If you’ve recently been diagnosed with eczema or are concerned you might have it, feeling nervous, confused, or uncomfortable is natural. Everyone with this condition has felt the way you do now at some point. Remember, knowledge is necessary to learn about the realities and challenges of eczema. It will also make you aware of the effective treatments, beneficial lifestyle changes, where to find support, and all the essential information to help you manage and prevent this condition. 

What Exactly Is Eczema?

Eczema, also referred to as Atopic dermatitis is a chronic inflammatory skin condition characterized by red, raw, and intensely itchy skin. Sometimes, the itch is so severe that it leads to scratching until the skin swells or bleeds. Eczema is more common in infants and young children.

Eczema can also reoccur, much like an unwanted sequel. According to the Global Report on Atopic Dermatitis 2022, almost 223 million people were found living with the condition. According to the National Eczema Society, one in four adults experience the onset of symptoms without having them in childhood. In India, the Global Asthma Network found over nearly 10% of Indian adults suffer from AR and eczema.

Research published in the Annals of Internal Medicine shows that the prevalence of eczema follows a U-shaped curve: high in children and teenagers, low in young and middle-aged adults, and high again in those in their 70s. Eczema commonly starts in childhood and may disappear in adulthood. Factors linked to Eczema included genetics, environment, and poor hygiene.

Types

There are six different types of eczema:

Hand eczema: Affects only the hands.

Neurodermatitis: Like atopic dermatitis, but with thicker scaly patches.

Nummular eczema: Features round, coin-sized spots that are itchier than other types.

Contact dermatitis: A red, itchy skin reaction to substances like nickel in jewelry or laundry detergent.

Dyshidrotic eczema: More prevalent in women, this type causes small blisters and bumps on the hands and feet.

Stasis dermatitis: Results from fluid leaking out of veins into the skin, causing painful swelling.

While there’s no cure for eczema, it goes through cycles of worsening symptoms (flares) and periods of no symptoms (remission).

Causes and Triggers

The exact cause of eczema remains unknown to researchers, but they believe a combination of genetic and environmental factors causes it. A family history of eczema increases the likelihood of developing the condition. One study published in Nature Genetics suggests that some individuals with eczema lack the necessary proteins to form a protective barrier in the skin’s outer layer, the epidermis. This deficiency allows essential moisture to escape and invites allergens, or triggers, to enter. Exposure to these triggers, such as certain soaps or stress, prompts the body to send inflammatory signals to the immune system, leading to flare-ups.

• Genetics: Eczema tends to run in families, suggesting a genetic predisposition to the condition. Specific genes related to skin barrier function and immune response are thought to play a role.
• Abnormal Immune Response: People with eczema often have overactive immune systems that react to triggers in the environment, leading to inflammation and skin symptoms.
• Skin Barrier Dysfunction: The skin barrier in individuals with eczema is often compromised, allowing irritants, allergens, and microbes to penetrate the skin more easily and trigger inflammation.
• Environmental Factors: Various environmental factors can exacerbate eczema symptoms, including harsh soaps and detergents, extremes in temperature or humidity, allergens (such as pollen, pet dander, dust mites), and irritants (such as wool or synthetic fabrics). Cold or dry environments strip moisture from the skin, causing it to become brittle and scaly, leading to an eczema flare. However, excessive moisture can also be problematic.
• Food Allergies: Some people with eczema may have food allergies or sensitivities that can worsen their symptoms. Common food triggers include dairy, eggs, nuts, soy, and wheat.
• Stress: Emotional stress can increase eczema symptoms or trigger flare-ups in some individuals. Stress hormones released by the body can worsen inflammation and weaken the skin barrier.
• Hormonal Changes: Hormonal fluctuations, such as those occurring during puberty, pregnancy, or menstruation, can affect eczema symptoms in some individuals.
• Microbial Infections: Bacterial, viral, or fungal infections can worsen eczema symptoms or trigger flare-ups. Staphylococcus aureus bacteria are commonly found on the skin of individuals with eczema and can exacerbate inflammation.
• Chemical Irritants: Exposure to certain chemicals found in skincare products, cosmetics, cleaning agents, or other household products can irritate the skin and trigger eczema flare-ups.
• Excessive sweating: This can irritate the skin, particularly during a flare and in areas where sweat accumulates, like the elbows, knees, and neck.

It’s important to note that triggers can vary from person to person, and identifying and avoiding individual triggers is often a key part of managing eczema effectively. Additionally, while there is currently no cure for eczema, various treatments and strategies are available to help manage symptoms and reduce flare-ups.

Unlike allergies, eczema is not an allergic reaction but an immune response. While there’s ongoing research, children with eczema are more likely to have food allergies (e.g., peanuts, milk, eggs), but food allergies don’t directly cause eczema or flares. Nonetheless, since eczema is an inflammatory condition, many find relief by consuming anti-inflammatory foods like fish and vegetables.

Symptoms

Appearance: Babies often develop eczema in areas they can reach and scratch, like their cheeks, belly, or scalp. As children become more mobile, eczema appears on body parts that come in contact with surfaces. Adults, especially those with a long history of eczema, may develop a ring of eczema around their eyes when exposed to allergens or irritants or in areas like the back of their knees and elbows. Chronic eczema can lead to thicker, leathery, and darker skin due to prolonged scratching.

Itching: Intense itching is a common symptom for eczema sufferers of all ages, leading to the “itch-scratch cycle,” where itching causes scratching, releasing more inflammatory chemicals, worsening eczema by initiating inflammation and dry skin. Untreated, continuous scratching can result in a bacterial skin infection.

Other symptoms include:

• Thick, scaly skin
• Darkened skin around the eyes, possibly with an extra skin fold beneath them.

Diagnosis

Unfortunately, there isn’t a definitive test for eczema. However, a dermatologist can diagnose the condition by closely examining your skin and reviewing your medical history. Signs that may indicate you have eczema include:

• A history of the rash appearing and disappearing since childhood, potentially leaving scars or skin discoloration.
• Uncontrollable itching, which is a hallmark of eczema, can be intense.
• Specific factors, such as hay fever season or weather changes, trigger rash flare-ups.
• A personal or family history of eczema, allergies, or asthma. According to the National Eczema Foundation, over 20% of adults with eczema also suffer from hay fever and/or allergic asthma.

If you’ve never been diagnosed with eczema, it’s important to have any eczema-like rash examined by a doctor rather than self-treating with over-the-counter remedies. The rash could be a different condition, such as psoriasis or a rare form of cancer called cutaneous T-cell lymphoma, which may also present with swollen lymph nodes and/or hair loss. If there’s any doubt, your doctor may perform a biopsy to confirm the diagnosis.

The Best Treatment Options for Eczema

There’s no cure-all medication for eczema. Research indicates that nearly 75% of children are free of eczema by age 16. Still, it’s a chronic condition with no guarantee of outgrowing it. For years, the primary treatment was steroid creams, which can cause side effects like skin thinning, cataracts, and glaucoma if used for extended periods (more than a year).

However, the past decade has seen the introduction of more treatment options, particularly for severe cases that are difficult to manage. Here’s what’s effective:

Self-Care

Self-care is vital for managing eczema. A ceramide-rich moisturizer creates a barrier that prevents water loss, protects against infection, and replenishes moisture. Apply it immediately after bathing or showering.

Bathing

Regarding showers, opt for lukewarm water (hot water can dry out the skin) and limit bathing to under 15 minutes. Use a gentle, unscented cleanser instead of a bubbly soap bar.

Bleach Bath

The National Eczema Society suggests a ten-minute bleach bath to kill bacteria and reduce infection or inflammation risk. Add 1/4 cup (about 59 ml) to 1/2 cup (about 118 ml) of bleach to 151-liters of water if you’re using a bath tub. If using a bucket of 15 liters, add bleach according to the calculated ratio above. That should work out to 5ml to 10ml of bleach.

Alternatively, an oatmeal bath two to three times a week can help alleviate itching. Consult your doctor before trying nay natural remedy in conditions like eczema.

Topical Creams

For mild eczema affecting small areas of the body, dermatologists may prescribe topical corticosteroids to reduce inflammation. These come in various strengths and are typically applied once or twice daily during flare-ups. However, they’re not recommended for long-term use (more than two weeks at a time) due to the risk of skin thinning.

Medication

For worrisome conditions, medication or injectables are considered as prescribed by a doctor. Dupilumab, Alclometasone and Tacrolimus are some examples used in India. Do not self-medicate in eczema, but consult a doctor.

Immunosuppressants

In extremely severe cases with widespread eczema and significant inflammation, dermatologists may prescribe immunosuppressant drugs to control the immune system and reduce symptoms. The most common medications are azathioprine, cyclosporine, and methotrexate, which are potent drugs used in organ transplant patients or chemotherapy. These are considered a last resort due to their potential side effects, including gastrointestinal issues, kidney or liver damage, and increased infection risk. Regular blood tests are necessary to monitor your health while on these medications.

Can Eczema Lead to Serious Complications?

While eczema primarily affects the skin’s surface, causing raw, itchy, and inflamed patches, its impact can extend beyond the skin, potentially affecting overall health. Some potential complications include:

• Staph infections: The lack of infection-fighting proteins in the skin can increase the risk of bacterial infections like staph. If eczema patches become swollen and red (or grey on dark skin), seeking medical attention immediately is essential.
• Bone fractures: Recent studies have associated severe eczema with an increased risk of fractures, particularly in the hips, back, and spine. This is partly due to the chronic inflammation associated with eczema.
• Heart disease: A study published in the British Medical Journal in May 2018 found that individuals with severe eczema have a 50% higher risk of heart attack and death from heart disease than those without the condition. The exact link between eczema and heart disease is still unclear, and further research is needed to determine whether eczema treatments play a role. However, if you have severe eczema, it’s advisable to get screened for heart disease and its risk factors, such as hypertension and high cholesterol.

The Impact of Eczema on Daily Life

Is eczema a life-threatening disease? Generally, no. Can it be life-restricting? If left untreated or unmanaged, yes. Adults with eczema are up to three times more likely to suffer from depression or anxiety than those without the condition, with about half of these cases going undiagnosed. The impact of eczema on a person’s life can be significant as it can affect their social/dating life, work life, sleep, and other daily activities.

Read: Everything You Need to Know About Psoriasis

Managing the impact of eczema in your life involves adopting the countermeasures and treatment options mentioned above. This can help alleviate anxiety and may even get rid of the condition. However, if you’ve tried to treat it independently and see no results, consult a dermatologist for the best possible treatment options.