What eczema is
Eczema, also called atopic dermatitis, is a common skin condition that makes the skin dry, itchy, red and rough. It often starts in babies and young children, and many grow out of it or become much better as they get older. Some people continue to have eczema as adults, and it can also start for the first time in adulthood.
Eczema is not contagious. It tends to run in families along with asthma and allergies such as hay fever. The skin barrier in eczema does not hold moisture well and lets irritants in easily, which sets off itching and inflammation.
Common triggers
Eczema usually comes and goes in flares. Learning your own triggers is one of the most useful things you can do. Common triggers in Indian homes and weather include the following. Food allergy triggers eczema in some young children, but foods should only be removed from the diet on a doctor's advice.
- Soaps, detergents, bubble baths and scented products
- Hot water baths and long bathing times
- Dry winter air, and sweating in hot, humid weather
- Woollen or rough synthetic clothes
- Dust mites, pet dander and pollen
- Stress, illness and scratching
Symptoms of eczema
The main symptom is itching, which is often worse at night and can disturb sleep for the whole family when a child is affected. The skin becomes dry, red or darker brown on Indian skin, scaly and rough. Scratching can make the skin thick and leathery over time, and may cause small cracks, oozing and crusting.
In babies, eczema often appears on the cheeks, scalp and outer arms and legs. In older children and adults it is common in the folds of the elbows and knees, the neck, wrists and ankles. Areas of old eczema may leave pale or dark patches that fade slowly.
How eczema is diagnosed
Doctors diagnose eczema by looking at the skin and asking about itching, where the rash appears and any family history of allergy or asthma. Most people do not need tests. If the doctor suspects a contact allergy, a patch test may be done. Allergy blood tests are used only in selected cases, because positive results do not always mean a real allergy.
Other conditions such as fungal infection, scabies and psoriasis can look similar and need very different treatment. It is important to get the diagnosis confirmed by a doctor rather than using random creams from a shop, many of which contain a mix of a steroid, an antifungal and an antibiotic that can worsen the problem.
Treatment approach
Moisturisers, called emollients, are the foundation of treatment and should be used every day, even when the skin looks clear. For flares, doctors prescribe steroid creams of suitable strength for a short time to calm inflammation. Used correctly, as advised, these are safe and effective. Problems usually come from using strong steroid creams for long periods without supervision, especially on the face.
Other options include non-steroid creams such as tacrolimus for sensitive areas like the face, antihistamines at night to help sleep, and antibiotics if the skin becomes infected, only on a doctor's prescription. Severe eczema that does not respond may need specialist medicines taken by mouth or injection, or light therapy under a dermatologist.
Daily skin care routine
A steady daily routine prevents many flares and reduces the need for steroid creams. It works for both children and adults. Keep children's nails short to reduce damage from scratching, and use soft cotton gloves or mittens at night if scratching during sleep is a problem.
- Bathe in lukewarm, not hot, water for a short time
- Use a soap-free, fragrance-free cleanser instead of regular soap
- Pat the skin dry and apply moisturiser within a few minutes
- Apply moisturiser generously two or more times a day
- Wear soft, loose cotton clothing
- Wash clothes with mild detergent and rinse well
When to see a doctor for eczema
See a doctor if the itching disturbs sleep, the rash is spreading, or moisturisers and simple care are not controlling it. Pregnant and breastfeeding women, and parents of babies, should ask a doctor before using any steroid cream. A doctor or pharmacist can help you choose a suitable moisturiser and show you how much cream to use and for how long.
Medicines doctors commonly use
Only your doctor can decide which medicine, dose and combination is right for you.
- Emollients and moisturisers (fragrance-free creams or ointments)Repair the skin barrier, lock in moisture and reduce itching.Use generously every day; follow the label or your pharmacist's advice.
- Topical corticosteroid creams such as hydrocortisone or mometasoneCalm inflammation and itching during flares.Only as prescribed; strong steroids should not be used on the face or for long periods without a doctor's advice.
- Topical calcineurin inhibitors such as tacrolimusReduce inflammation without steroids, useful on the face and folds.Only on a doctor's prescription; may sting at first.
- Oral antihistamines such as cetirizineMay reduce itching and help with sleep.Some cause drowsiness; ask a doctor before giving to young children.
- Antibiotics (cream or tablets)Treat skin infection that sometimes complicates eczema.Only on a doctor's prescription.
See a doctor urgently if
- See a doctor urgently if eczema suddenly worsens with painful blisters, punched-out sores and fever, which may be a herpes infection.
- See a doctor soon if the skin is oozing yellow fluid, crusting or very red and hot.
- See a doctor soon if a baby has widespread eczema, poor feeding or poor weight gain.
- See a doctor soon if the itching stops you or your child from sleeping most nights.
- See a doctor if the skin becomes thin or develops stretch marks from steroid creams.
Tests that may help
This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.