Eczema

Is this your symptom?

  • An itchy rash that your doctor told you was eczema
  • Recurrent flare-ups of redness and severe itching occur

Symptoms of Eczema

  • The main symptom is itching. If it doesn't itch, it's not eczema.
  • With flare-ups (itching attacks), the rash becomes red or even raw and weepy.
  • Onset: atopic eczema often starts in childhood, but can present for the first time in adults. Other forms of eczema are more likely to present in adults.
  • Location: atopic eczema can affect any area of the body, but it is most often found in the joint creases. The rash is usually the same on both sides of the body. The elbows, wrists, and knees are the most common places. Discoid eczema usually spares the face and scalp. Varicose eczema affects the lower legs..

Cause of Eczema

  • Atopic eczema is often inherited and common in families with asthma and hay fever.
  • The cause of discoid eczema is unknown. It does not run in families.
  • Contact dermatitis is caused by contact with specific irritants. It is often a problem in the workplaces where chemicals are used.
  • Flare-ups of all types of eczema are from skin contact with soap, shampoo, pollen or other irritating substances.

Triggers of Eczema Flare-Ups

  • Soaps. Never use bubble bath. It can cause a major flare-up.
  • Pollens. Avoid lying on the grass during grass pollen season.
  • Animals. Avoid any animals that make the rash worse.
  • Foods. If certain foods cause severe itching (flares), avoid them.
  • Wool. Avoid wool fibers and clothes made of other scratchy, rough materials.
  • Dry Air. Use a humidifier if the air in your home is dry.
  • Herpes Virus Infection (serious). Keep away from anyone with fever blisters (cold sores). The herpes virus can cause a serious skin infection in people with eczema.
  • Eczema is not caused by laundry soap you use to wash clothing.

Itching Scale

  • Mild: doesn't interfere with normal activities
  • Moderate: interferes with work, sleep, or other normal activities
  • Severe: constant itching that can't be controlled

Food Allergy and Eczema Flare-Ups

  • Food allergies may be a factor.
  • The main allergic foods are cow's milk and eggs.
  • The main symptoms are increased skin redness and itching.
  • The eczema becomes easier to control if you avoid the allergic food.

Diagnosing Food Allergy and Eczema Flare-Ups

  • Your doctor may suggest the steps listed below:
  • Remove the suspected food or foods from your diet for 2 weeks. The eczema should greatly improve if the foods were the cause.
  • You can try that food again when the eczema is under good control. This is called a "challenge."
  • If the food is causing flare-ups, the eczema should become itchy and red. The flare-up should occur quickly within 2 hours of eating the food.
  • If this occurs, avoid this food in the future.

Other Dry Skin Problems in Adults:

  • Acanthosis nigricans. These are dark, dry velvety patches of skin appear in the area of the neck, groin or armpits. It grows slowly and may be caused by other health problems, so needs to be checked by a doctor. The areas are sometimes very itchy. It is more common in people with obesity, type 2 diabetes and problems that affect hormone levels, such as Cushing’s syndrome, polycystic ovaries or under-active thyroid. The patches often fade over time once the cause is treated.
  • Icthyosis causes widespread thick, dry, "fish-scale" skin. There are many kinds; some start in childhood and others in adults. It is genetic and cannot be cured. Daily lotion can help manage this problem.
  • Psoriasis causes patches of dry, raised scaly skin. It occurs when skin cells are replaced faster than usual. This may be caused by an immune system problem. Patches often occur over the front of the knees and back of the elbows and also in the scalp although all parts of the body can be affected.
  • Ringworm is a fungal infection of the skin. It can be mistaken for eczema. It appears as a scaly, dry, swollen and itchy rash. It can affect any part of the body. As it spreads, the edge of the rash moves outwards, the center part of the rash gets clearer. It can be treated with over-the-counter creams. No prescription is needed.

When to Call for Eczema

When to Call for Eczema

Call Doctor or Seek Care Now

  • Looks infected (spreading redness, pus, soft oozing scabs) and you have a fever
  • Many small blisters or punched-out sores occur
  • You feel very sick
  • You think you need to be seen, but the problem is urgent

Contact Doctor Within 24 Hours

  • Rash is very painful to touch
  • Looks infected, but you have no fever
  • Cracking and bleeding skin
  • Itching is severe after using steroid cream for more than 48 hours
  • You think you need to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Itching flare-ups occur often
  • Eczema diagnosis was never confirmed by a doctor
  • Rash is getting worse, even after using care advice
  • You have dry, dark velvety patches of skin that have grown slowly
  • You have round patches of dry skin which are spreading. They are clearer in the middle.
  • You have other questions or concerns

Self Care at Home

  • Eczema with no other problems
  • Questions about prevention of eczema flare-ups

Call Doctor or Seek Care Now

  • Looks infected (spreading redness, pus, soft oozing scabs) and you have a fever
  • Many small blisters or punched-out sores occur
  • You feel very sick
  • You think you need to be seen, but the problem is urgent

Contact Doctor Within 24 Hours

  • Rash is very painful to touch
  • Looks infected, but you have no fever
  • Cracking and bleeding skin
  • Itching is severe after using steroid cream for more than 48 hours
  • You think you need to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Itching flare-ups occur often
  • Eczema diagnosis was never confirmed by a doctor
  • Rash is getting worse, even after using care advice
  • You have dry, dark velvety patches of skin that have grown slowly
  • You have round patches of dry skin which are spreading. They are clearer in the middle.
  • You have other questions or concerns

Self Care at Home

  • Eczema with no other problems
  • Questions about prevention of eczema flare-ups

Care Advice

Treatment for Eczema

  1. What You Should Know About Eczema:
    • Eczema is a chronic skin disease. So, you need to learn how to control it.
    • Itching attacks (flare-ups) are to be expected.
    • The goal is to treat all flare-ups quickly. Reason: to prevent skin damage.
    • Here is some care advice that should help.
  2. Treatment is Based on Severity of Eczema:
    • Mild Eczema. Just need to use a moisturizing cream and to avoid flare-up triggers.
    • Moderate Eczema. Also need to use a steroid cream and bedtime allergy medicine.
    • Severe Eczema. Also may need antibiotics for a skin infection caused by Staph bacteria. This infection starts in open skin from severe itching.
  3. Moisturizing Cream or Ointment for Dry Skin:
    • The skin needs a moisturizing cream (such as Eucerin). Apply once or twice daily.
    • Apply the cream after a 5 or 10-minute bath or shower. To trap moisture in the skin, apply the cream while skin is still damp. Do this within 3 minutes of leaving the bath or shower.
    • The steroid cream should be applied to any itchy spots first. Then use the moisturizing cream as the top layer.
    • While most people prefer creams, moisturizing ointments are sometimes needed in the winter. An example is Vaseline.
    • Caution: never stop the moisturizing cream. Reason: the rash will come back.
  4. Steroid Cream or Ointment for Itching:
    • Itchy skin is the main symptom of eczema.
    • Steroid creams or ointments are essential for controlling red, itchy skin.
    • Apply steroid creams only to itchy or red spots (not to the normal skin).
    • 2 types of steroid cream may be needed. (1) A mild steroid cream is used to treat any pink spots or mild itching. This is often 1% hydrocortisone cream (such as Cortaid). No prescription is needed. (2) Another stronger steroid cream is needed to treat any spots with severe itching. This is a prescription steroid cream, such as Synalar. Never apply this stronger cream to the face.
    • Apply these creams as directed or 2 times per day.
    • After the rash quiets down, apply it once per day. After 1 good week just use moisturizing cream.
  5. Bathing - Avoid Soaps:
    • Take one bath or shower a day for 10 minutes in lukewarm water. Reason: water-soaked skin feels less itchy. After the bath, apply a moisturizing cream (such as Eucerin) to all the skin.
    • Avoid all soaps and bubble baths. Reason: eczema is very sensitive to soaps, especially bubble bath.
  6. Allergy Medicine for Itching at Bedtime:
    • Some people with eczema need an allergy medicine (such as Benadryl) at bedtime. No prescription is needed.
    • Reason: scratching in bed can cause severe skin damage. It may also impact falling sleep.
  7. Itching Attack - Shower to Remove Irritants:
    • Gardening (pollens), being around animals, or swimming can cause increased itching.
    • For itching from these causes, take a quick shampoo and shower.
  8. Itching Attack - Treatment:
    • At the first sign of any itching, use the steroid cream. Put it on the areas that itch. If unsure, apply 1% hydrocortisone cream (such as Cortaid). No prescription is needed.
    • Keep your fingernails cut short and smooth.
    • Try not to scratch.
    • For constant itching, you may want to cover your hands with socks or cotton gloves.
  9. Call Your Doctor If:
    • Itching is not under control after 2 days of steroid cream
    • Rash looks infected (spreading redness, yellow scabs or pus)
    • You think you need to be seen
    • Your skin gets worse

Prevention of Eczema Flare-Ups

  1. Tips to Help Prevent Flare-Ups:
    • Some flare-ups of eczema cannot be explained. But others are triggered by things that can be avoided.
    • Avoid chlorine in swimming pools and spas, harsh chemicals, and soaps.
    • Never use bubble bath. It can cause a major flare.
    • Keep off the grass during grass pollen season.
    • Avoid any animals that make the rash worse.
    • If certain foods cause severe itching (flares), avoid them.
    • Avoid things that irritate your skin, such as chemicals, greases or detergents.
    • Use gloves and a barrier cream if you cannot avoid irritants
    • Wear clothes made of cotton or cotton blends as much as possible. Avoid wool fibers and clothes made of other scratchy, rough materials. They make eczema worse.
    • Try to avoid excess heat, excess cold and dry air (use a humidifier). Avoid over-dressing. Heat can make the rash worse.
    • Caution: avoid anyone with fever blisters (cold sores). The herpes virus can cause a serious skin infection in people with eczema.
  2. Call Your Doctor If:
    • You have other questions or concerns

And remember, contact your doctor if you develop any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Copyright 2000-2023. Schmitt Decision Logic LLC.

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