Unidentified bumps and rashes can be caused by anything from allergies to keratosis pilaris, but eczema is one of the most common culprits. Also known as atopic dermatitis, eczema is a disorder of the skin barrier that causes dry, itchy patches. For some, it is just a mild annoyance, but it can also escalate to a level of itchiness that disrupts daily life. “The proteins that link skin cells together don’t work as well in people who have eczema versus those who have healthy skin,” board-certified dermatologist Rita Linkner, M.D., F.A.A.D., tells SELF. “They’re missing that mortar between the bricks, and the bricks are [open] to the elements.”
It’s a misconception that eczema is something only children have to deal with. While the symptoms can sometimes fade somewhere between first grade and the early 20s, there are plenty of adults who have to deal with eczema as well. According to the National Eczema Association, approximately 31.6 million Americans have eczema. Ten percent of children have the disorder, and the same percentage of adults are dealing with eczema. “You can get it at age one, you can get it at age 81, or you can get it at age 101,” New Jersey dermatologist Jeanine Downie, M.D., tells SELF. “It can come up at any point in your life for no reason.”
The symptoms typically come and go in sporadic flare-ups (except in extremely severe cases where it can be more persistent). Doctors don’t know why some people have eczema and others don’t, but there seems to be a genetic component. “If you have a history of allergies or asthma, you’re predisposed genetically to get eczema,” says Downie. “If you have asthma, many years later you could get eczema. If your parents have eczema or allergies, you could pop up years later with eczema.” Once you have eczema, there is no cure. However, you can manage the patches with proper eczema treatment tactics.
What does eczema look like?
Common areas where eczema can pop up include the back of the neck, behind the knees, in the creases of the elbows, on the lower back, and the hands and feet in adults. But you can get eczema anywhere, including the face and the eyelids. Most children get eczema across the entire body, while adults typically have it in certain spots. And it does tend to recur in the same spot again and again.
In the first few days of a flare-up, eczema can look red and inflamed. Breakouts can also appear as the same color as your skin or a bit lighter. Then if left untreated, it can turn dark brown or even purple, especially on darker skin tones. The appearance and length of a flare-up really depends from case to case. It could last for a week or a month or even longer. And if the area isn’t properly moisturized and scratching continues for an extended period of time, eczema can harden into bark-like scales. (Linkner says this is called lichenification and that it usually happens when her patients aren’t taking their prescriptions as advised.)
Eczema can be mistaken for many other things including an allergic reaction, bug bites, dandruff, or even psoriasis. “Psoriasis and atopic dermatitis affect different areas. Psoriasis can also affect internal organs and joints, and [there are] more chronic inflammation changes in hands, feet, and back,” explains Linkner. And while both dandruff and psoriasis result in thick, yellow scales or white flakes, eczema is more likely to appear as cracking or peeling. It can be a bit harder to differentiate between an allergic reaction and eczema. However, an allergy test will determine if there are any specific ingredients or products causing an eczema-like reaction. If you’re not sure, go to a dermatologist to get a solid diagnosis.
What triggers an eczema breakout and how can you treat it?
Once you’ve been diagnosed with eczema, there are certain triggers to look out for. Cold, dry weather is the most common cause of a flare-up. “Someone who has eczema isn’t as good at retaining water as someone who doesn’t have eczema,” says Linkner. “The decrease in humidity levels, the dryness, the wind factor—all of these winter elements make the skin more compromised. And when you can’t retain that moisture, you get dry skin and with that comes inflammation, itchiness, redness, peeling.”
So the best way to combat dryness is to double down on moisturizing. Linkner recommends her patients apply moisturizer right after taking a quick, lukewarm shower. “Showers should be business not pleasure,” she says. “People think you add moisture when you bathe and wash your hands, but you’re actually stripping your skin of moisture, so less is more.” Once you’re out of the shower, pat dry. The skin should still be damp when you add a moisturizer. If you have serious eczema, you might want to moisturize again after getting home from work and once more before bed. And don’t forget to plug in your humidifier in the evening, which adds moisture to the dry air.
When it comes to choosing a moisturizer, you want to avoid any skincare products with heavy fragrance. “Technically, some fragrance-free products do have some fragrance,” says Linkner. “So you want to make sure it says ‘unscented’.” Downie likes Aveeno Eczema Therapy Itch Relief Balm ($23), and Linkner recommends Cetaphil Moisturizing Cream ($15). Recent studies have also shown that petroleum jelly like Vaseline ($4) can help prevent the development of eczema in babies who have a family history of the disorder.
In addition to getting a heavy-duty moisturizer, take care with your choice of body wash, laundry detergent, and fabric softener sheets. Stock up on Dove bars for sensitive skin ($13) and All Free Clear detergent ($8). Also don’t forget your hands and feet (which are common places to get eczema as an adult). Linkner recommends using something a bit greasier on the thick skin in these areas. Keep a small tube of Aquaphor Healing Ointment ($7) at your desk or in your purse to reapply after you wash your hands.
If you are prone to eczema, wool clothing can also cause irritation. So, stick to loose-fitting cotton tops during this time of year. It’s also important to trim your nails as short as possible. “Scratching 100 percent makes it worse,” says Downie. “And if you don’t have weapons, you won’t go to war.” Linkner agrees, “I tell my patients, ‘If I were to put you in a straight jacket, a lot of your eczema would disappear.’ The itching kind of causes the scratching, which causes inflammation, and it all feeds back on to itself.” If your eczema flare-up is particularly itchy, ice the area or take an allergy medication like Zyrtec or Claritin to keep from scratching.
What if moisturizer isn’t cutting it and the itch won’t go away?
If these moisturizing strategies aren’t working, your dermatologist can prescribe medications to help with the eczema treatment. First, your doctor may recommend using a cortisone or another steroid cream for a week or so. “Steroid creams target the cells that are creating that inflammation and turn those cells off,” says Linkner. There are also other topical treatments like Elidel for moderate cases.
Severe, full-body cases might also benefit from phototherapy. This eczema treatment is also used on autoimmune disorders like psoriasis and vitiligo. “You get into the light booth where the bulbs emit a narrow band of UVB light,” says Linkner. “It’s very different than going to the beach. It’s taking out the safest portion of UV light and exposing your eczema for very short amounts of [time].” This light treatment helps reduce inflammation with only a few minutes of treatment.
In the most extreme cases of atopic dermatitis, patients could end up in the hospital with fever and chills. “Your skin is the biggest organ of your body, so if the barrier is not intact and you’re itchy all over, it’s not going to be a good,” says Downie. “Perhaps you’re scratching so much; and there is staph underneath your fingernails; and you have an infection.” A compromised skin barrier opens up your body to other infections and viruses. “If you have eczema, it’s easier for you to get warts,” says Downie. “If you have cold sores (otherwise known as the herpes virus), it could be worse because your barrier is not completely intact.” Luckily, there are many innovations happening in the treatment of eczema.
“Currently there is no cure for eczema, but I do think that in our lifetime there will be,” says Linkner. “There are injectable medications in clinical trials that are gaining traction.” One of these drugs, called Dupilumab, was given a breakthrough therapy designation by the U.S. Food and Drug Administration and could be on the market as soon as 2019.
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