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atopic dermatitis, eczema-infantile, atopic eczema
Eczema is a skin condition that causes patches of dry, scaly, extremely itchy skin.
What is going on in the body?
Eczema usually results from a hypersensitivity or allergy-like sensitivity causing inflammation. The inflammation causes the skin to become itchy and scaly. Eczema is not a true allergy. Rather, it is a condition in which the skin may react or become sensitive to allergens, or allergy-causing substances.
What are the signs and symptoms of the condition?
Symptoms of eczema include:
What are the causes and risks of the condition?
- dry patches of skin
- red, extremely itchy skin
- rash, which may have the following characteristics:
- more abundant behind the knees and in the folds of the elbows and wrists
- appears on the neck, ankles, and feet
- in infants between the ages of 2 to 6 months, starts on the cheeks
- appears on the forearms and lower legs in infants who are crawling
- blisters, which may be surrounded by redness and inflammation. The blisters may also ooze and crust over.
- itching, which may worsen with heat, abrasions, or stress
- constant dry, scaly skin
Eczema is usually related to a history of hypersensitivity or reaction in the body similar to an allergy. Although eczema is more common in babies and young children, older children and adults may also experience eczema. It seems to be more evident in those with a history of asthma or hay fever. It is also more common in a person who has a family history of eczema, hay fever, or other respiratory allergies.
Flare-ups of eczema may occur with exposure to environmental factors, such as stress, dry climate or high temperatures, soaps, chlorine, and other irritating substances. Foods that may cause worsening of symptoms include peanut butter, milk, or eggs.
What can be done to prevent the condition?
Eczema cannot be prevented, but progression of symptoms may be decreased by avoiding allergens that seem to cause flare-ups. Controlling stress or anxiety-producing situations may also decrease risk of eczema flare-ups.
How is the condition diagnosed?
Diagnosis of eczema is often based on the appearance of the rash. The doctor will usually obtain a family and personal history of allergy-related conditions. A thorough examination will usually be done to examine the rash and rule out any other possible causes for the rash. Sometimes culture or biopsy of lesions may be done to rule out other causes. If the rash continues, blood tests may also be done.
What are the long-term effects of the condition?
Long-term effects of eczema include possible infection and scarring. Other long-term effects may include emotional frustration from scarring. Children will usually outgrow eczema by about 6 years of age, although sometimes improvement is not seen until puberty or adulthood. Long-term effects can usually be lessened with early treatment.
What are the risks to others?
Eczema is not contagious, but if the lesions become infected, the infectious agent may be contagious.
What are the treatments for the condition?
The main goal of treatment is to minimise and treat symptoms. Treatment may include the following recommendations:
Medications used to treat eczema include:
- Avoid irritants that tend to worsen symptoms.
- Avoid scratching the lesions.
- Keep the skin moist with lotions and ointments to reduce symptoms.
- Avoid excessive bathing and lengthy exposure to baths to reduce flare-ups.
- Babies don't need to be bathed with soap frequently. Mild neutral soaps are recommended as needed, and bubble baths should be avoided. Dry skin appears to make itching and symptoms worse.
- Keep infants and children's fingernails cut short to avoid irritating lesions if scratched.
- Avoid heavy ointments such as petroleum jelly or vegetable shortening. These can make symptoms worse because these products block the sweat glands.
What are the side effects of the treatments?
- topical ointment for lesions that are oozing or extremely itchy. These ointments may include mild anti-itching lotions or topical steroids.
- coal-tar compound ointments or topical steroids for chronic thickened patches
- oral steroids, such as prednisone, for severe cases of eczema or inflammation
- antibiotics for infection
- antihistamines to reduce inflammation and itching
Side effects to treatment depend on the treatment used. Topical steroid ointments and oral steroids can cause side effects including further irritation of the skin or secondary skin conditions. Antibiotics can cause stomach upset, diarrhoea, and allergic reaction. Antihistamines may cause drowsiness.
What happens after treatment for the condition?
After treatment, a person with eczema may need to avoid situations or conditions that make the eczema worse.
How is the condition monitored?
The doctor should be notified if the symptoms worsen, the rash interferes with sleep, or the skin lesions start to look infected. Signs of infection include fever, pain, weakness, and abnormal discharge from the skin lesions.
Author: Eileen McLaughlin, RN, BSN
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request