Eczema

Eczema can vary in severity from mild to severe and can go through periods of flare-ups and remission.

The hallmark symptoms of eczema include:

• Dry, sensitive skin
• Itching, which can be intense and interfere with sleep
• Red or inflamed skin
• Rash, typically appearing as small bumps or patches of irritated skin
• Thickened, cracked, or scaly skin
• Oozing or crusting of the skin (in severe cases)
• Darkened or leathery thickening of the skin (in chronic, longstanding cases)

The exact cause of eczema is not fully understood, but it is believed to result from a combination of genetic, immune system, and environmental factors. People with eczema often have a genetic predisposition to the condition, with a family history of eczema, asthma, or allergic rhinitis (hay fever). In some individuals, food allergies may worsen eczema. Immune system dysfunction and abnormalities in the skin barrier function also play a role in the development of eczema.

Common triggers for eczema flare-ups include:

• Dry skin: Environmental factors such as low humidity, harsh soaps, and hot showers can dry out the skin and exacerbate eczema symptoms. This cause is especially pronounced in winter months.
• Irritants: Exposure to irritants such as certain fabrics (wool or synthetic fibers), soaps, detergents, and household cleaners can trigger eczema flare-ups.
• Allergens: Allergens such as dust mites, pet dander, pollen, mold, and certain foods can trigger allergic reactions and worsen eczema symptoms in some individuals.
• Stress: Emotional stress or anxiety can exacerbate eczema symptoms and trigger flare-ups.
• Hormonal changes: Hormonal fluctuations, such as those that occur during puberty, pregnancy, or menstruation, can affect eczema symptoms.
• Infections: Bacterial, viral, or fungal infections can trigger eczema flare-ups, particularly in areas of broken or irritated skin.

Medical History

The team at Apex Skin Center will begin by asking about your medical history, including any symptoms you are experiencing, the duration and pattern of those symptoms, previous skin conditions or treatments, previous asthma or allergies, family history or other autoimmune disorders, and any potential triggers or exacerbating factors.

Physical Examination

Board-certified dermatologist Dr. Knackstedt will conduct a thorough examination of the skin, looking for characteristic signs of eczema.

Skin Biopsy (if necessary)

In some cases, a skin biopsy may be performed to confirm the diagnosis of eczema and rule out other skin conditions with similar features. During a skin biopsy, a small sample of skin tissue is removed and examined under a microscope by a pathologist to look for characteristic histopathological changes consistent with eczema. In most cases of eczema, this is not necessary.

Treatment for eczema aims to alleviate symptoms, reduce inflammation, prevent flare-ups, and improve overall skin health. Here are some common treatment approaches for eczema:

• Emollients and Moisturizers: Regular use of emollients and moisturizers is essential for managing eczema. These products help hydrate the skin, restore the skin barrier function, and prevent moisture loss. Emollients should be applied liberally and frequently, especially after bathing or showering, to lock in moisture and soothe dry, itchy skin. Ointments and creams tend to be more moisturizing than lotions. Fragrance free products are preferred.
• Topical Corticosteroids: Topical corticosteroids are commonly used to reduce inflammation and relieve itching associated with eczema flare-ups. They come in various strengths and formulations. Topical corticosteroids are typically applied to affected areas of the skin for a limited duration until symptoms improve.
• Topical Calcineurin and Phosphodiesterase-4 (PDE4) Inhibitors: Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, and topical phosphodiesterase-4 (PDE4) inhibitors, such as crisaborole, are immunomodulatory medications that help reduce inflammation and itching in eczema. They are particularly useful for sensitive areas of the skin, such as the face, neck, and genital area, where topical corticosteroids may be less suitable. They are safe for longer-term use.
• Antihistamines: Oral antihistamines may be used to relieve itching and help improve sleep quality in individuals with eczema. Antihistamines are particularly useful during flare-ups when itching is more severe.
• Wet Wrap Therapy: Wet wrap therapy involves applying a layer of emollient or topical medication to the skin, followed by a layer of wet bandages or clothing, and then a dry layer on top. This technique helps hydrate the skin, enhance the absorption of topical medications, and provide relief from itching and inflammation.
• Phototherapy (Light Therapy): Phototherapy is the controlled use of targeted, narrow band ultraviolet light. It may be recommended for people with moderate to severe eczema Phototherapy may be combined with topical treatments or photosensitizing drugs in more severe and extensive eczema.
• Oral Medications: In some cases, oral medications may be prescribed to help manage severe eczema or control symptoms during flare-ups. These medications may include oral corticosteroids, immunosuppressants (such as cyclosporine or azathioprine), or systemic medications that target specific immune pathways involved in eczema inflammation.
• Biologic Therapies: Biologic therapies, such as interleukin inhibitors (IL-3/13) target specific immune system pathways involved in eczema inflammation. Biologics are typically reserved for moderate to severe eczema and are administered by injection.