Doctor's Notes on Eczema (Atopic Dermatitis)
Eczema is a pattern of skin reaction that can be seen with a number of different skin diseases. Dermatitis for skin inflammation due to allergic reactions or contact with irritants is one common cause of eczema. Dry skin and scabies are two additional common causes.
Signs and symptoms characteristic of eczema include a rash consisting of red, elevated plaques on the skin that contain tiny red blisters filled with fluid. The blisters may leak fluid causing oozing and weeping of the affected area of skin. When eczema is present over the long term, the skin becomes thickened and scaly. Itching is a prominent associated symptom. Different types of eczema may cause a rash to appear in different locations of the body.
Eczema (Atopic Dermatitis) Symptoms
Medical professionals sometimes refer to eczema as "the itch that rashes."
- Usually, the first symptom of eczema is intense itching.
- The rash appears later and is red and has bumps of different sizes.
- The rash itches and may burn, especially in thin skin like the eyelids.
- If it is scratched, it may ooze and become crusty.
- In adults, chronic rubbing produces thickened plaques of skin.
- Having one or more round areas is referred to as nummular (coin shaped) eczema and may be confused with fungal infections.
- Some people develop red bumps or clear fluid-filled bumps that look "bubbly" and, when scratched, add wetness to the overall appearance. This type of eczema is especially common on the sides of the finger in dyshidrotic eczema and also goes by the name pompholyx.
- Painful cracks in the skin can develop over time.
- Although the rash can be located anywhere on the body, in adults and older children, it is most often found on the neck, flexures of the arms (opposite the elbow), and flexures of legs (opposite the knee). Infants may exhibit the rash on the torso and face. It usually first appears in areas where the child can rub against sheets, since they may not have the coordination to precisely scratch yet. As the child begins to crawl, the rash involves the skin of the elbows and knees. The diaper area is often spared.
- The scalp is rarely involved.
- While the skin behind the ear may be involved, the outer ear itself is usually spared.
- Eyelids are often puffy, red, and itchy.
- The itching may be so intense that it interferes with sleep.
- While classic eczema and psoriasis are distinctly different and seldom coexist, both conditions may have severe erythrodermic (red skin) forms in which the patient has inflammation of most of the skin surface area.
- Asteatotic eczema is a term often applied to describe patients who have thin, dried, cracked-appearing skin, usually especially bad on the lower legs.
- Significant involvement of the palms and soles of the feet is not usual and may suggest a different condition such as fungal infection, scabies infestation, or allergic contact dermatitis.
Eczema (Atopic Dermatitis) Causes
It is generally agreed that the tendency to atopy is inherited. For the purposes of this discussion, the term eczema and atopic dermatitis will be synonymous. Individuals with atopic dermatitis have a variety of abnormal immunologic findings, like elevated IgE antibody (immunoglobulin E) levels and defective cell-mediated immunity, which causes difficulty in fighting off certain viral, bacterial, and fungal infections. Despite a susceptibility to certain infections, eczema is not itself contagious in any way.
Like most other noninfectious diseases, atopic skin disease can be triggered by environmental factors. One of the hallmarks of atopic dermatitis is excessive skin dryness, which seems to be due a lack of certain skin proteins called filaggrins. Any factor that promotes dryness is likely to worsen atopic dermatitis. A very dry sleeping environment may be improved with a bedroom or house humidifier.
Common triggers of atopic dermatitis include the following:
- Harsh soaps and detergents
- Overwashing of skin
- Low humidity
- Rough wool clothing
- Occlusive rubber or plastic gloves
- Staphylococcus bacteria
- Repeated wetting and drying of the skin (as occurs with food handling or other professions requiring frequent hand washing)
- While food allergies are implicated as triggers in some patients, there is no dietary restriction or recommendation which is universally helpful.
- Eczema may be worsened by the development of additional problems such as allergic contact dermatitis, which may occur as a reaction to preservatives and active ingredients in moisturizers, and even as a reaction to the topical corticosteroids used themselves.
Eczema is a descriptive term for a chronic skin condition that usually begins in early childhood. It is seen most commonly in individuals who have family members who have asthma and hay fever. This is not to say that eczema is a classical allergic disease. There seems to be general agreement that this condition is inherited because of the complete loss or relative lack of a skin protein.
Atopic Eczema (Atopic Dermatitis) : Test Your Skin Disorders IQ QuizQuestion
Eczema (also atopic eczema or atopic dermatitis) is a general medical term for many types of skin inflammation.See Answer
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.