Eczema (pronounced eg-zuh-MUH) is one of the most common skin conditions that we see in our practice. The term “eczema” is derived from a Greek word that means “to boil over”, and describes a spectrum of skin disorders, all of which demonstrate similar appearing skin rashes. Common findings in eczema include red, itchy, crusted, scaly, and weeping skin areas.
What Causes Eczema?
Often, the term “eczema” and “atopic dermatitis” are used interchangeably; however, “eczema” is a much broader term that encompasses a variety of distinct entities, which include atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, hand eczema, and several others.
The essential function of our skin is to provide our bodies with a protective barrier from the outside world. Much like the brick wall of your home, our skin contains two main structural components: skin cells called keratinocytes (similar to bricks) and a mortar-like extracellular matrix that holds the skin cells together. Unlike the brick wall of your home (which requires a mason to repair any damage), our skin can respond to situations of increased skin degradation (such as when exposed to an irritating chemical) by ramping up production of the barrier. Eczema results when the balance of skin production and degradation is upset, causing inflammation and a characteristic rash.
In some forms of eczema, there may be a genetic predisposition. In recent years, a mutation in a gene that produces a component of the extracellular matrix (called filaggrin) has been discovered. This filaggrin deficiency may decrease the protective barrier function of the skin, and make individuals more susceptible to eczema rashes.
What are common eczema triggers?
It is important to understand that every individual with eczema is different, and that triggers for disease flares can be quite diverse. However, understanding the common triggers and learning to avoid them is an important component of eczema disease management. One of the most common triggers is dry skin, which can be improved by regular use of bland moisturizers (see below for product recommendations). Exposure to skin irritants is also a common trigger for disease flares. Common irritants include detergent soaps, alcohol-based products, and mechanical irritants such as from repetitive trauma or contact with rough materials. Allergy may also cause eczema, the most common of which is poison ivy. However, there are thousands of chemicals to which our bodies are exposed on a regular basis that can cause allergic eczema rashes (e.g. preservatives, hair dye, glues/adhesives, fragrances). At the Pennsylvania Center for Dermatology, we have a special interest in identifying each patient’s unique triggers. Additionally, we are a regional referral center for epicutaneous patch testing, which is non-invasive medical procedure used to identify specific chemical allergies. Once identified, our trained providers can provide detailed information about safe personal products and educate patients on appropriate allergen avoidance measures.
What types of treatments are available for eczema?
Although there is no permanent cure for eczema (yet), there are a variety of treatments available. The core of eczema skin care revolves around three components:
- Know your triggers so that you can avoid exposure (if allergy is suspected, consider having skin patch testing to identify the specific allergens)
- Follow appropriate eczema maintenance regimen including frequent use of moisturizers and following gentle cleansing practices
- Use over-the-counter or prescription medications as directed by your dermatology provider.
Do you have any specific skin care product recommendations?
- Non-detergent cleanser. One of the most common causes of skin irritation is exposure to harshdetergent cleansers. Non-detergent cleansers are much better for the skin. In my eczema patients, I recommend Vanicream Cleansing Bar. This non-irritating formula is ideal for sensitive skin and is free of fragrances, parabens, formaldehyde, gluten and lanolin.
- Hand Moisturizer: Individuals with hand dermatitis will benefit from frequent use of a hand cream with both barrier and moisturizing properties. I recommend CeraVe Therapeutic Hand Cream for many of my patients with dry, irritated, cracked and scaly hands.
Daily facial moisturizer with SPF: For the face, especially for patients withsensitive skin, I often recommend EltaMD UV Clear for daily use. This SPF46 broad spectrum sunscreen contains hyaluronic acid (a fantastic moisturizer) and niacinamide, and provides excellent moisturization while still maintaining a pleasant silky and lightweight texture.
What treatments are available for severe or widespread eczema?
When eczema is severe or not responsive to more conservative measures, your provider may recommend treatment with a special form of light called phototherapy. Alternatively, some patients may be candidates for treatment with systemic immunosuppressive agents such as prednisone, mycophenolate mofetil (Cellcept), cyclosporine, methotrexate or azathioprine. Recently, the FDA approved a new biologic called Dupixent (dupilumab) for the treatment of adult patients with moderate-to-severe atopic dermatitis whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable.