Eczema is a chronic skin condition and is also called dermatitis. The most common type is atopic eczema, in which a dry, itchy rash develops.
Atopic eczema usually starts in infancy or childhood but many children outgrow it. Occasionally, adults develop it. Eczema is not dangerous or contagious but it can cause discomfort and distress, including social stress for children and job difficulties for adults.
Atopic eczema is an immune system disease, the exact cause of which is unknown. It is likely inherited and is associated with having allergies and asthma. Outbreaks, or flare-ups, are often caused by environmental factors such as certain fabrics, chemicals, perfumes, pets, dust, smoke, foods, or stress.
Symptoms usually involve an extremely itchy rash that causes the skin to turn red, swell, and scale, burn, or form small blisters. If small blisters develop, they may ooze and become crusty. Eczema typically comes and goes (flares up). A flare-up can start with severe itching that causes a rash, in turn making the itching worse. Over time, the skin may thicken and as a result itch constantly.
There is no cure for eczema and no single treatment, but you and your doctor can work together to manage it for you or your child. Eczema can be stressful for families because of a child’s discomfort and appearance from the rash. The goals of treatment are to prevent flare-ups and, when they happen, to prevent infection. Treatment involves preventing environmental triggers when possible, maintaining appropriate skin care, and using medications.
Moisturizers are the mainstay of treatment, including between flare-ups.
Cover damp skin with thick lotion or cream (such as petroleum jelly).
Avoid soap; use a soap substitute instead.
Take lukewarm baths or showers.
Avoid rough, scratchy fabrics such as wool.
Avoid cold, dry air.
Corticosteroids can be applied to the skin as a cream or ointment. Sometimes they are given as an injection or a pill for a severe flare-up, but they can cause a rebound flare-up when you stop taking them. Steroids can have significant side effects.
Topical immunomodulators are medications that can be used by children older than 2 years. They are applied to the skin and help control inflammation and reduce immune system reactions. They have fewer side effects than steroids. Because they are newer drugs, long-term risks are unknown, such as the risk of skin cancer. Generally a specialist should be consulted.
Antihistamines are used to reduce allergic reactions and especially to help with itching during sleep.
Immunosuppressant drugs can be used in severe cases; they are used for short periods of time because of severe side effects.
Light therapy with UV light can be used alone or along with the drug psoralen for children older than 12 years.
Antibiotics are used if the skin gets infected.
National Institute of Arthritis and Musculoskeletal and Skin Diseases: http://www.niams.nih.gov/Health_Info/Atopic_Dermatitis
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at jama.com. Many are available in English and Spanish.
Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Sources: National Institute of Arthritis and Musculoskeletal and Skin Diseases, British Association of Dermatologists; Habif TP. Clinical Dermatology. 5th ed. Edinburgh, UK: Mosby Elsevier; 2010:chap 5.
Sugerman DT. Atopic Eczema. JAMA. 2014;311(6):636. doi:10.1001/jama.2013.280498