the application of moisturizer on a regular basis can be very helpful. And, in most cases, the eczema will disappear as the child ages. In the meantime, avoid as many eczema triggers as possible. Keep your child's skin moist. After bathing, apply moisturizer within three minutes to retain the moisture in the skin. Avoid sudden temperature changes. Keep your child's bedroom and play areas free of dust mites (a common trigger). Use mild soaps - both on your child's skin and on your child's clothing. Dress your child in breathable, preferably cotton, clothing.

If these methods fail to help your child, you should seek further advice from a dermatologist. After consultation, an over-the-counter cream, a prescription cream, ointment, antihistamines, or antibiotics may be advised. Regardless, most children will see improvement as time goes by.

One of the most important components of an eczema treatment routine is to prevent scratching. Because eczema is usually dry and itchy, the most common treatment is the application of lotions or creams to keep the skin as moist as possible. These treatments are generally most effective when applied directly after bathing (within three minutes is a common recommendation) so that the moisture from the bath is "locked in." Cold compresses applied directly to itchy skin can also help relieve itching. If the condition persists, worsens, or does not improve satisfactorily, another effective treatment is the application of nonprescription corticosteroid creams and ointments to reduce inflammation.

Alternatives to nonprescription corticosteroids include more potent prescription corticosteroid creams and ointments, which are effective, but which may have some side effects. To prevent side effects such as skin thinning, your doctor may limit the length of treatment time and locations where you can apply treatment. For severe flare-ups, your doctor may prescribe oral corticosteroids, but be aware that side effects including new flare-ups can develop when treatment is discontinued (this treatment is not recommended for long-term use).

Skin affected by eczema may frequently become infected. If this happens to you, your doctor may prescribe topical or oral antibiotics to kill the bacteria causing the infection.

For severe itching, sedative antihistamines are sometimes used to reduce the itch and are available in both prescription and over-the-counter varieties. Because drowsiness is a common side effect, antihistamines are often used in the evening to help a person restless from eczema get to sleep. Because of the same sedative effect, though, persons taking these agents should not drive. Tar treatments and phototherapy are also used and can have positive effects; however, tar can be messy. Phototherapy requires special equipment (lights). Finally, in cases where eczema is resistant to therapy, your physician may prescribe the drug cyclosporine A, which modifies immune response; however, this is used only in extreme cases because of its association with serious side effects.

Two topical medications, tacrolimus and pimecrolimus, have been approval by the U.S. Food and Drug Administration (FDA) to treat atopic dermatitis. These medications belong to a class of drugs called calcineurin inhibitors and work by modulating the immune response. Pimecrolimus and tacrolimus are a much-welcomed addition because they have not produced some of the side effects associated with long-term topical corticosteroid use, such as thinning skin and loss of effectiveness.

In teens and young adults, patches typically occur on the hands and feet. However, any area such as the bends of the elbows, backs of the knees, ankles, wrists, face, neck, and upper chest may be affected. When it appears on the palms, backs of the hands, fingers, or on the feet, there can be episodes of crusting and oozing.

Other eczema patches in this stage are typically dry, red to brownish-gray, and may be scaly or thickened. The thickened areas may last for years without treatment. The intense, almost unbearable itching can continue, and may be most noticeable at night. Some patients scratch the skin until it bleeds and crusts. When this occurs, the skin can get infected.

Eczema/Atopic Dermatitis

Since the disease does not always follow the same pattern, proper, early, and regular treatment can bring relief and may reduce the severity and duration of the disease.

Q. Since this condition is associated with allergies, can certain foods be the cause?

A. Rarely (perhaps 10%). Although some foods may provoke atopic dermatitis, especially in infants and young children with asthma, eliminating those foods is rarely a cure. You should eliminate any foods that cause immediate severe reactions or welts.

Q. Are environmental causes important and should they be eliminated?

A. Rarely. The elimination of contact or airborne substances does not bring lasting relief. Occasionally, dust and dust-catching objects like feather pillows, down comforters, kapok pillows and mattresses, cat and dog dander, carpeting, drapes, some toys, wool, and other rough fabrics, can worsen atopic dermatitis.

Q. Are skin tests, like those given for hay fever or asthma, of any value in finding the causes?

A. Sometimes, but not as a rule. A positive test means allergy only about 20% of the time. If negative, the test is good evidence against allergy.

Q. Are "shots" such as those given for hay fever and other allergies, useful?

A. Not usually. They may even make the skin condition worse in some patients.

Q. What should be done to treat this condition?

A. See your dermatologist for advice on avoiding irritating factors in creams and lotions; rough, scratchy, or tight clothing; and woolens. Rapid changes of temperature and any activity that causes sweating can aggravate atopic dermatitis. Proper bathing, moisturizing, and dealing with emotional upsets which may make the condition worse can be discussed.

Eczema/Atopic Dermatitis

Your dermatologist can prescribe external medications such as steroids and newer immune modifying creams. Internal medications such as antihistamines can help with the itch. Oral antibiotics may be prescribed if there is a secondary infection. For severe cases, your dermatologist may recommend ultraviolet light treatments, or other treatments.