Eczema is the name given to a group of diseases that cause inflammation of the skin. It is also referred to as Dermatitis.
Inflamed or eczematous skin is red, itchy and swollen sometimes with fluid-filled bumps that ooze and crust.
Common causes of eczema include an allergic reaction to something touching the skin, such as poison ivy or nickel, or contact with chemicals that damage the outer skin, such as strong soaps and substances that dry or irritate the skin.
Eczema is a common problem, but it is not contagious. Some types are hereditary. While some children outgrow the condition, eczema cannot be cured. A dermatologist can provide a proper diagnosis and a treatment plan to manage eczema and control flare-ups.
Treatment is important because it can prevent eczema from getting worse and relieve the pain and itching. The proper treatment can also reduce stress, prevent infections, and prevent skin thickening, which can lead to constant itching.
Common Types of Eczema
Atopic Dermatitis (AD) is hereditary and the most common type of eczema. It is estimated that up to 17 per cent of Canadians will suffer from AD at some point in their lives.
AD almost always starts in infancy or before age 5. It is characterized by itchy, inflamed skin, usually behind the knees, the inside of the elbows, and on the face, neck and hands. Children with eczema often develop asthma and/or hay fever and have family members who also have these problems.
Flare-ups of eczema are common, and while attempts should be made to identify and avoid the triggers that cause these flares, they can occur despite strict trigger avoidance and diligent skin care.
Failure to follow treatment recommendations are the most significant barrier to successful management of eczema, and only an estimated 24% of patients with eczema do properly follow recommended treatments.
Contact Dermatitis: There are two types of contact dermatitis: allergic and irritant.
Allergic Contact Dermatitis (ACD) is caused by a delayed immune reaction following skin contact with an allergenic substance. Poison ivy is the most common cause of ACD. Other common causes include metals, dyes, perfumes, and preservatives in cosmetics.
Irritant Contact Dermatitis is more common than ACD and is caused by repeated exposure to substances that chemically damage the skin, such as harsh soaps, detergents, and cleaning products. These irritants remove oil and moisture from the outer layer of the skin, damaging the protective layer and triggering inflammation. Beauticians, nurses, bartenders, and others who spent lots of time with wet hands often develop this form of dermatitis.
Damage from contact dermatitis can be:
- Acute (sudden and quick) after contact with a high concentration of a chemical that sets off a reaction such as a burn
- Chronic (persistent) or delayed (when it occurs after months or years of contact with an irritant)
Eczema FACTS
- Eczema is not contagious
- Eczema is most common in children
- Baths are good—apply a moisturizer right after
- Wear and sleep on soft natural fabrics
- Avoid harsh soaps, scented products and perfumes
- Without a proper diagnosis and adequate treatment, eczema can become chronic and disabling
Atopic Dermatitis and Contact Dermatitis are the most common types of eczema. Below is a list of some other types of eczema.
| Dyshidrotic Eczema | An acute recurrent eruption of multiple tiny, intensely itchy water blisters on the palms, sides of fingers and soles of the feet. |
| Lichen Simplex Chronicus | Localized, chronic thick itchy plaques that commonly occur on the sides or back of the neck, wrists, ankles, lower legs and inner area of the thighs. |
| Nummular Eczema | Multiple, round plaques of eczema that are usually associated with dry skin and occur on the outer surfaces of the hands, arms and legs. |
| Seborrheic Eczema | Yellowish-brown, greasy, scaly patches on the scalp, eyebrows, nose and chest. |
| Stasis Dermatitis | A chronic eczema on the inner area of the lower legs and associated with varicose veins. |
Where does eczema usually appear?
The areas of the body that eczema affects tends to vary with age. In babies, a patchy rash usually appears on the face, elbows, and knees. Diaper rash is also common. In older children, the rash appears most often behind the knees, inside the elbows, on the sides of the neck, and on the wrists, ankles, and hands.
How can I help my child?
You can help prevent eczema in your child by keeping the skin soft and moist and avoiding known triggers that cause itching and flare-ups.
When should you call your child’s doctor?
Children with eczema are prone to skin infections. Call your child’s doctor if you notice signs of skin infection, which may include: fever, redness and tenderness, or pus-filled bumps on or around affected areas. Also, call your child’s doctor if you notice a sudden change or worsening of your child’s condition.
When should you see a dermatologist?
If following guidelines and your family doctor or pediatrician’s treatment is not improving your child’s skin, a dermatologist can help.
What is cradle cap?
Cradle cap is common in babies and is easily treated. It is caused by the normal buildup of sticky skin oils, and scales of sloughed skin cells on a baby’s scalp.
Cradle cap is not harmful to your baby. It usually goes away by a baby’s first birthday.
Tips for parents
- Try to bathe and then moisturize their skin daily
- Avoid skin contact with wool and rough fabrics
- Apply medication to any areas of inflamed skin regularly every day
How common is it?
The number of cases of contact dermatitis in Canada is not currently known but according to some US statistics, skin disorders comprise more than 45 per cent of all occupationally related diseases. Among all occupational dermatitis, irritant contact dermatitis accounts for about 80 per cent and allergic contact dermatitis accounts for about 30 per cent (some patients have both).
Can you still work?
Most workers who have contact dermatitis can return to work. It will depend on:
- What kind of contact dermatitis you have
- How severe it is
- How it is treated
Think you may have occupational eczema?
Ask yourself these questions:
- Did your skin problem start when you changed jobs?
- Does your skin problem improve when you are away from your job?
- Do you think that any specific substance at work is causing your skin problem?
If you have answered ‘yes’ to any of these questions, consult your dermatologist.
Some jobs and the irritants and allergens associated with them
Job |
Irritant |
Allergen |
|---|---|---|
| Agriculture workers | Artificial fertilizers, disinfectants, pesticides, cleaners, gasoline, diesel oil, plants and grains | Rubber, oats, barley, animal feed, veterinary medications, cement, plants, pesticides, wood preservatives |
| Cabinet makers, and carpenters | Glues, detergents, thinners, solvents, wood preservatives | Stains, glues, woods, turpentine, varnishes, colophony |
| Construction workers | Cement | Chromates, cobalt, rubber and leather gloves, resins, woods |
| Daycare workers | Detergents, cleaners, wet work | — |
| Dentists and dental technicians | Detergents, hand cleansers, wet work | Local anaesthetics, mercury, methacrylates, eugenol, disinfectants, rubber, dental impression material |
| Electricians | Soldering fluxes | Fluxes, resins, rubber |
| Hairdressers | Permanent wave solutions, shampoos, bleaching agents, wet work | Dyes, persulphates, nickel, perfumes, rubber |
| Homemakers | Detergents, cleansers, foods, wet work | Rubber gloves, foods, spices, flavours, nickel, chromates, polishes |
| Mechanics | Oils, greases, gasoline, diesel fuel, cleaners, solvents | Rubber gloves, chromates, epoxy resin, antifreeze |
| Medical personnel, Nurses, Hospital workers | Disinfectants, detergents, wet work | Latex gloves, anaesthetics, antibiotics, antiseptics, phenothiazines, formaldehyde, glutaraldehyde, liquid chloroxylenol, hand creams |
| Plastics workers | Solvents, acids, styrene, oxidizing agents | Hardeners, phenolic resins, polyurethanes, acrylics, plasticizers |
| Teachers | Chalk dust | — |
Information provided by WSIB. For a more complete list view the full Workplace Contact Dermatitis fact sheet
Patients with AD lack an essential oil in their skin. This means that their skin has a reduced water-holding capacity. Dry skin is more sensitive to irritants and makes it more difficult to control the eczema. Management of dry skin is essential for treatment success. Daily dry skin management should include gentle cleansing and moisturizing.
Cleansing
Regular soaps can irritate skin and worsen the condition. Use a mild liquid cleanser or gentle bar soap. Liquid agents are often better choices for patients with sensitive skin, as they are less abrasive and are more easily and effectively rinsed off.
Bathing
This is a critical component of dry skin management and hydration. The duration of the bath or shower should be brief (5 to 10 minutes) and should be done with clear warm water (not hot water) once daily or every other day. Moisturizer should be applied to the skin after every water exposure, including showering, bathing, and hand washing. Gentle cleansers can be used only on areas that need cleaning, and should be used at the end of the bath or shower.
Moisturizers
After bathing, gently pat the skin dry. Follow your doctor’s recommendations for moisturizing and medication use (such as immediately applying your prescription treatments to skin with eczema patches, and applying a moisturizer to areas of the skin that don’t have active eczema). Thick moisturizers are best that will both moisturize the skin, and provide a thicker barrier. While there is insufficient evidence to recommend a specific optimal regimen for use of moisturizers, experts suggest that generous application, one to several times a day, is necessary to help minimize skin dryness.
Avoid irritants and triggers to reduce flare-ups
AD and ACD can worsen with exposure to allergens and irritants. Avoid the common ones, such as dust, animal dander, smoke and grass. Allergy testing can often identify specific environmental allergens. If you have ACD a dermatologist will do patch testing to try to determine the cause.
Do:
- Use mild detergents to wash clothing, with no bleach or fabric softener
- Double-rinse clothing
- Moisturize often, especially in colder weather
- Choose cotton for bed linens and clothing
- Reduce stress as much as possible
Don’t:
- Expose skin to very hot or very cold water
- Expose skin to excessive heat or low humidity
- Dress in synthetic fabrics or wear wool next to the skin
- Use harsh detergents or perfumed products
Most types of eczema require a combination of treatments and medications. Your dermatologist will choose the ones that will work the best to control your condition.
The three main steps of eczema management involve:
- Bathing and moisturizing to repair skin
- Medications to reduce inflammation
- Avoiding triggers that cause flare-ups
Nonprescription Medications
Antihistamines that cause sedation may be prescribed in those whose symptoms are interfering with sleep.
Moisturizers and emollients decrease dryness and scaling, leaving the skin feeling more comfortable. Barrier repair moisturizers also known as physiologic moisturizers, contain some of the essential oils that are missing from eczematous skin, most commonly ceramide.
Coal tar is an old remedy but still effective. It soothes inflamed skin and helps reduce itching, flaking and redness. It is available in bath oils, shampoos, gels, creams, ointments and in combination with corticosteroids.
Bleach baths in a solution of bleach and clear, warm water for 5-10 minutes twice weekly can be effective in those susceptible to frequent infections which can worsen eczema.
Cool compresses relieve inflammation and itching.
Prescription Medications
Antibiotics are used to treat secondary skin infection, which is a common complication of any type of eczema. The skin barrier is broken both by scratching and the inflammation allowing bacteria to penetrate the skin.
Corticosteroids are the most effective anti-inflammatory agents. They come in a variety of strengths, ranging from mild to extremely potent. They should be applied regularly until the inflammation has resolved. When used appropriately, the incidence of side-effects is low.
Topical Calcineurin Inhibitors specifically inhibit the cells of the immune system in the skin. They are very effective at reducing itch and preventing flare-ups if applied regularly.
Phototherapy: In those who have severe eczema, regular exposure to specific rays of ultraviolet light is very effective in reducing symptoms. This treatment should only be done under the supervision of a dermatologist.
Cool compresses relieve inflammation and itching. Follow these easy instructions for fast relief:
- Use several layers of cheesecloth or soft cotton cloth cut to fit over the affected area.
- Soak the cloth with water or Burow’s solution
- Place on the skin for 20 to 30 minutes
- Keep the cloth continuously wet and uncovered to allow evaporation.
- Then pat the skin dry and apply your medication