Eczema (Atopic Dermatitis)

Who's At Risk?

Infants and children are most frequently affected, but eczema may persist into adolescence and adulthood in some individuals.

Signs & Symptoms

Eczema is usually itchy. The most common locations for eczema include the face, neck, in front of the elbows, and behind the knees. Adults with eczema may notice the most irritation on the arms and legs, but any part of the skin may be affected.

• Thickened, scaly papules (small, raised bumps) and plaques (areas of raised skin that is larger than a thumbnail and feels rough and flaky) are seen in these areas, and the condition can be:
  • Mild – a few scattered areas of involvement that are easily treated with self-care measures.
  • Moderate – more extensive involvement that is more difficult to control with self-care measures and may require prescription therapy.
  • Severe – diffuse involvement that is difficult to treat even with prescription therapy.
• In lighter skin colors, affected areas may appear pink or red; in darker skin colors, the redness may be subtle, or affected areas may appear purplish or darker brown.
• There may also be accentuation of the hair follicles and shininess without obvious thickened, raised areas.
• Areas of eczema that become infected (known as a superimposed infection) can develop thick crusts.

Self-Care Guidelines

Maintaining healthy skin is very important for those with eczema.

• Moisturizing skin-care routines are essential.
• Avoid long, hot showers. Hot water can dry the skin.
• Hypoallergenic moisturizing soaps, such as unscented Dove Sensitive Skin Beauty Bar, Vanicream Cleansing Bar, and Nature by Canus, are recommended.
• Thick moisturizers such as petroleum jelly (Vaseline), Aquaphor Healing Ointment, Eucerin Original Healing Cream, CeraVe Healing Ointment, or CeraVe Moisturizing Cream should be applied to damp skin daily after bathing.
• Treat red, itchy areas with over-the-counter hydrocortisone (eg, Cortaid) cream or ointment 0.5%-1% twice daily. Avoid using steroid cream on the eyelid area for more than a few days.
• Attempt to minimize exposure to heat, humidity, detergents / soaps, abrasive clothing, chemicals, smoke, and stress.
• Fragrance-free laundry detergent may be beneficial.
• Keep the home from getting too dry by using a humidifier, especially in the bedroom.

Treatments

Topical or oral (systemic) medications can include:

• Topical steroid creams or ointments to treat active areas of limited (localized) eczema. Low-strength steroids may be used on the face, and medium-to-high-strength steroids may be used on the body (trunk) and arms or legs (extremities). Care should be taken when using topical steroids in skin folds because of the risk of thinning (atrophy) of the skin.
• Tacrolimus (Prograf) ointment or ruxolitinib (Jakafi) cream may be prescribed in place of topical steroids.
• Pimecrolimus (Elidel) cream may be prescribed for milder eczema or for certain areas of involvement, such as the face.
• Oral antihistamines may be prescribed to decrease itching.
• A short course of oral steroids may be prescribed for flared eczema.
• Light therapy may be recommended for treatment of widespread, resistant eczema, as may immunosuppressive medications, such as methotrexate.
• Newer medications such as dupilumab (Dupixent) or Janus kinase (JAK) inhibitors may be prescribed for severe cases.
• In patients who have multiple areas of broken skin or a history of bacterial skin infections, diluted bleach baths may be recommended.
• If an infection is suspected, topical or oral antibiotics may be prescribed.

Visit Urgency

Seek medical care if there is a lack of response to self-care measures or if the condition worsens (flares).

Also see a medical professional if you see areas of pus or large numbers of crusty areas (scabs), as this might be caused by infection with bacteria.

Trusted Links

• Eczema
• Clinical Information and Differential Diagnosis of Dermatitis, Atopic (Eczema)
• Living Your Best Life With Atopic Dermatitis: A Patient and Caregiver Education and Resource Center

References

Bolognia J, Schaffer JV, Cerroni L. Dermatology. 4^th ed. Philadelphia, PA: Elsevier; 2018.

James WD, Elston D, Treat JR, Rosenbach MA. Andrew’s Diseases of the Skin. 13^th ed. Philadelphia, PA: Elsevier; 2019.

Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology. 9^th ed. New York, NY: McGraw-Hill Education; 2019.

Paller A, Mancini A. Paller and Mancini: Hurwitz Clinical Pediatric Dermatology. 6^th ed. St. Louis, MO: Elsevier; 2022.