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The skin is a barrier to keep out bacteria, irritants, and allergens and keep in moisture and natural oils. It is vital to life. Impaired skin barrier function leads to water loss which leads to eczema lesions. Eczema has a significant impact on the quality of life including psychological stress and depressed mood.

What is Eczema?

Eczema, also known as atopic dermatitis, is a chronic, relapsing, and remitting inflammatory skin condition characterized by patches of dry, itchy, red, and sometimes cracked or oozing skin. Studies suggest that about 50% of cases begin in the first year of life, 85% begin within in five years and a majority resolve by adolescence. But there is adult-onset atopic dermatitis that is estimated to affect 3% and 7% of people in the US.

What causes Eczema?

Eczema is caused by genetic vulnerability that compromises the skin barrier which allows toxic chemicals, bacteria, irritants, pollutants, and allergens to penetrate the skin. This triggers an immune response that shows as red, itchy skin. It is related to asthma, allergic rhinitis and food allergy, and many patients have all these conditions.

What are the symptoms?

In children, symptoms include rashes in the bends of the elbows, behind the knees, on the neck, wrists, or ankles. In adults the rash appears on the face, behind the knees, wrists, hands, and feet.

Eczema symptoms can vary from mild to severe and can include:

  • Red, raw, inflamed, and itchy skin
  • Thickened, cracked skin
  • Dry itchy skin
  • Severe itching at night
  • Dark colored patches of skin
  • Rough, leathery, or scaly patches of skin
  • Patches of small, raised bumps that can ooze and crust over
  • Swollen skin
  • Skin infections caused by scratching

What are triggers?

Triggers are factors that activate or worsen eczema (flareups). Everyone’s triggers are different. Common triggers include:

  • Dry skin
  • Irritants (e.g., soaps, detergents, shampoos, disinfectants)
  • Stress
  • Heat and sweating
  • Infections
  • Allergens (e.g., pollen, pet dander, dust mites)
  • Hormonal changes (like those occurring during menstruation)

Are there different types of eczema?

While atopic dermatitis is the most common form, there are other types of eczema, including:

  • Contact dermatitis (caused by skin contact with irritants or allergens)
  • Dyshidrotic eczema (blistering on the hands and feet)
  • Nummular eczema (circular patches of irritated skin)
  • Seborrheic dermatitis (commonly appearing on the scalp as dandruff) 

How is Eczema diagnosed?

The diagnosis is based on an assessment of symptoms. Dr. Michael Rains will inquire about your symptoms, review your medical history, and ask about allergies. He will perform an examination of your skin. He will ask if you have noticed anything that causes your symptoms to worsen or improve and ask about your skin care routine.  With this information, he will make his diagnosis and discuss your treatment options. 

How is eczema treated?

Eczema can be a challenging condition to manage, but there are a variety of treatments available that can help reduce symptoms and prevent flare-ups. Here’s an overview of the most common treatments for eczema:

  • The cornerstone of treatment is protection of the skin barrier from water loss. This may include soaking baths in lukewarm water daily. Adding oatmeal preparations can soothe the skin. Soaps should be bland and contain no dyes or fragrances to avoid irritations.
  • Topical corticosteroids are anti-inflammatory and are applied to the skin to reduce flares.
  • Crisaborole is an ointment used to treat mild to moderate eczema. It works by reducing certain enzymes in the body that cause inflammation.
  • For severe cases that don’t respond to creams or ointments, oral or injected medications might be prescribed, such as:
    • A short course of oral corticosteroids
    • Drugs like cyclosporine, methotrexate, or mycophenolate mofetil can suppress the immune system to reduce or prevent skin inflammation.
    • Dupilumab is an injectable medication for moderate to severe eczema that works by targeting specific parts of the immune system.
  • Phototherapy is a treatment that exposes the skin to controlled amounts of natural or artificial light. UVB light is most used.
  • If eczema becomes infected, you may need antibiotics to clear up the infection.
  • Allergy testing: If allergies seem to trigger or worsen eczema, allergy testing can identify potential irritants or allergens.
  • Education and counseling: Understanding the condition and how best to manage it can improve quality of life and reduce symptoms.

Contact Dr. Michael Rains at Beacon Dermatology in Asheville, North Carolina to schedule an appointment to discuss your concerns and goals. He is a board-certified dermatologist with the experience and expertise to diagnose and treat all dermatologic conditions.

Dr. Rains is a board-certified dermatologist and the founder of Beacon Dermatology in Asheville, North Carolina. His approach to aesthetic and dermatologic treatments is holistically focused on revealing and enhancing a patient’s natural beauty. Dr. Rains is known for his caring and compassionate approach to medicine, listening to patients’ concerns and goals and ensuring they receive excellent care and education to ensure that they can make an informed decision about their treatments.

At a Glance

Michael Rains, MD, FAAD

  • Board certified in dermatology
  • Specializing in medical, surgical and cosmetic dermatology
  • Author of multiple peer-reviewed publications and previous adjunct faculty at Dell Medical School at the University of Texas at Austin
  • Learn more

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