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How do people get eczema?

What is eczema?

Eczema is a condition that causes skin to become itchy, red, dry and cracked. It is also known as atopic dermatitis. Eczema is a common problem that affects over 30 million Americans. It can develop at any age but often starts in infancy or childhood. Eczema is not contagious.

The most common symptoms of eczema are:

  • Dry, itchy skin
  • Rashes on the face, inside the elbows, behind the knees, and on hands and feet
  • Red, cracked, thick and scaly skin
  • Raw, sensitive skin from scratching
  • Oozing or crusting
  • Areas of swelling

Eczema symptoms can range from mild to severe. In mild cases, small areas of the skin look dry and flaky. In more severe cases, the skin over a large area of the body becomes inflamed, causing constant itching and discomfort. Symptoms can flare up from time to time.

What causes eczema?

The exact cause of eczema is not known. It is believed to be linked to an overactive response by the immune system to an irritant. Some common triggers that can cause eczema to flare up include:

  • Stress
  • Changes in temperature or humidity
  • Soaps, detergents, shampoos, disinfectants
  • Fragrance in skin care products, perfumes, scented lotions
  • Dust mites
  • Food allergies
  • Seasonal allergies
  • Clothing fabrics like wool
  • Infections

When the immune system overreacts to these triggers, it causes inflammation that leads to eczema symptoms. The immune system activates inflammatory substances such as histamine, which causes itching and swelling. It also stimulates cells in the skin to proliferate and causes changes in the skin that lead to dryness and flaking.

In addition, people with eczema seem to have low levels of substances called ceramides in their skin. Ceramides help form the skin’s protective barrier. With fewer ceramides, the skin barrier is weakened allowing moisture to escape and irritants to penetrate the skin more easily. This leads to the dryness and itching of eczema.

Are there different types of eczema?

There are several different types of eczema:

  • Atopic dermatitis – The most common form, usually starts in infancy or childhood.
  • Contact dermatitis – Caused by contact with an irritating substance.
  • Dyshidrotic eczema – Occurs on palms of hands and soles of feet.
  • Nummular eczema – Causes coin-shaped spots, most common in older adults.
  • Seborrheic eczema – Affects areas with a lot of oil-producing glands like the scalp, face, upper body.
  • Stasis dermatitis – Related to poor blood circulation in the lower legs.

Atopic dermatitis is the most common type, accounting for around 85% of eczema cases. It often first appears in infancy or childhood but can also develop later in life. The rashes typically occur where the skin creases such as inside elbows, back of the knees, front of ankles, around the neck, and around the eyes.

Contact dermatitis occurs when the skin reacts after touching an irritating substance such as harsh chemicals. The rash appears where the substance touched the skin. Common triggers include nickel jewelry, rubber latex, cosmetics, poison ivy, and topical medicines.

Who gets eczema?

Eczema is very common. In the United States:

  • Over 30 million Americans have some form of eczema.
  • Roughly 10% of adults have atopic dermatitis.
  • Up to 20% of children have atopic eczema.

Eczema often runs in families with a genetic predisposition. If one parent has eczema, a child has about a 50% chance of developing it. If both parents have eczema, the child’s risk is over 75%.

In infancy, boys are more likely to get eczema. By adulthood, women are more commonly affected than men. Some ethnic groups have a higher incidence of eczema such as blacks and Asians.

People with allergies like hay fever and asthma are more prone to developing eczema. More than 75% of people with atopic dermatitis have hay fever or asthma.

How is eczema diagnosed?

Eczema can often be diagnosed simply by examining the appearance and location of the rash. Doctors will look for the typical dry, scaly or leathery patches on areas of skin. They will ask about symptoms such as itching and when it worsens.

To confirm the diagnosis, they may examine the skin more closely under a microscope or with a skin biopsy. This can help rule out other potential causes for the rash like fungal infections, psoriasis and skin cancer.

Allergy testing may be done with a skin prick test or blood test. This can identify specific allergies that can trigger eczema flares.

How is eczema treated?

There is no definitive cure for eczema, but many treatment options are available to relieve symptoms and prevent flares. Typical treatments include:

  • Moisturizers – Use gentle moisturizers several times a day to hydrate the skin and restore its protective barrier.
  • Corticosteroid creams/ointments – Reduce inflammation and itching. Available in over-the-counter mild forms and stronger prescription products.
  • Immune modulators – Help control inflammation when steroids fail. Examples are topical tacrolimus or pimecrolimus.
  • Antihistamines – Block the action of histamine and reduce itching. Can help control nighttime itching.
  • Phototherapy – Involves exposing the skin to ultraviolet light under medical supervision to calm inflammation and reduce symptoms.
  • Oral immunosuppressants – Medications that work throughout the body to calm the immune system response. Used for severe cases unresponsive to other treatments.
  • Biologic drugs – Target specific parts of the immune system reaction. Used for severe eczema when other treatments fail.

The main treatments are moisture and topical steroids to reduce inflammation. For mild cases, over-the-counter 1% hydrocortisone cream may be sufficient. More severe cases often need prescription topical steroids.

Other topical calcineurin inhibitors like tacrolimus work for problem areas like the face and skin folds where steroids can cause unwanted side effects.

For severe itching, oral antihistamines like diphenhydramine (Benadryl) and hydroxyzine can help control symptoms, especially at night.

Phototherapy with UV light is an additional option that can supplement medication treatments.

For severe eczema unresponsive to other treatments, systemic oral immunosuppressants or newer biologic medications may be used under close medical supervision.

Lifestyle changes and home remedies

In addition to medical treatments, lifestyle measures and home remedies that can help control eczema include:

  • Take lukewarm baths using gentle cleansers and pat skin dry
  • Apply moisturizer immediately after bathing while skin is still damp
  • Use gentle, fragrance-free skin care and laundry products
  • Wear soft, breathable fabrics like cotton
  • Use a humidifier to add moisture to dry air
  • Keep skin cool and calm – avoid overheating
  • Reduce stress through relaxation techniques
  • Avoid scratching or rubbing the skin
  • Apply cold, wet compresses to itchy areas for relief

It’s also important to identify and avoid triggers that worsen eczema flares. These commonly include specific foods, products with fragrances, seasonal allergies, low humidity, and stress. Keeping fingernails short and smooth can prevent damage to the skin from scratching.

Can eczema be prevented?

There is no way to completely prevent eczema, especially in those with a family history of atopic disorders. However, the following measures may help reduce the risk of developing eczema:

  • Moisturize skin regularly, especially after bathing and hand washing
  • Avoid harsh soaps, detergents and cleansing products
  • Use gentle, fragrance-free skin care and cosmetics
  • Wear soft, breathable natural fabrics
  • Use a humidifier to prevent dry air
  • Bathe in lukewarm water for short periods
  • Identify and avoid triggers such as certain foods
  • Reduce stress and practice relaxation techniques

These skin care habits help maintain the integrity of the skin barrier and prevent the dryness that can lead to eczema flares.

For babies with a family history of eczema, gently cleansing with mild cleansers and daily moisturizing may help reduce risk. Breastfeeding for at least 4 months can also lower the chances of developing eczema.

Complications of eczema

Eczema symptoms can negatively impact quality of life. Severe itching can interfere with sleep and concentration. Cracked, inflamed skin is vulnerable to infection. Constant scratching can damage the skin leading to thicker plaques, permanent discoloration and scarring.

Some potential complications of eczema include:

  • Bacterial skin infections
  • Viral infections like herpes simplex or molluscum contagiosum
  • Allergic reactions to topical antibiotics or steroid creams
  • Eye problems if eczema occurs around eyes
  • Permanent changes in skin color and texture
  • Scarring from chronic scratching

The intense itching and subsequent skin damage can also cause significant emotional stress, anxiety and depression.

Children with eczema may develop social issues due to discomfort, appearance of skin and bullying. They are also more prone to skin infections. Proper treatment can help prevent many of these complications.

The takeaway

Eczema is a common inflammatory skin condition marked by intense itching, dryness and rashes. Underlying causes are not fully understood but involve the immune system and skin barrier defects. A variety of effective treatments are available to control symptoms and improve quality of life. While eczema cannot be cured, it can often be well-managed with proper skin care, avoidance of triggers, and medical treatment when necessary.