Eczema is also known as atopic dermatitis, the most common and often the most severe form of eczema. It is a skin condition that often develops before a child turns 5 years old. It starts as an itchy, red, dry, scaly rash and can occur anywhere on the body.

Infants typically develop eczema on the scalp, cheeks, and elbows, while in children it tends to appear on the creases of the elbows, behind the knees and on the neck, wrists, and ankles.

While we do not know for sure what causes eczema, we do know that there are genetic and environmental factors involved. People with eczema have a deficiency in a skin protein called filaggrin.  Filaggrin is necessary to form a healthy outermost protective skin layer and to form natural skin oils that are necessary to keep our skin hydrated. Individuals with a deficiency of this skin protein have a broken skin barrier, which causes excessive water loss that leads to dry, sensitive, and itchy skin.

It is common for those with eczema to also have asthma or seasonal allergies (hay fever). If a parent has atopic dermatitis, asthma, or seasonal allergies, their child has a 50% chance of developing at least one of these conditions.

Eczema affects as many as 20% of children and 3% of adults worldwide. Research shows that the incidence of eczema has been increasing in the last 20 years. In the US alone, there are 18 million people who suffer from this chronic inflammatory skin condition. It may begin in children as young as 2-3 months old and can also occur in adults who have no history of eczema.

There are multiple environmental triggers that may worsen eczema, including:

• Dry climates (especially worse during winter months)
• Very hot and cold temperatures and excessive sweating
• Environmental allergens such as tree and weed pollen, dust mites, and pet dander
• Bacterial or viral infections
• Cigarette smoke
• Drying soaps, detergents, and household cleaners
• Personal care products with fragrances and perfumes
• Emotional stress and anxiety
• Food allergies

In children who have mild or moderate eczema, it is unlikely that a food allergy is causing their eczema.  In children with severe eczema, or those who have eczema that does not respond well to standard treatments, food allergies may be a trigger.

The most common food allergies that can trigger eczema are cow’s milk, peanuts, wheat, soy, eggs, and seafood/shellfish. If there is concern for a potential food allergy, your dermatology provider may refer you to an allergist for testing.

Moisturizing: The most important step to take in caring for your eczema is to moisturize your skin several times daily. The best time to moisturize is immediately after a bath or shower, when your skin is still damp. Applying moisturizers on damp skin will help prevent water loss from the skin and lock in the moisture. Thicker moisturizers that are cream- or ointment-based are better for dry skin than lotions and gels. 

Some effective over-the-counter moisturizing creams include: CeraVe cream, Cetaphil cream, Eucerin Original Healing Cream, and Mustela Stelatopia moisturizing cream. CeraVe Healing Ointment, Aquaphor, and Vaseline (petroleum jelly) are good over-the-counter ointments.

Bathing: Taking a bath or shower daily can be an integral part in helping to control your eczema. A bath or shower that is 5-10 minutes long and warm, but not hot, is best for individuals with eczema. Long, hot baths and showers can strip the skin of natural oils, leaving the skin dry and irritated.

Typical soaps can be very drying to the skin. Gentle cleansers that are free of soap are: CeraVe Hydrating Skin Bar, CeraVe Hydrating Cleanser, Cetaphil Restoraderm Eczema Calming Body Wash, Cetaphil Gentle Skin Cleanser, Cetaphil Gentle Cleansing Bar, Aquanil Cleanser and Mustela Stelatopia Cream Cleanser.

Search for a laundry detergent that is fragrance-free and dye-free, as these extra chemicals can irritate sensitive skin. It is also best to skip fabric softeners and instead use dryer balls (usually made of plastic or wool).

Humidifiers: Many people will notice that their eczema improves if they visit a state with a more humid climate than Colorado. Colorado Springs has an average daily relative humidity of 50%, which can drop down to as low as 34% during winter months.

A humidifier releases moisture in the air and can prevent your eczema from worsening. Place a cool mist humidifier in your bedroom and turn it on with the door closed for a few hours before you go to sleep. Sleep with your humidifier on and the door closed and you will notice improved skin hydration.

Currently there is no cure for eczema, but there are many effective prescription treatments. If proper skin care and moisturizing are not enough, topical steroid creams and topical calcineurin inhibitors (non-steroid) are often prescribed. If an adult has severe eczema, oral medications such as prednisone, methotrexate, cyclosporine, azathioprine, and mycophenolate mofetil may be recommended. New research has developed the first biologic drug for adults who have moderate-to-severe eczema. In addition, there is a new non-steroid cream for individuals ages 2 and up with mild to moderate eczema.  As more is understood about what causes eczema, new medications will be available. Currently, there are more than 40 new drug trials for eczema medications.

Bleach baths are essentially like making swimming pool water in your bathtub. Your dermatology provider may recommend a bleach bath if there is concern for a skin infection. If your eczema is flaring and very itchy, the skin can crack, become raw, and develop a superficial infection. Studies show that bleach baths are an excellent way to rid the skin of bacterial infections that may worsen eczema.

If you are bathing an infant in a small baby tub, add one teaspoon of bleach per gallon of water. For a regular-sized bathtub, add ¼ cup of bleach for a half tub full and ½ cup bleach for a full tub. A plain, fragrance-free bleach such as Clorox Regular Bleach is a good option.

After bathing for 5-10 minutes, rinse off, pat dry, and apply moisturizers immediately. Bleach baths are normally recommended 2-3 times a week.

Wet wrap therapy can significantly improve eczema by making your topical medication more effective, increasing skin hydration, reducing itching, and improving sleep. Wet wrap therapy can be used on the whole body or just on specific areas where eczema may be flaring.

This is wet wrap therapy step-by-step:

1. Shower or bathe for 5-10 minutes in warm water, using a gentle skin cleanser as necessary (as outlined above).
2. Pat dry, making sure that the skin stays damp.
3. Apply topical medications to areas of eczema if directed by your dermatology provider.
4. Apply an effective moisturizing cream or ointment over the whole body (as outlined above).
5. Choose a tight-fitting item of clothing that will be soaked in warm water, rung out, and worn. For instance, if treating eczema on the whole body for an infant, choose a zippered light cotton sleeper. If treating just the legs on a toddler, choose a pair of cotton pajama pants. If treating ankles and feet on a teenager, choose a pair of cotton athletic socks.
6. Wear a dry layer of clothing on top of the wet clothing that was first applied.
7. Keep the wet wrap on for 2 hours, then remove.
8. If using topical steroid medications, wet wrap therapy should only be used for 1 week at a time. If using just moisturizers, wet wrap therapy can be performed daily if preferred.

A recent study performed by National Jewish Health in Denver demonstrated that wet wrap therapy improved eczema symptoms by 71%. See a demonstration of wet wrap therapy.

Most children will grow out of their eczema by adolescence, and many even earlier by elementary school. Only a small percentage will continue into adulthood with severe symptoms. There are many adults who had eczema as a child who still struggle with dry, often sensitive skin.

Atopic dermatitis is just one form of eczema, but it is the most common. Other forms of eczema include asteatotic eczema, nummular eczema, allergic contact dermatitis, irritant contact dermatitis, lichen simplex chronicus (neurodermatitis), dyshidrotic eczema, hand eczema, stasis dermatitis, and seborrheic dermatitis.

Your dermatology provider will diagnose the type of eczema you or your child has and recommend a treatment plan.