Eczema risk factors: who is more likely

What eczema is

Eczema, also called dermatitis, is a term for several different types of skin swelling. Most types cause dry, itchy skin and rashes on the face, inside the elbows and behind the knees, and on the hands and feet. The most common type is atopic dermatitis (MedlinePlus).

Atopic dermatitis is a chronic (long-lasting) disease that causes inflammation, redness and irritation of the skin. It usually begins in childhood, but anyone can get it at any age. It is not contagious, so it cannot spread from person to person. Most people have flares, when it is worse, followed by remissions, when the skin improves or clears up (NIAMS).

Who is more likely to get it

NIAMS says (NIAMS):

• Family history: the chance of atopic dermatitis is higher if there is a family history of atopic dermatitis, hay fever or asthma.
• Age: it usually appears during infancy and childhood. For many children it goes away before the teenage years, but some keep having symptoms as teens and adults, and for some people it first appears in adulthood.
• Race and ethnicity: research shows it is more common in non-Hispanic Black children.
• Sex: women and girls tend to develop it slightly more often than men and boys.

MedlinePlus adds that atopic dermatitis is most common in babies and children, but adults can have it too, and that as children grow older it may get better or go away (MedlinePlus).

What causes it

No one knows exactly what causes atopic dermatitis. Researchers know that changes in the protective layer of the skin can make it lose moisture, so it becomes dry, damaged and inflamed. NIAMS says these may contribute to the changes in the skin barrier (NIAMS):

• Genes: researchers found changes in genes that control a protein which helps keep a healthy layer of skin. Without normal levels of it, moisture escapes and the skin's immune system is exposed to the environment.
• The immune system: sometimes it becomes overactive and creates inflammation in the skin.
• The environment: exposure to tobacco smoke, certain air pollutants, fragrances and other compounds in skin products and soaps, and excessively dry skin.

MedlinePlus says the cause of eczema is unknown and is likely both genetic and environmental (MedlinePlus).

Conditions that often come with it

People with atopic dermatitis often have other conditions, such as asthma and allergies (including food allergies), other skin diseases such as ichthyosis, depression or anxiety, and sleep loss. Researchers are studying why having atopic dermatitis as a child can lead to asthma and hay fever later in life (NIAMS). MedlinePlus also says people who have eczema may develop hay fever and asthma (MedlinePlus).

Symptoms

The most common symptom is itching, which can be severe. Other common symptoms are red, dry patches of skin; rashes that may ooze, weep clear fluid or bleed when scratched; and thickening and hardening of the skin. People with darker skin tones often see darkening or lightening of the skin where it is inflamed (NIAMS).

Where the rash shows up changes with age. Up to age 2 it is most common on the face, the scalp and the skin around joints that touch when they bend. In childhood it is most common in the bend of the elbows and knees, the neck and the ankles. In teens and adults it is most common on the hands, neck, bend of the elbows and knees, skin around the eyes, and ankles and feet (NIAMS).

Complications

NIAMS lists bacterial skin infections that can get worse from scratching, viral skin infections like warts or cold sores, sleep loss that can lead to behavior issues in children, hand eczema, and eye problems such as conjunctivitis (pink eye) and blepharitis (NIAMS).

Diagnosis and treatment

A doctor will ask about your or your child's medical history, including a family history of allergies, whether you also have hay fever, asthma or food allergies, and exposure to irritants such as soaps and detergents, some perfumes and cosmetics, and cigarette smoke. They will examine the skin and may order blood tests or a skin biopsy. It can take several visits to be sure of the diagnosis (NIAMS).

Treatment is planned around the rash, your own triggers and how the skin responds. It can include moisturizing creams, corticosteroid creams and ointments, other prescription creams, pills or injected biologic medicines for more severe disease, careful skin care, and light therapy (NIAMS). MedlinePlus lists medicines, skin creams, light therapy and good skin care (MedlinePlus).

Lowering the chance of flares

MedlinePlus says you can prevent some types of eczema by avoiding (MedlinePlus):

• things that irritate your skin, such as certain soaps, fabrics and lotions;
• stress;
• things you are allergic to, such as food, pollen and animals.

NIAMS tips for daily care include lukewarm baths no more than once a day, a mild unscented soap or non-soap cleanser, patting the skin dry and moisturizing right after bathing, protecting the skin from irritants and rough clothing such as wool, talking to your doctor about possible food allergies, managing stress, avoiding scratching (keep a child's fingernails short), and keeping the home at a cool, stable temperature and humidity (NIAMS).

Common questions

Is eczema contagious?

No. Atopic dermatitis cannot be spread from person to person (NIAMS), and MedlinePlus says eczema is not contagious (MedlinePlus).

Does eczema run in families?

The chance of atopic dermatitis is higher with a family history of atopic dermatitis, hay fever or asthma, which suggests genes play a role (NIAMS).

Can adults get eczema for the first time?

Yes. It usually starts in infancy or childhood, but occasionally it first appears in adulthood, and anyone can get it at any age (NIAMS).