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Itchy, red, scaly skin: Do you have eczema?

Eczema is a condition that makes your skin red, dry, sore and itchy. It can be a patch of skin or more widespread all over the body. Symptoms can be long lasting (chronic) and flare periodically. Clinical research is growing our understanding of eczema and how to treat it. Read on to learn more.

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Symptoms

What are the symptoms of Eczema?

Eczema signs and symptoms vary widely from one person to the next. Symptoms may include:

  • Dry skin
  • Itching, which may be severe, especially at night
  • Red to brownish-gray patches, especially on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of the elbows and knees, and in infants, the face and scalp
  • Small, raised bumps, which may leak fluid and crust over when scratched
  • Thickened, cracked, scaly skin
  • Raw, sensitive, swollen skin from scratching

Eczema most often begins before age 5 and may persist into adolescence and adulthood. For some people, it flares periodically and then clears up for a time, even for several years.


Causes and Risk Factors

What causes eczema?

Healthy skin helps retain moisture and protects you from bacteria, irritants and allergens. Eczema is related to a gene variation that affects the skin’s ability to provide this protection. This allows your skin to be affected by environmental factors, irritants and allergens.

The main risk factor for eczema is having a personal or family history of allergies, hay fever or asthma.

Prevalence increases with decreased sun exposure: For example, up to 25% of the population in northern Europe is affected, where there is less sunshine, while in the coastal region of southern Europe, only around 1% is affected. It is also much more prevalent in children, with 23% of babies and toddlers affected. About 2%-4% of adults are affected.


Complications

Complications of eczema may include:

  • Asthma and hay fever. Eczema sometimes precedes these conditions. More than half of young children with eczema develop asthma and hay fever by age 13.
  • Chronic itchy, scaly skin. A skin condition called neurodermatitis (lichen simplex chronicus) starts with a patch of itchy skin. You scratch the area, which makes it even itchier. Eventually, you may scratch simply out of habit. This condition can cause the affected skin to become discolored, thick and leathery.
  • Skin infections. Repeated scratching that breaks the skin can cause open sores and cracks. These increase the risk of infection from bacteria and viruses, including the herpes simplex virus.
  • Irritant hand dermatitis. This especially affects people whose work requires that their hands are often wet and exposed to harsh soaps, detergents and disinfectants.
  • Allergic contact dermatitis. This condition is common in people with eczema.
  • Sleep problems. The itch-scratch cycle can cause poor sleep quality.

Diagnosis and Treatment

How is eczema diagnosed?

It’s important to recognize the condition early so that you can start treatment. Your doctor will likely make a diagnosis by examining your skin and reviewing your medical history. He or she may also use patch testing or other tests to rule out other skin diseases or identify conditions that accompany your eczema.

How is eczema treated?

No cure has been found for eczema. But treatments and self-care measures can relieve itching and prevent new outbreaks. For example, it helps to avoid harsh soaps, moisturize your skin regularly, and apply medicated creams or ointments. You may need to try various treatments over months or years to control it. And even if treatment is successful, signs and symptoms may return (flare).

Your doctor may suggest one or more of the following treatments:

  • Corticosteroid creams or ointments that control itching and help repair the skin.
  • Calcineurin inhibitors, a type of cream that affects your immune system and helps to control the skin reaction — such as tacrolimus (Protopic) and pimecrolimus (Elidel).
  • Antibiotics. Your doctor may prescribe an antibiotic cream if your skin has a bacterial infection, an open sore or cracks. He or she may recommend taking oral antibiotics for a short time to treat an infection.
  • Oral drugs that control inflammation. For more-severe cases, your doctor may prescribe oral corticosteroids — such as prednisone. These drugs are effective but can’t be used long term because of potential serious side effects.
  • An injectable biologic (monoclonal antibody) called dupilumab (Dupixent) has been approved in some countries to treat people with severe disease who do not respond well to other treatment options. This is a newer medication, so it doesn’t have a long track record in terms of how well it helps people.

Beyond medications, your doctor may suggest therapies such as:

  • Wet dressings. An effective, intensive treatment for severe eczema involves wrapping the affected area with topical corticosteroids and wet bandages. Sometimes this is done in a hospital for people with widespread lesions because it’s labor intensive and requires nursing expertise. Or, ask your doctor about learning how to do this technique at home.
  • Light therapy. This treatment is used for people who either don’t get better with topical treatments or who rapidly flare again after treatment. The simplest form of light therapy (phototherapy) involves exposing the skin to controlled amounts of natural sunlight. Other forms use artificial ultraviolet A (UVA) and narrow band ultraviolet B (UVB) either alone or with medications. Long-term light therapy can cause premature skin aging and an increased risk of skin cancer. Talk with your doctor about the pros and cons of light therapy.
  • Counseling. Talking with a therapist or other counselor may help people who are embarrassed or frustrated by their skin condition.
  • Relaxation, behavior modification and biofeedback. These approaches may help people who scratch habitually

Source: Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/atopic-dermatitis-eczema/diagnosis-treatment/drc-20353279).


Self-Care

The following self-care tips may help prevent flare-ups and lower the drying effects of bathing:

  • Moisturize your skin at least twice a day. Creams, ointments and lotions seal in moisture. Choose a product or products that work well for you. Using petroleum jelly on your baby’s skin may help prevent development of eczema.
  • Try to identify and avoid triggers. Things that can worsen the skin reaction include sweat, stress, obesity, soaps, detergents, dust and pollen. Try to reduce your exposure to your triggers.
  • Avoid certain foods. Infants and children may experience flares from eating certain foods, including eggs, milk, soy and wheat. Talk with your child’s doctor about identifying potential food allergies.
  • Take shorter baths or showers. Limit your baths and showers to 10 to 15 minutes. Use warm, rather than hot, water.
  • Take a bleach batch. The American Academy of Dermatology suggests considering a diluted bleach batch to reduce flares and eliminate bacteria. Soak from the neck down or just the affected areas of skin for about 10 minutes. Do not submerge the head. Take a bleach bath no more than twice a week.
  • Use only gentle soaps. Choose mild soaps. Deodorant soaps and antibacterial soaps can remove more natural oils and dry your skin.
  • Dry yourself carefully. After bathing gently pat your skin dry with a soft towel and apply moisturizer while your skin is still damp.

Source: Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/atopic-dermatitis-eczema/diagnosis-treatment/drc-20353279).


Clinical Trials - Learn More

Clinical trials are helping medical researchers better understand and treat eczema. Finding these answers depends on people like you to take part.

Have you considered taking part in a clinical trial for people with eczema?

Potential benefits of participating in a clinical trial include:

  • Close care and monitoring by a study doctor and staff throughout the study
  • No cost for study treatment, related tests and procedures
  • Contribute to our understanding of the treatment options for eczema

If you would like to be considered for an upcoming clinical trial in eczema, take our survey.

Please take some time to answer a few questions and be considered for an upcoming clinical trial for people with eczema. We also invite you to join our patient community.

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