Eczema

 What is eczema?

Eczema is the most common inflammatory skin rash and is also referred to as atopic dermatitis. Some use the terms interchangeably while others use eczema to describe more limited forms of skin inflammation (dermatitis) and reserve the term atopic dermatitis to describe a more chronic and widespread form of eczema.  It consists of generalized dryness, itching, and inflammation of the skin. It is most commonly seen in children starting in early infancy and usually resolves by adulthood. Patients may experience eczema at any point in their lives as it is not limited to childhood. 

While there is no single underlying cause, there are many factors that contribute to eczema. There is a strong genetic component and most patients have a family member who is also affected. Many people with eczema have been shown to have specific gene mutations that affect formation of the skin barrier. One such example are mutations to the gene that forms filaggrin, a protein essential to forming a strong and healthy skin barrier. Patients with eczema also seem to have a stronger inflammatory reaction when the skin is exposed to common environmental factors. Other factors include having dry skin and improper care of the skin causing excessive dryness and irritation. 

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Eczema is also commonly associated with seasonal allergies (hay fever) and asthma. One doesn't seem to cause the other but rather patients with eczema show a greater tendency toward developing these inflammatory types of reactions. The same can be said about food allergies. 

In most causes, a simple visual examination and brief medical history by a trained skin specialist such as a dermatologist is all that is needed for diagnosis. Eczema can appear similar to other skin diseases so there are instances where a skin biopsy will be recommended. This involves taking a sample of skin to examine under the microscope to look for features characteristic of eczema. 

Eczema typically requires multiple types of interventions to get the rash under control and keep it under control. A major step involves trying to maintain a healthy skin barrier. This means using mild soaps, avoiding hot showers or other things that will dry and irritate the skin, and frequent use of moisturizers to hydrate the skin. 

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The next step typically involves using medications to decrease skin inflammation to allow the skin to heal. Treatment typically starts with topical steroids to calm down the skin. Topical steroids are very safe and effective for short term or limited use. For those who can't be controlled with topical medications due to severity or other reasons, oral medications or injections may be needed. Options would include anti-inflammatory steroid pills or injections. There are also several pills used to help calm down the body's immune system. There are now injectable medications referred to as biologics such as Dupixent that block some of the inflammatory pathways in the skin and are safer for long-term use. Recently oral medications such as Rinvoq have been approved to treat eczema and provide another option for patients with resistant or severe disease. 

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Regardless of the treatment, some form of longer term intervention is usually needed as eczema tends to be a chronic condition with episodes of flares followed by periods of little to no rash. For some, simply following good skin care habits as described above is enough, while others may need to use prescriptions periodically to maintain adequate control.