What is Eczema and How Do You Treat it?

Eczema, a common yet complex skin condition, affects millions of people worldwide, manifesting in various forms and severity levels. This chronic condition not only impacts the skin but can also significantly affect an individual’s daily life and mental health due to its unpredictable flare-ups and often uncomfortable symptoms.

Understanding eczema’s symptoms, triggers, and treatment options is crucial for improving the quality of life for those experiencing it. In this blog, we’ll explore the different types of eczema, challenges, and management strategies.

We’ll also delve into dermatologists’ role in effectively managing this often distressing ailment, examining both traditional treatments and innovative therapies that offer new hope to sufferers.

What is eczema?

Eczema encompasses a range of persistent skin conditions, including symptoms like dryness, itching, and red, inflamed patches that can disrupt daily life and comfort. Predominantly appearing during childhood, eczema can also continue into or start in adulthood, affecting both personal well-being and self-confidence.

There remains some debate between the exact cause of eczema, if it’s due to a dysfunctional skin barrier or immune dysregulation. Regardless, healthy skin needs moisture. In individuals with eczema, the skin does not hold moisture properly. This leaky skin ends up with more water loss and an impaired ability to protect against harmful substances.

What are the differences between eczema, rosacea, and psoriasis?

Eczema, rosacea, and psoriasis are all chronic skin conditions, each with distinctive features and triggers.

Eczema typically presents as patches of dry, itchy skin that may become inflamed or infected due to scratching. It’s often associated with other allergic conditions like asthma or hay fever and can be triggered by environmental factors, allergens, or stress. 

Rosacea, on the other hand, primarily affects the face and is characterized by redness, flushing, and visible blood vessels, sometimes accompanied by acne-like bumps. It can be provoked by factors like heat, spicy foods, or alcohol.

Psoriasis is marked by thick, red patches covered by silvery scales, often found on the scalp, elbows, and knees. It’s an autoimmune condition, meaning it results from the immune system mistakenly attacking healthy skin cells, leading to rapid cell turnover. 

What are the different types of eczema? 

Immune system dysfunction or a dysfunctional skin barrier and factors like certain personal care products, stress, scratching, and rough fabrics combine to cause eczema symptoms. Winter weather can also contribute as dry air can further leech moisture from your skin. Combined with hot showers and the multiple layers the cold brings, winter is harsh on eczema skin.

Altogether, there are many different kinds of eczema, each one triggered by different factors. The most common types include:

1. Atopic dermatitis: the most common type, often called the ‘itch that rashes’. It can start suddenly with very itchy skin, with dry and scaly areas. Itching causes a red rash leaving the skin looking raw. Flare-ups come and go, and over time, the skin can become thickened, scaly, leathery, and cracked. 
2. Contact dermatitis: one of the most common forms of eczema, this version of the disorder occurs after contact with something that irritates the skin or causes an allergic reaction. Such things can include poison ivy, jewelry, personal hygiene products, harsh soaps, or cleaning products. After exposure, skin may become red, itchy, and swollen. It may also discolour, become dry, crack, or even blister.
3. Dyshidrotic eczema: itchy blisters resembling tapioca pudding are the telltale sign of this form of eczema. The condition most often affects the palms of the hands and the soles of the feet, although it may also be present on the legs and forearms. Its underlying cause isn’t known although certain factors such as allergen exposure, severe sweating, and UV radiation may play a role.
4. Neurodermatitis: this version of eczema manifests as intensely itchy skin. As this area is scratched, it becomes itchier leading to what is known as the itch-scratch-itch cycle. This chronic scratching, in turn, can cause pain, hair loss, or damage (when on the scalp), and result in dark, thickened areas on the skin known as lichenified plaques.
5. Nummular dermatitis: although the exact cause of this condition which results in itchy, coin-shaped lesions isn’t known, it’s highly responsive to treatment.
6. Seborrheic eczema: this skin condition manifests as scaly or crusty patches on the scalp or other areas containing numerous oil glands, such as the face or in the folds of the body. Seborrheic eczema tends to appear most commonly in the middle-aged and newborns, where it’s sometimes known as cradle cap.
7. Stasis dermatitis: the result of poor blood circulation in the veins of the legs, known as venous insufficiency which causes fluid to pool, resulting in swelling in your lower extremities. The outcome of this is dry, itchy skin that may discolour. In more severe cases rough skin and sores may develop.

How to treat eczema

If you have eczema, there are three main steps in treating it. 

1. Bathe in lukewarm (not hot) water, and lock in that moisture right after. Moisturizing twice a day as well as after washing when your skin is most hydrated. Since eczematous and sensitive skin may lack natural ceramides, barrier-repair moisturizers that contain lipids like ceramide can help to protect it. 
2. Reduce the inflammation. 
3. Avoid triggers that cause your flare-ups.

However, many find that despite incorporating thick moisturizers, they need additional support. A dermatologist can provide alternatives such as:

UV light therapy: This treatment uses ultraviolet light to reduce inflammation and bacterial growth on the skin, which can significantly alleviate eczema symptoms.

Medicated creams: Corticosteroids are commonly prescribed to reduce inflammation and immune responses. Calcineurin inhibitors, another type of topical medication, work by modulating the immune system to decrease inflammation without the side effects associated with steroids.

Antibiotics: If eczema leads to cracked skin, it can become infected. In such cases, oral or topical antibiotics are necessary to combat these infections and prevent worsening of the symptoms.

Oral anti-inflammatory medication: These medications help reduce inflammation from within and can be particularly useful in severe cases.

Injectable biologics: For severe eczema, biologic drugs like Dupilumab, which are monoclonal antibodies, target specific parts of the immune system that contribute to inflammation. This treatment is often used when other therapies have failed.

Talking to a dermatologist

Through diligent home care and advanced medical treatments, individuals suffering from eczema can find relief and improve their quality of life. Each case of eczema is unique, and treatments must be tailored to the individual’s specific condition and needs.

Dermatologists can evaluate the severity of the condition, discuss lifestyle factors that may influence flare-ups, and recommend a combination of topical treatments, systemic therapies, and lifestyle modifications. Regular follow-ups with a dermatologist can help to adjust treatments as the condition evolves, ensuring that management strategies remain effective over time.

You can speak to your family doctor to get a referral to a dermatologist. However, if you’re among the 6.5 million Canadians without a primary care provider, Maple provides direct access to a dermatologist through the app. Dermatologists on Maple are the same specialists you’d see in person, but they also practice outside of their own clinic hours to see patients virtually.

Information presented here is for educational purposes, and not to replace the advice from your medical professional. Virtual care is not meant for medical emergencies. If you are experiencing an emergency like chest pain or difficulties breathing, for example, please call 911 or go to your nearest emergency room.