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Sarah S. Kehl, M.D.

Allergy, Asthma & Immunology

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What is eczema?

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160223EczemaEczema is a chronic, itchy skin condition that affects around 10 percent of U.S. children* and 1 to 3 percent of adults. The term eczema is often used interchangeably with atopic dermatitis.  

What does eczema look like?

In babies, eczema tends to show up on the cheeks and extensor areas, such as the elbows, knees, and shins. The rash can be very red and weepy if in the acute stage, or it can look dry and thickened in the chronic stage. In young children, eczema usually affects the creases of the body (inside of the elbows, wrists, neck, behind the knees, and at the ankles). Although the rash typically will begin before age 5, you can also develop eczema as an adult. Adults with eczema may find that their hands are affected along with the flexor areas. The rash of eczema tends to worsen the more you scratch.

What causes eczema?

It’s a complicated answer, but genetics seems to be a factor. Children with eczema often have a family history of asthma, allergies or eczema. Some people with severe eczema have what’s called a “loss of function” mutation in a gene called filaggrin; this mutation leads to the skin barrier becoming “leaky” which allows it to dry out, and allows allergens and irritants to get under the skin. Sometimes there is an allergic component, as well. Environmental allergens, such as dust mites and animal dander, can trigger eczema, and people with pollen allergy may find their skin flares up during pollen season. Foods can also sometimes trigger eczema, though this is more common in babies and young children. The most common food triggers in eczema are egg and wheat**.  Stress, infection and changes in humidity are other potential factors that can lead to an eczema flare.

How is eczema treated?  

If you have eczema, it’s important to try to reduce irritants in your environment. Use a fragrance-free, dye-free laundry detergent and skip the fabric softeners and dryer sheets. Bathe with a fragrance-free, dye-free bar soap. When you get out, pat yourself dry, leaving some water droplets on your skin, and then immediately seal in the moisture with a gentle moisturizer. If your skin is flared and you are using a topical steroid cream, apply that first, and then the moisturizer after.  
Stubborn eczema may call for additional therapies

Sometimes the skin can get very thickened; adding “wet wraps” to those areas can help the creams penetrate that thickened layer of skin more effectively. A wet wrap is typically a layer of damp gauze or other cotton material that is then covered with a dry layer of material. Oral antihistamines can sometimes help reduce itching, while oral or topical antibiotics may be prescribed if the skin becomes infected. Some eczema patients who have frequent skin infections can benefit from a bleach bath by adding a small amount of bleach to their bath water to help reduce bacteria on the skin.

Watch for my upcoming blog about the interrelationship between eczema, allergies and asthma. For more information, or to speak with an allergist, contact us.

References:

*Eczema prevalence in the United States: data from the 2003 National Survey of Children's Health;Shaw  et al;J Invest Dermatol. 2011;131(1):67.

**(Patterns of food and aeroallergen sensitization in childhood eczema. Hon et al.Acta Paediatr. 2008;97(12):1734)

Dr. Sarah Kehl brings to Oak Street Medical her combined expertise as a board certified allergy/immunology specialist and pediatrician. Warm and approachable, Dr. Kehl tries to put all of her patients at ease.