Women in Motion

Susan Blatt, MD

Eczema is a chronic skin condition that is partly genetic in origin and partly allergic.  It may be mild, requiring regular skin moisturizing to keep it under control; or it may involve large portions of the skin, with a scaly, itchy rash.  About one in ten persons of all ages has some problem with eczema.

Areas of skin affected by eczema are red, flat, and scaly.  People complain of itching and they tend to scratch the areas, making the condition worse.  They may complain of pain, especially at night.  If the rash is in exposed areas, it can be disfiguring, causing embarrassment.

Allergic eczema is also called atopic dermatitis. Often the patient also has asthma or hay fever.  Generally, even with severe cases, the actual allergic agent is not identified.  Sometimes with babies and infants, it is helpful to change the diet. Occasionally blood tests or patch tests are used to investigate certain allergic causes.

Contact dermatitis is another form of eczema where the rash develops at the site of contact.  People with contact dermatitis may be irritated by jewelry.  Those who are irritated by dishwater may benefit by wearing gloves.  On the other hand some people are irritated by certain gloves, especially latex. If latex problems are suspected, vinyl gloves should be used.

Children may have severe eczema, making daily functioning difficult.  Many, but not all, will outgrow the problem.  It is important with children to try to avoid scar formation. 

It appears that eczema sometimes flares up when there are emotional problems.  It is not clear whether emotional issues actually cause the condition directly, or if scratching is increased in these situations.

Patients with eczema benefit from the use of moisturizing creams or ointments.  Different forms may work for different people.  These creams should be applied over the entire body once a day. 

Steroid or hydrocortisone creams are the basic element of treatment.  Non-prescription creams contain a low dose of steroids.  Other prescription forms of steroid creams are stronger.  Steroids reduce the inflammation and allow the skin to heal.  Usually oral steroids are not required. Some steroid creams cannot be used on the face because they can damage the eyes. The stronger steroid creams may sometimes be absorbed and cause increased steroids in the body, but that is not very common.

People with eczema use various antihistamines to suppress the itchiness.  In children it is usually helpful to keep itchy areas covered by clothes during the day and bedclothes at night.

If the skin rash of eczema is moist and there is oozing from the rash, it may be infected.  Antibiotics may be used, both topically and orally.

New medications, called immunomodulators, are now available.  These are only prescribed by specialists such as allergists or dermatologists and they are only used when traditional treatments have failed.

Many of the medications used to treat eczema should not be used before or during pregnancy.  The obstetrician should be consulted.

To prevent flare-ups of eczema patients use moisturizing creams, non-prescription hydrocortisone creams, and oral antihistamines.  It may help to avoid stressful situations, if possible.  For flare-ups of eczema the primary care provider or a dermatologist should be consulted.