Eczema

Eczema has been called "the itch that rashes" because the itching usually occurs first. This group of skin rashes may first appear in babies and toddlers, becoming a drier, flaky rash in older children. Adults may see scaly, leathery patches or a stubborn hand eczema. Atopic dermatitis is a common, often inherited form, but there are other types, as well as many treatment options.

Itching is the defining symptom. Once you start scratching, the skin becomes inflamed -- and even itchier. The appearance can vary greatly and may include: Red, scaly areas, Small, rough bumps, Thick, leathery patches, Bumps that leak fluid and crust over. In darker-skinned people, the affected area might be lighter or darker.

Infants who are just 6 to12 weeks old can develop atopic dermatitis as a patchy facial rash. It can progress, becoming red and scaly, and may appear on the forehead or scalp. Moisture from drooling worsens the rash. In some cases, the condition goes away by age 2. But about half of people who had atopic dermatitis as a child will have the condition as an adult.

Children may develop the rash on the inside of their elbows or behind the knees, around their mouths, on the sides of their necks, or on wrists, arms, and hands. Those with atopic dermatitis are more likely to have food allergies, including allergies to peanuts, milk, or other nuts. However, experts say you shouldn't restrict foods unless there is a confirmed food sensitivity. Reassure children that it isn't contagious.

Adults typically notice itchy patches on the hands, elbows, and in the "bending" areas of the body, such as the inside of the elbows and back of the knees. But eczema can appear anywhere, including the neck, chest, even the eye lids. Those who had atopic dermatitis as a child may see drier, scaly rashes as adults. The skin may be discolored or thickened.

If a rash persists, causes significant discomfort, or develops a crust or pus-filled blister, you may want to see your health care provider. A diagnosis of eczema  is usually based on a detailed medical history, symptoms, measurable physical signs, and a family history of allergic conditions. Your doctor may also order allergy tests or a microscopic exam of a skin scraping (seen here) to rule out infections.

There's a link between atopic dermatitis and hay fever or asthma. If a parent has hay fever or asthma, their children are more likely to have the skin condition. And about half of children with atopic dermatitis will go on to develop hay fever or asthma. The substances that bring on an allergy attack -- dust mites, pollen, animal dander, mold -- can cause some people with atopic dermatitis to break out in a rash. Food allergies also can trigger a flare-up. These allergens cause the immune system to overreact, activating cells that produce inflammation in the skin.  

Irritants can cause inflammation and itching, bringing on a bout of eczema. Touching harsh chemicals can cause a nasty rash in anyone, but people with eczema may be sensitive to mild irritants, such as wool, detergents, astringents, or fragrances. Emotional stress can trigger a flare-up, as can sweating and frequent wetting and drying of the skin -- even everyday hand-washing.

We don't know exactly what causes atopic dermatitis, the most common form of eczema. Experts believe genetic, environmental, and skin factors all play a role. A malfunction of the immune system may be involved, creating inflammation in the skin, even when there is no infection to fight. Emotional disorders do not cause eczema, as doctors thought many years ago, but stress can make symptoms worse.

Almost all people with atopic dermatitis have Staphyloccocus aureus bacteria on their skin, compared with just about 5% of people without the skin condition. Be alert to the signs of infection, including honey-colored crusts, pus- or fluid-filled blisters, scaly red patches, swelling, or fever, and contact your doctor or health care provider.

Even when the eczema subsides, the dry skin remains. Hydrate the skin with short daily baths in warm water. Pat the skin partially dry and apply a thick moisturizer -- emollients and creams are usually more effective than lotions -- on top of any medication and elsewhere on the body within three minutes of taking the bath. Apply moisturizers throughout the day and use only mild soaps or cleansers. Look for fragrance-free products to help prevent a reaction. Remember, "unscented" may just mean the product contains another ingredient to mask the scent.

Your child may feel self-conscious about the appearance of the rashes. Help him or her avoid triggers and cope with stress. Adults may need to adjust their activities. Jobs that require a lot of hand-washing or exposure to chemicals or other irritants, such as health care, housecleaning, or hairdressing, may not be a good choice for someone with eczema.