Eczema

Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition that causes redness, itching, dryness, and irritation. There are several types of eczema, each with distinct triggers, characteristics, and patterns. The most common types include:

1. Atopic dermatitis: Atopic dermatitis typically begins in childhood but can occur at any age. It is associated with a personal or family history of allergies, asthma, or hay fever. Skin becomes dry, itchy, and inflamed, especially in areas such as the face, neck, inner elbows, and behind the knees. Flare-ups can be triggered by allergens, stress, weather changes, or irritants like soaps or fabrics.
2. Contact dermatitis: This form occurs when the skin comes into direct contact with an irritating substance (irritant contact dermatitis) or something that triggers an allergic reaction (allergic contact dermatitis). Common triggers include soaps, detergents, metals like nickel, fragrances, or certain plants such as poison ivy. Symptoms include redness, itching, burning, and blisters in the area of contact.
3. Dyshidrotic eczema (pompholyx):
This type affects the hands and feet, leading to small, itchy blisters, often along the edges of fingers, toes, palms, and soles. The blisters can be painful and may ooze or peel. It is more common in adults and can be triggered by stress, allergies, moist environments, or exposure to irritants.
4. Nummular eczema (discoid eczema):
This form is characterized by round or coin-shaped patches of irritated skin, often appearing on the arms, legs, hands, or torso. These patches can be intensely itchy and may ooze or crust over. It tends to affect adults and is often linked to dry skin, cold weather, or skin injury.
5. Seborrheic dermatitis:
This type commonly affects areas of the skin with many oil glands, such as the scalp, face, upper chest, and back. It causes greasy, yellowish scales, redness, and itching. In infants, it is often called “cradle cap.” In adults, it can be a chronic condition and may worsen with stress or weather changes.

Each type of eczema requires a tailored approach to management and treatment, based on its specific cause, location, and severity. Identifying triggers, maintaining skin hydration, and using topical treatments under the guidance of a dermatologist can help control symptoms and reduce flare-ups.

People with eczema typically have a compromised skin barrier, meaning their skin is less able to retain moisture and more prone to allowing irritants, allergens, and microbes to penetrate the skin. In atopic dermatitis, this defective barrier is often linked to mutations in genes responsible for skin structure and immune function, including the filaggrin gene, which plays a crucial role in maintaining healthy skin.

In individuals with eczema, the immune system overreacts to minor irritants or allergens, triggering inflammation that leads to redness, swelling, and itching. Common environmental triggers include:

• Harsh soaps and detergents
• Fragrances and dyes
• Wool or synthetic fabrics
• Changes in temperature or humidity
• Sweat and heat
• Dust mites, pollen, and pet dander
• Food allergens, especially in infants and children (such as milk, eggs, soy, wheat, peanuts, and fish)

When the skin is exposed to one of these triggers, it can flare up—becoming more red, itchy, or swollen. Scratching can make things worse and may lead to skin infections. Stress and hormonal changes can also worsen symptoms.

While atopic dermatitis is not an allergic reaction itself, it is closely associated with allergic conditions, particularly in individuals with a personal or family history of asthma or allergic rhinitis. This connection is known as the “atopic triad.”

There is no single test to confirm eczema, so diagnosis is based on the appearance of the skin, distribution of symptoms, and asking questions about family history of atopic diseases, and history of flares and triggers.

Dr. Austin Newsome will review your medical history and ask questions about when the itching started or the rash appeared, what makes it better or worse, and whether there is history of asthma or hay fever, and any known irritants or exposures. In some cases, additional tests may be performed to rule out other conditions or to identify specific allergens, including:

• Patch testing: to identify substances that may be causing allergic contact dermatitis.
• Skin swabs or cultures: if there is concern about secondary bacterial or viral infections.
• Blood tests: to check for elevated levels of immunoglobulin E (IgE), which may indicate an allergic component.

Diagnosis may be more complex in adults who develop new-onset eczema later in life or in cases where the rash mimics other skin conditions, such as psoriasis, fungal infections, or scabies. Although eczema can be frustrating, there are many ways to manage it. The first step is to understand what triggers your symptoms and try to avoid those things. Keeping your skin well-moisturized is also key to reducing flare-ups.