Patient at Saguaro Dermatology with Eczema

Eczema

Eczema is a condition that causes patches of skin to become red, scaly, and itchy. There are many different stages and types of the disease, and over 30 million Americans have some form of the condition. Eczema commonly appears in infancy or early childhood, but babies and children who have it may grow out of it. Still, about 10-20% of cases globally persist into adulthood. Although there is no cure for eczema, there are many ways to treat it. And, it is not contagious, so you can’t catch it from another person.

Are There Different Types of Eczema?

There are actually seven types of eczema; the most common form is also known as atopic dermatitis, or AD. “Atopic” refers to diseases involving the immune system. More generally, being atopic means you have an inherited tendency to have allergic reactions to certain foods or inhaled substances; on the skin, these reactions take the form of eczema, but they can also manifest as asthma and hay fever. It is estimated that 15-30% of children and 2-10% of adults globally have this form of eczema.

What Causes Eczema?

We don’t know the specific cause of eczema, but it is commonly connected to a family history of allergies. Children are more likely to develop eczema if one parent has the condition; if both parents have eczema or a related skin disease, the chances are even greater. Environmental factors such as smoke and pollen may also play a role, as can foods such as nuts and dairy products. Whatever the trigger, the mechanics of the disease are the same: a substance activates the immune system, which over-reacts and produces an inflammatory response in the form of a rash.

What are the First Signs of Eczema?

Eczema is connected to impaired skin barrier function, which means that the skin cannot effectively retain moisture. Early signs to look for are dry, sensitive skin; red, inflamed skin; bad itching; and dark colored patches of skin. Moreover, symptoms of eczema vary by age. In infants under two years old, it commonly appears as a red, itchy rash on the cheeks, chin, chest, or scalp. In older children, rashes typically develop in the creases of elbows and the backs of knees, as well as on the neck, ankles, and wrists. In adults, rashes appear in these same places but can also cover much of the body; they may particularly affect the neck, face, and area around the eyes.

What is the Difference between Eczema and Dermatitis?

Eczema is just one type of dermatitis, which is a general term for skin conditions characterized by dry, itchy, scaly patches and inflammation. As noted above, eczema is the form of dermatitis known as atopic dermatitis. Other forms of dermatitis include contact dermatitis, which may look like atopic dermatitis. While it is possible to have atopic dermatitis and another type of eczema at the same time, remember that eczema runs in families and is associated with allergies, hay fever, asthma, and stress.

Why is Eczema so Itchy?

Simply put, eczema itches because the nerve endings in the top layer of your skin are stimulated by factors such as the dry skin itself, a flare of the eczema, or substances in your skin called “chemical mediators,” which serve to deliver messages to the nerve endings. The itching leads to scratching, which in turn leads to a worsening of the eczema and an endless cycle of itching and scratching.

How Can I Stop Eczema from Itching at Night?

Itching is an unpleasant physical sensation at any time, but at night it also significantly contributes to poor sleep. Along with some of the different treatments discussed below, using a cold compress or a wet wrap therapy can provide some immediate relief. Check out the National Eczema Association for other ways to manage itch.

What is the Best Eczema Treatment?

Because eczema alternates between relapse and flares, it can be difficult to treat. However, both over-the-counter (nonpharmacological) and pharmacological treatments are available. 

Nonpharmacologic Treatment for Eczema

The foundation of treatment for eczema focuses on preventing transepidermal water loss (TEWL), which means stopping moisture from evaporating through your skin1. This requires daily skin care, including the following measures:

 Bathe in lukewarm water for about 10 minutes a day using mild soaps free from dyes and fragrances. Pat the skin dry, allowing some moisture to remain. Follow with moisturizer. You can also add various ingredients to your bath to moisturize or relieve itching.
There are three basic types of moisturizer. Depending on the severity of your eczema, you can choose from lighter lotions and creams to those with a higher lipid (fats and oils) content.

  • Emollients: These are the most common moisturizers and are available in lotions and creams. Lotions have higher water content and, therefore, may not be as effective as creams in preventing moisture loss, or TEWL. Emollients soften and smooth the skin by filling in the cracks with oil.  Common beneficial additives include ceramides and cholesterol.
  • Occlusives: These are ointments with a higher lipid content. They are effective at moisturizing very dry skin but are thick and greasy. Additives used in these products include lanolin, mineral oil, petrolatum, and dimethicone. Lanolin has been known to lead to contact dermatitis, so you should test on a small area of skin before use, or discuss your options with a dermatologist.
  • Humectants: These are substances in lotions and creams that hydrate the skin by pulling moisture from the dermis (second layer of the skin) to the epidermis (top layer of the skin). Natural humectants such as hyaluronic acid, aloe vera, and seaweed may add to the cost of the moisturizer, but they may be healthier for you than synthetic humectants such as urea and lactic acid.
When moisturizers are not sufficient to soothe the skin, your dermatologist may prescribe a topical or systemic treatment, or an alternative therapy.
  • The base-line topical treatment for eczema is topical corticosteroids1. These come in a range of potencies, with the least potent prescribed for thinner-skinned areas of the body, such as the eyelids, and the most potent for thicker-skinned areas, such as the soles of the feet and the palms. Whether a mild, moderate, or strong corticosteroid is used depends on the severity of the eczema and part of the body affected. Some common corticosteroids used include hydrocortisone cream, desonide cream, fluticasone propionate cream or ointment, and clobetasol propionate cream.
  • A nonsteroidal topical therapy option for eczema is topical calcineurin inhibitors. The two available options in the United States are pimecrolimus 1% cream and tacrolimus 0.1% and 0.03% ointment. Pimecrolimus is used for treating mild-to-moderate eczema and tacrolimus for moderate-to-severe eczema3.
  • Oral corticosteroids can be used to provide quick relief of inflammation caused by severe eczema, but they should be used with caution as they can result in a flareup or other adverse reactions after treatment is finished.
  • Oral immunosuppressants are used to control flares in patients for whom other therapies have been ineffective. They also carry some risk of severe side effects1. Examples of oral immunosuppressants include cyclosporine, azathioprine, methotrexate, and mycophenolate mofetil (MMF).
  • Phototherapy is a treatment involving the use of ultraviolet A (UVA) light, ultraviolet B (UVB) light, or a combination of both to treat stubborn eczema that  is resistant to other treatments.
  • Biologics are a relatively new treatment option that targets the underlying causes of inflammation in patients. To date, trials have focused on the drug, dupilumab.
  • Antihistamines are used, with limited success, to relieve itching, allowing the patient to sleep better and reduce scratching.

Does Eczema Ever Go Away?

Eczema does not generally go away. While some children outgrow it, about 50% of Americans who develop the condition in childhood will continue to have symptoms as an adult.  However, eczema is an unpredictable disease; in between flareups, you may have periods of improvement. And even though there is no cure for eczema, the many different treatments available can help you to manage it.

What Type of Eczema Do I Have?

While all types of eczema cause redness and itching, each type of the condition has different triggers and symptoms. The National Association of Eczema can help you learn more about the causes and give you tools to manage your eczema.

Final Word on Eczema

The first step in managing eczema is knowing what type you have. If you have not been diagnosed yet, or you need more support, consider visiting our board-certified dermatologist, Dr. Dathan Hamann. He and the dedicated staff at Saguaro Dermatology can help you learn more about your eczema, identify your triggers, and manage your condition. We’re here to help!

What is an Allergy Patch Test?

Saguaro Dermatology, located in central Phoenix (just south of the Biltmore/Arcadia area and north of Tempe) offers patch testing for persistent eczema. There are many types of allergies, but many people aren’t aware of the allergic form of eczema called “allergic contact dermatitis” (ACD).

Learn More

Saguaro Dermatology Reviews

Itaro Elaisa
Itaro Elaisa

“I totally recommend this place to anyone who’s looking for a dermatologist who’s professional, informative, respectful and very helpful. They are quick to solve your problems and get you home.”

Wendy L.

I had an awesome experience with Dr Hamann and staff. I was very comfortable and i was able to have all my questions answered without feeling rushed. The staff was courteous and welcoming.

Kristin Ulrich-Uhles
Kristin U

“Dr Dathan and the team were very helpful, kind and knowledgeable. Plus, there was no wait time so I was able to get back to work faster than expected. I would highly recommend.”

Robert P.

Staff was friendly, & on time. office is super clean!! Doctor was awesome, felt like a family member taking care of me.

Sally Shepstead
Sally S.

“Very friendly and professional. I had a great experience, Dr. Hamann was very good at answering my questions and concerns. I will certainly come back for another visit.”

Amanda C.

Great doctor and friendly, professional staff. The doctor spends time listening and answering questions, something rare to find anymore. The office is beautiful and very clean. I love all the artwork with saguaros.

Kylin Chen
Kylin L.

“The office was recently renovated–it is a beautiful, clean, and calm environment. I would highly recommend this practice for anyone who is looking for a general dermatologist.”

L

Dr. Hamann is very knowledgeable, nice, and professional. You can tell that he truly cares about his patients by the way he operates. He took the time to listen to all of my concerns then address them with good, well-informed answers.

Saguaro Dermatology | Phoenix Dermatology

About Saguaro Dermatology

Our comprehensive dermatology clinic is dedicated to providing you with the highest quality of care, innovative practices, helpful resources and state-of-the-art technology to prevent and treat a multitude of skin disorders. Led by Medical Director, Dathan Hamann, MD, FAAD, our passionate team looks forward to serving you with respect and compassion.

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