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What is eczema?

Eczema (EG-zih-mah) is a long-lasting skin condition that can come and go. The skin becomes extremely itchy, red, scaly, and irritated. Eczema can appear on many parts of the body, depending on your age. The most common form of eczema is atopic dermatitis (ay-TOP-ick dur-ma-TIE-tiss).

Today, eczema (atopic dermatitis) affects about 6 million people in Canada. People of any age may get it, but it appears most often in infants and young children.

Eczema doesn’ t spread from person to person. Instead, it tends to run in families. Most people who get eczema have a history of eczema, hay fever, or asthma in their families.

What causes eczema?

No one really knows what causes eczema (atopic dermatitis). We do know that certain things can cause eczema to get worse. When eczema gets worse, it is called a flare-up. A flare-up occurs when the immune system in people’ s skin overreacts to environmental or emotional triggers. This reaction results in symptoms such as itching.

People with eczema may have different triggers. Some of the common things that can trigger an eczema flare-up include:

  • Changes in temperature or humidity
  • Chemical irritants, such as pesticides, paint strippers, alcohol, astringents, perfumes, harsh soaps, detergents, and household cleaners
  • Physical irritants, such as clothes made of rough or scratchy fabrics, like wool or burlap
  • Allergies (to dust, pollen, mold, animal dander, etc.)
  • Intense emotion or stress
  • Infections of any kind

People with eczema must work closely with their health care providers to figure out what triggers their eczema flare-ups. Then they can take steps to avoid these triggers.

Many people have eczema (atopic dermatitis). It is a very common problem in the Canada. In fact, eczema is the most common skin problem in children under the age of 12. Children with a parent, grandparent, brother, sister, aunt, or uncle who have or have had eczema, asthma, or hay fever often have eczema themselves. But even people who don’ t have these conditions in their families can develop eczema too.

Eczema appears most often in early childhood. Approximately, 9 out of 10 people who have eczema get it before they are 5 years old. People who have it as children may always have dry or extra-sensitive skin, even as adults.

About two thirds of eczema cases begin in babies under the age of 1 year. It starts usually in babies between the ages of 6 and 12 weeks. It may clear up but then may come back from time to time.

It is not common for someone to have eczema for the first time as an adult, but it can happen.

Many people with eczema also have asthma or hay fever as children or adults. Children with eczema often have allergies to such things as food or pollen.

What are the signs or symptoms of eczema?

The signs and symptoms of eczema (atopic dermatitis) may vary from person to person, but in most people the skin is very itchy.

The skin of people with eczema also tends to be very dry. Patches of red, swollen, and even drier skin develop. These patches may even become cracked, crusty, and scaly.

If the affected skin becomes very inflamed, open sores, called ulcers (UHL-sirs), may occur. A clear, sticky fluid may even weep from the affected skin. This can make it hard for the healthcare provider to decide if the skin is affected by eczema or by a skin infection. In fact, both can occur at the same time. When the skin has been affected for a long time, it can become thick and leathery. The good news is that with the right treatment the skin can look healthy again.

The areas of the body that eczema tends to affect vary with age.

  • In babies, a patchy rash usually appears on the face, elbows, and knees.
  • In older children, the rash tends to appear more behind the knees, inside the elbows, on the sides of the neck, and on the wrists, ankles, and hands.
  • In adults, the rash is most common on the arms, legs, hands, and neck, but it may appear anywhere.

How is eczema diagnosed?

There is no one test to diagnose eczema (atopic dermatitis). Your health care provider will look at your skin and ask you about your medical history. It may be hard to tell if your symptoms are due to eczema or to some other skin problem. These signs may mean you have eczema:

  • Very itchy skin
  • Rash that first appeared before the age of 5
  • An itchy rash appears on different parts of your body, depending on your age (for example, the face, elbows, or knees in babies)
  • The rash tends to flare up, then go away for a while before coming back again
  • Personal or family history of asthma, hay fever, or eczema
  • Very dry skin
  • Very sensitive skin

Symptoms can vary from person to person and may change over time. That’ s why your health care provider may want to see you more than once. Your health care provider also needs to know:

  • What medicines have been used in the past to treat your skin
  • What medicines have been used to treat your allergies or asthma, if you have them
  • How long you have had the rash
  • What seemed to trigger the rash

In some cases, skin tests or blood tests may be needed to help rule out other skin problems. If there is doubt about what you have, your family health care provider may send you to a dermatologist (skin doctor) or allergist (allergy doctor).

What can I do to help control an eczema flare-up?

People who have eczema (atopic dermatitis) tend to have dry skin that itches. Itching is the most troublesome eczema symptom. You can help prevent itching by keeping the skin moist. Apply bland, unscented moisturizing creams to your skin several times a day. You may need to apply them more often when the weather is dry or hot. People who have eczema (atopic dermatitis) tend to have dry skin that itches. Itching is the most troublesome eczema symptom. You can help prevent itching by keeping the skin moist. Apply bland, unscented moisturizing creams to your skin several times a day. You may need to apply them more often when the weather is dry or hot.

These steps can also help to manage an eczema flare-up:

  • Use lukewarm water for showers or baths. Hot water may dry out the skin and make itching worse.
  • Wash or bathe with gentle non-soap cleansers instead of strong soaps.
  • Pat your skin dry after bathing so you leave a little moisture on the skin. Apply your moisturizer within 3 minutes after drying off.
  • Wear soft clothing made of cotton instead of scratchy fabrics like wool.
  • Use a mild laundry detergent that has no scent.
  • Take steps that will help you to avoid sweating, which can trigger an eczema flare-up.
  • Avoid any known eczema triggers that may have caused you to have flare-ups in the past, such as wool clothing, perfumes, pollen, mold, dust mites, and animal dander.
  • Try to reduce stress.

What are the treatment choices?

Treatment can’ t cure eczema (atopic dermatitis). Treatment goals are to heal the skin and prevent future flare-ups.

If symptoms can’ t be prevented, there are many treatment choices. Your health care provider will choose the right treatment plan for you based on your specific condition. Treatment choices may include:

  • Cold compresses to help relieve itching.
  • Corticosteroid (KORE-tih-koe-STEER-oid) creams and ointments can help reduce the redness and itching caused by your inflamed skin. You can buy some brands over the counter, but a prescription is needed for the stronger corticosteroids. Follow your healthcare provider's instructions closely on how often and for how long to apply the cream or ointment.
  • Your health care provider may also prescribe other creams and ointments that do not contain steroids, that can stop the itch, and if used early, can help prevent the progression of flares.
  • Oral antihistamines (AN-tee-HIS-tuh-meens) can help reduce itching too. Many people take them for allergies. You can buy some of them at a drugstore. Others you can get only with a prescription. Some antihistamines can help you sleep better through the night by making you feel drowsy. Medicines that cause drowsiness should never be taken before driving or operating heavy machinery. There are also antihistamines that do not make you drowsy that are available either by prescription or from your drugstore.
  • Your health care provider may prescribe an antibiotic if you have a skin infection.

Make sure you tell your health care provider about all the medicines you (or your child) take. This applies even to over-the-counter medicines, vitamins, and herbal remedies.

Do I have to treat eczema?

Eczema (atopic dermatitis) can affect how you look. For people with eczema, the constant intense itching can disrupt their sleep.

There can also be other health problems.

  • Constant scratching can cause scarring.
  • Scratching can also lead to infection of the skin.
  • Even if you do not scratch, very inflamed skin with open sores can also become infected.

Although it won’ t cure eczema, treatment can relieve or stop the itch, reduce the redness, and make your skin look healthy again. With treatment, you can live more comfortably with eczema. Be sure to use creams and ointments the right way. Use them only as often and as long as your health care provider tells you to use them.

What questions might I ask my health care provider about treating eczema?

If your health care provider prescribes medicine for eczema (atopic dermatitis), you might ask:

  • Are there any side effects to watch for?
  • If it’ s a cream or ointment, how much should I apply?
  • If it’ s a pill or liquid (syrup), how much should I take?
  • How often should I apply the medicine or take the pill or liquid?
  • Are there any parts of my body where I should not apply the medicine?
  • How soon can I expect to start feeling better as a result of using this medicine?
  • Is it OK to go out in the sun when using the medicine?
  • Should I apply a bandage over the medicine?