Eczema

Eczema is also known as atopic dermatitis and is a chronic skin condition that causes areas of the skin to become red, itchy, dry, and sometimes even cracked and leathery. Eczema can appear on any part of the body. This condition typically starts in early childhood but can occur at any age. Eczema is a long-lasting condition that tends to flare up periodically and is often linked with people who have a family history of atopy, which refers to the genetic tendency to develop allergic diseases like asthma and hay fever. 

According to a study done by the National Eczema Association, eczema affects close to 32 million people in the U.S., which is over 10% of the population. Most people will develop this condition before the age of five, and it is said that 60% of children will no longer suffer from eczema by the time they're adolescents. 

What Causes Eczema?

Eczema often runs in families. Some genes cause some people to have sensitive skin. People with an overactive immune system may develop eczema. In some children, certain food allergies may play a role in causing eczema. It is not exactly known what specifically causes eczema, but it most often resembles an allergy. It is currently thought that eczema is caused by a combination of factors that could include:

• Genetics
• Abnormal function of the immune system
• Environmental factors
• Activities that may cause the skin to be more sensitive
• Defects in the skin barrier that allows moisture out and germs in
• Endocrine disorders like thyroid disease

 Things that could trigger eczema include:

• Stress, including anxiety
• Contact with irritating substances like wool, synthetic fabrics, and soap
• Heat and sweat
• Cold and dry climates
• Dry skin, such as patchy skin 

Signs & Symptoms of Eczema

Like many other conditions, people with eczema can often have periods of time when they experience more severe symptoms that are then followed by periods of time when they have little to non-existent symptoms. 

The symptoms of eczema are usually mild. The most common symptoms amongst people, regardless of age include:

• Dry, itchy, flaky, or scaly skin
• Redness, or flushing of the skin
• Open, crusty, or oozing sores

Symptoms of eczema vary depending on the age of the person and generally become more severe the older the person is. 

Symptoms in Infants

Most common in children under the age of two:

• Scalp and cheek rashes
• Rashes that become infected or bubble up before secreting fluid
• Extremely itchy rashes that can disturb sleep

Symptoms in Children

Most common in children over the age of two:

• Rashes that flair up on the creases of elbows, knees, neck, wrists, ankles, and legs
• Severely bumpy rashes 
• Rashes that can change the coloring in the skin, such as lightning or darkening
• Lichenification, or skin thickening; this can develop into a permanent itch 

Symptoms in Adults

Most common symptoms in adults include:

• Scaly rashes, usually more severe than what is experienced by children
• All over body rashes
• Extremely dry skin on affected areas
• Permanently itchy skin
• Infections

It is said that adults that have had eczema since childhood are less likely to experience symptoms the older they get, but may still have dry or irritated skin on their hands or around their eyes. 

The long-term effects on a person's skin are completely dependant on how much that person scratches, as this can irritate the skin and increase inflammation, which sometimes causes the skin to become infected. 

How Is Eczema Diagnosed?

There is no lab test required to identify eczema. Your Primary Care Physician or Dermatologist can usually diagnose eczema with a skin exam and medical history evaluation. Your doctor may do patch testing or other tests to rule out other skin diseases to be completely accurate.

How Is Eczema Treated?

It is important to know that there isn't currently a cure for eczema. However, there are various treatment options available for eczema. You may need to try a variety of treatments to determine what works best for you. Good skincare is key to help ease your eczema. If your eczema is mild, a good skin care regimen may be all you need, but your doctor may recommend medication if your eczema is more severe. A basic skincare routine could involve using a mild soap and a good moisturizer, take short warm showers and apply your moisturizer right after bathing, and have good stress management by exercising and setting aside time to relax. There are numerous medications and other therapies that your doctor may recommend to treat your eczema.

These could include:

• Hydrocortisone - an over the counter cream or ointment version could help mild eczema. If your eczema is severe, you may need a prescription-strength hydrocortisone cream.
• Antihistamines - these can be purchased over the counter to help relieve your symptoms. Some antihistamines will make you drowsy, and some will not, if this is a concern, make sure to carefully read the side effects.
• Corticosteroids - These are prescribed by a doctor, typically only when other treatments do not work. An example of an oral corticosteroid is prednisone and works to relieve itching and inflammation. Corticosteroids also come in a topical form applied directly to the affected area and work to relieve itchiness, inflammation, dryness and prevent flares from recurring.
• Phototherapy - This type of therapy can help if you have moderate to severe eczema. UV rays help prevent the immune system from overreacting. Phototherapy helps reduce itchiness and helps boost your body’s bacteria-fighting abilities. Doctors recommend the lowest dose possible as phototherapy does age your skin and increase your risk for skin cancer. There are two types of phototherapy:
• UV light therapy is performed in a dermatologist's office. Your skin is exposed to UVA and UVB rays. You will typically have sessions 2-5 times per week
• PUVA therapy - with this type, you take a prescription medication called psoralen that makes your skin more sensitive to UVA light. This is recommended for people who haven’t seen results from UV therapy alone.
• Medications that work on the immune system - examples include azathioprine, cyclosporine, or methotrexate. These medications work to prevent your body’s defenses from overreacting. These come in the form of pills, liquids, or injection. Possible serious side effects could include high blood pressure and kidney problems.
• NSAID ointment - This is a prescription ointment called Eucrisa, treats eczema, and works to control inflammation and reduce your immune system response. This should not be used long term and should not be used on children younger than 2.
• Topical calcineurin inhibitors - Examples include pimecrolimus (Elidel) and tacrolimus (Protopic). These medications work to reduce inflammation, itchiness, dryness, and prevent future flares. They may cause skin pain when applied and increase your risk of skin cancer.
• Injectable medication - Dupilumab (Dupixent) is an injectable medication used to treat moderate to severe eczema. It works to control your body’s inflammatory response. This injection is typically given every 2 weeks and should only be used for 12 years old and older.
• Prescription-strength moisturizers - these support your skin’s barrier
• Wet wrap therapy - This is a great option for those suffering from difficult to manage eczema. After you take a warm bath and apply medications, the skin damaged from eczema is wrapped in a layer of wet clothes, sometimes soaked with corticosteroids.

Some other, more homeopathic remedies that you can employ day-to-day and don't involve medication, include: 

• Lukewarm baths
• "Locking in the moisture," or applying body lotion within three minutes of showering or bathing
• Wearing natural fabrics, such as 100% cotton, and avoiding rough or scratchy fibers
• Using organic or natural soaps, including the soap used to wash clothes, towels, and sheets
• Using aloe vera, coconut oil, or apple cider vinegar on the affected skin areas

Where to Receive Treatment Online for Eczema

• MeMD
• CallonDoc
• Lemonaid
• Alpha Medical
• PlushCare
• CurieMD
• Rory
• Amwell

How to Prevent an Eczema Flare-up

• Moisturize your skin twice daily - Use whatever products work best for your skin, creams ointments, and lotions are great for sealing in moisture.
• Identify the triggers that worsen your condition - common triggers could include sweat, stress, obesity, soaps, detergents, dust, and pollen. Reduce your exposure to your triggers.
• Take shorter baths/showers
• Take a bleach bath - The American Academy of Dermatology recommends a bleach bath to help prevent flare-ups as it decreases bacteria on the skin. Dilute ½ cup of household bleach to a 40-gallon bathtub filled with warm water.
• Use gentle soaps - choose a mild soap. Soaps with deodorant or antibacterial properties can remove natural oils and dry your skin.
• Dry yourself carefully - after bathing, pat your skin gently (rather than dragging the towel across your skin) to dry with a soft towel.
• Avoid getting overheated - getting hot and sweaty can trigger itching and scratching
• Ease stress - make time to relax and get an adequate amount of sleep
• Wear 100% cotton clothes that fit comfortably - Avoid tightly fitted clothes

Eczema can cause uncomfortable side effects that can affect your overall health and well being. Thankfully, getting diagnosed and treated for eczema can be a simple process with the use of telemedicine. Many online companies can connect you with high-quality,  board-certified physicians who can diagnose and treat your eczema today. If your eczema is interfering with your daily life, check out our top online doctors' list that can help bring you relief from your eczema today.