Hi Eczema is often used as an umbrella term for a group of chronic, itchy skin rashes, a simple definition of the skin condition is hard to come by. Many people with eczema develop dry, itchy, red patches of skin. In some forms of eczema, blisters develop. Scratching can inflame the rash and cause “weeping” of clear fluid. Over time, the affected patches of skin can thicken. Eczema can look different depending on the type of rash and where it appears on the body. Symptoms typically flare up for a period of time and then calm down before surfacing again. More than 30 million Americans have some form of eczema. While the exact cause is unclear, a combination of factors, such as genes, environment, and immune system are thought to play a role Atopic dermatitis is the most common form of the skin condition, and it’s usually what people are referring to when they talk about eczema. About one in five children develop atopic dermatitis, often in infancy and usually by age 5. (Only a small percentage of adults develop this type of eczema.) Dry, scaly, red, and itchy patches can appear on the face, scalp, hands, or feet; inside the elbows; or behind the knees. In more severe cases, these patches crack and crust over, and they can become infected. Atopic dermatitis comes and goes, with periods when symptoms are worse and other times when the rash goes into remission and disappears. It tends to occur in families with a history of this eczema, hay fever, or asthma. It can be a lifelong condition, although some children outgrow it or see symptom improvement as they age. Eczema is usually accompanied by uncontrollable itching that worsens when you scratch it and can interfere with sleep. People sometimes scratch until they bleed, yet itching persists, and the wound becomes vulnerable to infection. The signs and symptoms of eczema can vary from one person to the next. Atopic dermatitis, the most common type of eczema, usually strikes in childhood. Babies tend to develop a red rash on their cheeks and scalp that turns dry and scaly. The rash can bubble up, ooze, and crust over. In young children, other body sites may be affected, such as the inside folds of the elbows or knees, or the hands, wrists, or feet. Over time, these patches can lighten or darken, and they may become thick and bumpy and constantly itchy. Dyshidrotic eczema typically strikes the hands and feet. People with this type of eczema develop small, fluid-filled blisters that itch and burn. The blisters weep, crust over, and crack, exposing the skin to painful infection. There’s no single test for diagnosing eczema. Your doctor or your child’s pediatrician will conduct a physical exam. Some patients may be referred to a dermatologist or allergist. Doctors look for typical signs and symptoms of eczema, such as itching and rash. The difficulty is often ruling out other conditions that cause irritating skin symptoms. Atopic dermatitis, for example, may be confused with seborrheic dermatitis (a common condition that mainly affects the scalp), while nummular eczema may resemble ringworm (a contagious fungal infection). Sometimes a skin patch test or allergy test may be required to confirm an eczema diagnosis by ruling out other conditions. Expect your doctor to ask about your family history of allergic disease, since eczema can run in families. Kids with eczema can also go on to develop food allergy, hay fever (also known as allergic rhinitis), and asthma—usually in that order (this is sometimes called the “atopic march”). Tell your doctor when symptoms first appeared, how often you or your child experiences symptoms, other body parts that are affected, whether the problem comes and goes, and when it seems to flare up. Your doctor may ask about any allergies you or your child have and potential triggers of symptoms. Unfortunately, there’s no single magic bullet to get rid of eczema. But there are a number of treatments and strategies for relieving symptoms, reducing inflammation, and preventing flare-ups. These include ointments and creams that are applied to the skin, oral antibiotics or antihistamines, and an injectable medication. Restoring moisture is crucial for preventing symptom flare-ups. Soaks and wet wraps can soothe pain and itching. Prescription and over-the-counter moisturizers can help repair dry skin and keep it hydrated. Steroid ointments and creams have long been the go-to remedy to clear up eczema rash. These topical treatments (also called corticosteroids) can help reduce inflammation and alleviate symptoms during a flare-up. But they are not recommended for long-term use due to serious potential side effects. Topical steroids come in different strengths, so if one doesn’t do the job, your doctor may switch to a more potent version. Newer non-steroidal medicines called calcineurin inhibitors are another option. These drugs include Elidel (pimecrolimus) cream for mild-to-moderate eczema and Protopic (tacrolimus) ointment is approved for moderate-to-severe symptoms. Eucrisa (crisaborole) ointment 2% is another option for eczema patients 2 years old and older. Approved by the U.S. Food and Drug Administration in December 2016, Eucrisa inhibits an enzyme that promotes inflammation. The newest weapon against eczema, approved in March 2017, is Dupixent (dupilumab) for adults with moderate-to-severe atopic dermatitis. It is administered as an injection under the skin and is intended for people whose eczema is not controlled by topical therapies or for whom topical treatment isn’t recommended. The active ingredient in Dupixent is an antibody that blocks a protein that causes inflammation. Light therapy (also called phototherapy) using a special device that emits ultraviolet light is an option for clearing difficult-to-treat eczema and rashes that are dispersed across the body. Topical products containing coal tar or antihistamines may be prescribed for itch relief. An antibiotic may be given to treat bacterial skin infections. Diluted bleach baths are sometimes used to treat baby eczema that results in frequent infections. (Be sure to consult your doctor first for specific instructions.) Medications Topical steroids such as hydrocortisone cream to relieve inflammation Calcineurin inhibitors such as Elidel (pimecrolimus) cream and Protopic (tacrolimus) ointment Eucrisa (crisaborole 2% ointment) Dupixent (dupilumab), an injectable drug Antihistamines to control itch Prescription or over-the-counter moisturizers Antibiotics to treat infections that may arise Regards DR DE