Eczema

Atopic dermatitis is typically considered a childhood disease because most cases develop by the age of five, according to the AAD. Although this condition commonly appears in childhood, adults can still develop atopic dermatitis—referred to as adult-onset atopic dermatitis—among other types of eczema.

It’s important to know that the presentation of atopic dermatitis can look different between age groups. “In babies, atopic dermatitis often presents on the scalp, face, and neck, while atopic dermatitis in children and adults often presents on the eyelids and in the inner elbows and backs of the knees,” Dr. Nakamura explains.

Per the AAD, here’s how eczema may occur in different locations depending on age:

• Infants and toddlers: In very young children, eczema usually forms on the face and scalp area, most commonly appearing on the cheeks. Signs of atopic dermatitis in infants and toddlers may include difficulty sleeping, fussiness, and “rubbing” against objects or items.
• Children: In older children, eczema often develops in areas where the skin is creased, such as the elbows, knees, neck, and beneath the buttocks. It can also develop on the wrists and ankles. The skin in these areas can thicken over time, especially from chronic rubbing.
• Adults: Eczema can still develop in the creases and folds of the skin in adulthood but can present anywhere, including the eyelids, scalp, and hands.

When it comes to treating eczema in different age groups, it’s really important to create a personalized treatment plan. “Treatments are similar, though we have to pay careful attention to side effects and risks that vary with age, and other diseases that may be present for each particular patient,” notes Dr. Martin.

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Although triggers can vary from person to person, common triggers of eczema include environmental irritants, dry skin, and stress, per the National Eczema Association.

One of the most common triggers for flare-ups in people with eczema is skin irritants, which can include anything that comes in contact with your body. If you’re wondering whether your favorite pumpkin-scented body wash could be triggering your eczema, there’s a good chance it’s a yes. That’s because self-care products that are applied directly to the body, such as body wash, shampoo, conditioner, lotion, and perfumes, are common irritants in people with eczema.

That’s not the only place you might need to purge triggers, though, as they might be hiding in your laundry basket. Irritants, which can include cleaners, disinfectants, and laundry soap, are also considered common triggers.

Other potential skin irritants in people with eczema include:

• Certain metals, such as nickel and cobalt (think jewelry and the rivets on jeans)
• Tobacco and cigarette smoke
• Wool, polyester, and other fabrics
• Antibacterial ointments and wipes
• Specific chemicals and compounds, such as formaldehyde

Dry skin is another common eczema trigger, which can be exacerbated by things like cold air and too-hot showers. It’s a vicious cycle: Eczema itself causes increasingly dry, damaged skin, which in turn becomes more susceptible to flare-ups.

And unfortunately, it’s not just physical triggers that can lead to a flare-up. Although the research on the link between eczema and stress is limited, the thought is that stress does play a role in the underlying immune response related to eczema, and may lead to other changes in the body that can weaken the skin barrier.⁵ Some people with the condition even report a worsening of symptoms during periods of emotional stress. So if you find your skin is raw and chapped after a particularly rough workweek, stress could be the culprit.

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Unfortunately, Dr. Martin explains, there aren’t any specific tests that specialists use to diagnose eczema. “It is diagnosed by clinical criteria and visualization of the skin and is often treated by primary care providers, dermatologists, and some allergists,” she says, noting that sometimes the process may also include other specialists like pulmonologists or immunologists.

According to the AAD, the process for diagnosing eczema generally includes:

• A medical history review, during which the doctor will ask questions about your family’s health history, including whether you have any close relatives with asthma, allergies, eczema, or other similar conditions.
• A physical exam, where your doctor will gather more information about your symptoms, including when they began, and take a look at your skin to determine if any signs of eczema are present.
• A skin patch test can also be done to determine whether you have specific allergies. Your doctor will attach patches containing suspected allergies to your skin (they will stay there and be checked 48, 72, and 96 hours later) to see whether you have an allergic reaction to them.

In some cases, your doctor may also want to take a sample of your skin—a procedure called a biopsy—to help determine whether the symptoms are due to eczema or another condition, such as a bacterial or fungal infection.

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Unfortunately, there is no cure for eczema, and there is no way to determine whether someone’s eczema will be chronic or not. The good news is that many people do grow out of eczema if they were diagnosed as a child.

About 80% of babies and kids who have eczema will grow out of their eczema by late adolescence or early adulthood, according to the National Eczema Association, while the other 20% will have eczema throughout adulthood. Dr. Nakumura explains that eczema is entirely unpredictable, with some people even developing the condition suddenly much later in life. In fact, about one in four adults with atopic dermatitis reports developing the condition as an adult.³

However, she notes, “there are many different treatment options that are available for eczema, and many people with eczema are able to manage it quite well.” When it comes to long-term management of chronic eczema, treatments are meant to help prevent known triggers from causing a flare, as well as manage symptoms and flare-ups that may arise—not stop or cure the condition. 

There is some good news too. Newer medications have been developed as maintenance therapy. These injectable medications lower the systemic immune response to environmental triggers and have dramatically minimized the severity and frequency of flares for both kids and adults in the last few years since they were approved.

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Eczema treatment involves a combination of approaches that can help reduce your symptoms, lower the chance of flare-ups, and prevent complications or a worsening of the condition. According to the AAD, treatments options for eczema should include:

• Following gentle bathing and skincare routines
• Identifying and reducing your exposure to triggers
• Applying topical medications to treat the itch and subsequent rash
• Considering systemic treatments such as steroids and newer injectable biologic treatments

One of the most common and effective types of medication for eczema is topical corticosteroids, which work to reduce skin inflammation—especially redness and swelling—as well as itching. Steroids, as they are commonly called, come in various topical forms, including ointments, creams, lotions, sprays, and foams. They also come in varying strengths that can be tailored for different situations, areas of the body, and people. They are extremely beneficial, especially once you and your doctor figure out which type of topical and strength works best for you.

The downside is they are generally not recommended for long-term use (and are often avoided on delicate areas of the face) due to potential side effects, like thinning of the skin and developing a tolerance to the treatment. Other topical treatment options for eczema are then used to avoid those steroid side effects. These include tacrolimus, pimecrolimus, and crisaborole, which all work in a similar way and can be used on delicate skin areas. A new topical cream, called ruxolitinib, was also recently approved for the treatment of atopic dermatitis.

In some situations, systemic steroids and immunosuppressants (which are taken orally) may be used to reduce severe symptoms and flare-ups. These medications affect your whole body, which is why they are used only in severe cases as a short-term option.

Since the effects of eczema are more than skin-deep, there are new therapies meant to be used continuously as maintenance therapy to improve the quality of life for people with chronic atopic dermatitis. These medications are called biologics and can reduce the internal inflammation driving the symptoms of an eczema flare. They reduce both the severity and frequency of flare-ups. They are also considered to be safer options long-term, compared with oral corticosteroids and other immunosuppressants. 

One biologic has been on the market since 2017, and is approved for both kids and adults with eczema, as well as for asthma and nasal allergies with polyps. That means it can effectively be used for people who have multiple components of the atopic triad (eczema, allergies, and asthma). Another biologic was just also approved for adults with moderate to severe atopic dermatitis.

Phototherapy is also worth mentioning, although it is not used as frequently. This is an exposure to UV light, usually via a light box in a doctor’s office. Phototherapy is effective, as it lowers the skin’s immune reaction to triggers, but long-term exposure can increase the risk for future skin cancer. 

Although most people find success using the treatments above, experts are still working hard to develop new treatment options for people with eczema, says Dr. Martin.

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When someone has eczema, the skin barrier—your body’s first line of defense that protects the outside from the inside—becomes compromised, which can result in an increased risk of bacterial, viral, or fungal skin infections.

Per the NIAID, one of the most common bacterial infections in people with eczema is from Staphylococcus aureus, otherwise known as a staph infection. According to the research, roughly 60% to 90% of people with eczema have S. aureus bacteria on their skin that can eventually lead to a staph infection. This can also make eczema symptoms worse and harder to treat, according to a 2019 study published in Advances in Dermatology and Allergology.⁶ In addition, viral skin infections—such as those that can develop from the herpes simplex virus—are more common in individuals with eczema. This can be serious and should be treated immediately.

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Sometimes you’re cruising through life and your eczema is under control, and then out of nowhere, your skin seems to go haywire. That’s when you know you’re smack dab in the middle of an eczema flare-up—a sudden worsening of eczema symptoms, such as redness, itching, and pain, which can last for days or weeks.⁷ Eczema flare-ups often happen after you’ve been exposed to a trigger, which is why it’s important to identify and avoid your triggers as much as possible.

During an eczema flare-up, the goal is to help ease your symptoms until your eczema is back in remission again, which means your flare-up treatment plan might include:

• Topical creams, gels, or ointments (most likely a steroid medication)
• Weekly light therapy at an office or clinic
• Daily wet therapy at home (where you slather skin in an ointment, then cover with wet gauze and a dry cover on top)
• Short-term systemic medications if your symptoms are severe

It can sometimes be difficult to navigate eczema treatment, especially during a flare-up, so make sure to reach out to your doctor for guidance and support during these times.

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If you are one of the millions of people who have been diagnosed with chronic eczema, you know that it can take time to find a routine that helps keep your symptoms to a minimum. But if you’re just starting on the road to treatment and prevention, here are some expert-backed tips for long-term management:

1. Identify and manage your triggers.

One of the most important steps in creating an eczema prevention plan is identifying your personal eczema triggers. If you’ve been working closely with an allergist or dermatologist, you can take advantage of allergy testing—such as a skin patch test or scratch test—to determine which specific allergens may be a trigger for you. Or, if you’re not able to do allergy testing, simply keeping a diary of things you and your doctor suspect could be triggers may help you ID the source of your eczema symptoms.

Unfortunately, you may not always be able to limit your exposure to triggers entirely—but when you know what they are, you can keep them out of your home and away from your skin as much as possible.

2. Create an eczema-friendly skin-care routine.

If you have mild eczema—meaning dry, itchy skin that feels manageable instead of unbearable—a gentle skin-care regimen can help relieve the symptoms and hopefully prevent flares, explains Dr. Nakamura. Here’s what she recommends:

• Take short showers (like 5 to 10 minutes short), with warm—not hot—water.
• Try a nonantibacterial, fragrance-free soap to wash your body, as these are less irritating to the skin.
• Use a fragrance-free, emollient cleanser (think balmy or lotion-like) to wash your face, as foamy cleansers can dry out your skin even more.
• Layer on a thick, sensitive-skin-friendly moisturizer cream for your entire body after the shower.
• Use a broad-spectrum, mineral-based sunscreen (look for titanium dioxide and zinc oxide in the ingredients list) with at least SPF 30. This will be the least irritating for most people with eczema and offer your skin the best protection from the sun.
• Make sure to use skin-care products that are fragrance-free and dye-free overall.

When it comes to eczema, the extra moisture is not just important but also necessary: “Moisturizing the skin on a regular basis protects the skin barrier that is weakened in eczema and helps with itching and dryness,” says Dr. Nakamura.

3. Follow your at-home prevention plan.

Once you’ve identified your triggers and created a gentle skin-care routine, you’ll have more success keeping your eczema at bay if you can create an eczema-friendly daily routine. So this may include small changes to your daily to-do list, such as:

• Closely monitoring the temperature and humidity inside your home
• Protecting your skin—like wearing sunscreen and loose-fitting cotton clothes—whenever you venture outside
• Limiting your exposure to allergens, both inside and outdoors
• Engaging in daily stress-relief activities, if stress is a trigger for you

Sometimes, try as you might, your prevention plan may not be enough to stop your symptoms from flaring—especially if you have a more severe case of eczema. In that case, Dr. Nakamura recommends seeking help from a specialist to further tailor your treatment plan, so you can start feeling better sooner.

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Sources:

1. Annals of Allergy, Asthma, and Immunology, Comorbidities and the Impact of Atopic Dermatitis
2. Frontiers in Immunology, Research Progress in Atopic March
3. Acta Dermato-Venereologica, Psychoneuroimmunology of Psychological Stress and Atopic Dermatitis: Pathophysiologic and Therapeutic Updates
4. American Journal of Clinical Dermatology, Adult-Onset Atopic Dermatitis: Characteristics and Management
5. Immunology and Allergy Clinics of North America, Wet Wrap Therapy in Moderate to Severe Atopic Dermatitis
6. Advances in Dermatology and Allergology, Staphylococcus Aureus: An Underestimated Factor in the Pathogenesis of Atopic Dermatitis?
7. Dermatologic Clinics, The Long-term Course of Atopic Dermatitis