Eczema is a chronic, inflammatory skin disorder. It can appear as blisters that crust over to become scaly, itchy rashes, or as dry, thick patches of skin with scales. The main symptom is itching, and symptoms can come and go. Although eczema is not contagious, it is very common. Estimates are that more than 15 million people in the United States have eczema. People with eczema often have a personal or family history of allergies. There is no cure, however, treatments can reduce symptoms and help prevent outbreaks.
Signs and Symptoms
The most common signs of eczema are:
Eczema in children under 2 years old generally starts on the cheeks, elbows, or knees. In adults, it tends to be found on the inside surfaces of the knees and elbows.
Researchers don’t know for sure what causes eczema. It may be a combination of hereditary (genetic) and environmental factors. In some people, having allergies may trigger eczema. Exposure to certain irritants and allergens can make symptoms worse, as can dry skin, exposure to water, temperature changes, and stress.
Stress can make eczema worse. Other irritants that can make eczema worse include:
Your doctor will look at your skin and ask questions about your personal and family medical history before making a diagnosis. Your doctor may ask about stress in your life, your diet, drugs you are taking, soaps and detergents you use, and chemicals or materials you may be exposed to at work. Your doctor may perform a skin lesion biopsy (removal of a small piece of skin), but it's not always needed to make the diagnosis.
Reducing stress, nervousness, anxiety, and depression may help prevent flares of eczema. Mind body techniques including cognitive behavioral therapy and autogenic training have been shown to help. Both techniques can also be combined with learning about eczema.
Avoiding eggs, fish, peanuts, and soy may help some people reduce flares, but it varies from person to person. Ask your doctor to help you determine if avoiding these foods in your diet might reduce how often you have a flare and how severe it is.
Although somewhat controversial, some studies show that children who are exclusively breast fed for at least 4 months are less likely to get eczema. This is particularly true when the nursing mother has avoided cow's milk in her own diet.
Some studies also suggest that babies whose mothers took probiotics (“friendly bacteria”) during pregnancy and while breastfeeding were less likely to have eczema at up to 2 years of age. Other studies found no association. More research is needed.
Preliminary studies suggest that using skin creams containing omega fatty acids can reduce the severity of eczema or prevent eczema entirely.
Other preliminary studies suggest that children who have a pet dog are significantly less likely to have eczema at age 1, or at age 2 or 3, than children who don't have a pet dog.
The goals when treating eczema are to heal the skin, reduce symptoms, prevent skin damage, and prevent flares. Developing skin care routines, identifying what triggers flares, and avoiding these triggers are a large part of any treatment plan.
Dry skin often makes the condition worse. Remember to:
Parents can help their children by:
Surgery and Other Procedures
Phototherapy and Photochemotherapy
Treatment with ultraviolet light may help mild to moderate cases of eczema in children over age 12 and adults. Phototherapy or light therapy may be combined with a type of drug called psoralen. It is then called photochemotherapy.
Nutrition and Dietary Supplements
Many people who have eczema have food allergies, so eating a healthy diet may help reduce inflammation and allergic reactions.
Check with your doctor before giving a supplement to a child.
Avoid exposure to environmental or food allergens. Common foods that cause allergic reactions are dairy, soy, citrus, peanuts, wheat (sometimes all gluten containing grains), fish, eggs, corn, and tomatoes. There is much controversy regarding the most effective way to test for food allergies or sensitivities.
Eat fewer refined foods, and sugar. These foods contribute to inflammation in the body.
Eat more fresh vegetables, whole grains, and essential fatty acids (cold water fish, nuts, and seeds).
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider before starting any treatment and ask your doctor before taking any herbs. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of eczema based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. Any remedy that causes aggravation of symptoms should be discontinued right away.
Massage and Physical Therapy
One clinical study looking at essential oils for treating children with eczema found that massage with and without essential oils helped improve dry, scaly skin lesions. Children with this scaly, itchy skin problem seem to have less redness, scaling, and other symptoms if they had massage between flares. Don’t use massage when skin is actively inflamed. The essential oils most often chosen by the mothers in the study included sweet marjoram, frankincense, German chamomile, myrrh, thyme, benzoin, spike lavender, and Litsea cubeba.
In one clinical study, regular group sporting activities improved symptoms in people who participated for 3 weeks. Exercise may improve symptoms because of the positive impact it has on emotions. Sports should be avoided during the worst stages of an outbreak.
Climatotherapy uses sunlight and water (such as the ocean) as therapy. The Dead Sea in Israel is known for its healing properties, and many people with eczema go there to sit in the sun and swim in the water. Clinical studies back up the benefits. One clinical study looked at the experience of more than 1,500 people with eczema and found that 95% of skin was cleared in people who had previous stays at the Dead Sea longer than 4 weeks.
Flares of eczema are associated with anxiety and stress. Several clinical studies show that relaxation techniques can reduce the number of flares and relieve symptoms of eczema. Biofeedback seems to be particularly useful.
Starting an infant on solid foods slowly and gradually may help prevent the food sensitivities that may contribute to eczema.
People who are allergic to ragweed, chrysanthemums, asters, echinacea, or feverfew should avoid chamomile because it is in the same plant family.
Avoid the use of burdock and sulfur during pregnancy.
Warnings and Precautions
Chinese herbal treatments for eczema have been gaining popularity in both the United States and the United Kingdom, but you should be cautious. Some of the Chinese herbal creams have high amounts of steroid medications. In a few rare instances, the use of oral Chinese herbs (like a tea) for eczema has led to kidney damage. If you want to try TCM for your eczema, find a respected TCM practitioner and make sure your doctor knows about all herbs you are using, either orally or on your skin.
Prognosis and Complications
Although eczema can lead to complications -- such as bacterial infections of the skin and permanent scar formation -- in many cases is can be easily controlled by avoiding triggers and treating your dry, scaly patches. See your doctor if your eczema does not respond to treatment or if signs of infection (such as fever, redness, pain) occur. Often children with eczema go into remission after a period of time. The remission may last the rest of their lives, although skin may remain sensitive and dry.
Abrahamsson TR, Jakobsson T, Bottcher MF, et al., Probiotics in prevention of IgE-associated eczema: a double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol. 2007;119(5):1174-80.
Anandan C, Nurmatov U, Sheikh A. Omega 3 and 6 oils for primary prevention of allergic disease: systematic review and meta-analysis. Allergy. 2009 Jun;64(6):840-8. Epub 2009 Apr 7. Review.
Anderson C, Lis-Balchin M, Kifk-Smith M. Evaluation of massage with essential oils in childhood atopic eczema. Phyother Res. 2000;14(6):452-456.
Anderson PC, Dinulos JG. Atopic dermatitis and alternative management strategies. Curr Opin Pediatr. 2009 Feb;21(1):131-8. Review.
Berger MM, Shenkin A. Vitamins and trace elements: Practical aspects of supplementation. Nutrition. 2006; 22(9):952-5.
Biagini Myers JM, Wang N, LeMasters GK, et al. Genetic and environmental risk factors for childhood eczema development and allergic sensitization in the CCAAPS cohort. J Invest Dermatol. 2010;130(2):430-7.
Billmann-Eberwein C, Rippke F, Ruzicka T, Krutmann J. Modulation of atopy patch test reactions by topical treatment of human skin with a fatty acid-rich emollient. Skin Pharmacol Appl SkinPhysiol. 2002;15(2):100-104.
Boyle RJ, Bath-Hextall FJ, Leonardi-Bee J, Murrell DF, Tang ML. Probiotics for the treatment of eczema: a systemic review. Clin Exp Allergy. 2009;39(8):1117-27.
Bruno EJ Jr, Ziegenfuss TN, Landis J. Vitamin C: research update. Curr Sports Med Rep. 2006; 5(4):177-81.
Byremo G, Rod G, Carlsen KH. Effect of climatic change in children with atopic eczema. Allergy. 2006;61(12):1403-10.
Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.
Doron S, Gorbach SL. Probiotics: their role in the treatment and prevention of disease. Expert Rev Anti Infect Ther. 2006; 4(2):261-75.
Dryden GW Jr, Deaciuc I, Arteel G, McClain CJ. Clinical implications of oxidative stress and antioxidant therapy. Curr Gastroenterol Rep. 2005;7(4):308-16.
Ernst E, Huntley A. Tea tree oil: a systematic review of randomized clinical trials. ForschKomplementarmed Klass Naturheilkd. 2000; 7(1):17-20.
Ernst E. Adverse effects of herbal drugs in dermatology. Br J Dermatol. 2000;143(5):923-929.
Fleischer AB Jr, Abramovits W, Breneman D, Jaracz E; US/Canada tacrolimus ointment study group. Tacrolimus ointment is more effective than pimecrolimus cream in adult patients with moderate to very severe atopic dermatitis. J Dermatol Treat. 2007;18(3):151-7.
Furuhjelm C, Warstedt K, Larsson J, Fredriksson M, Böttcher MF, Fälth-Magnusson K, Duchén K. Fish oil supplementation in pregnancy and lactation may decrease the risk of infant allergy. Acta Paediatr. 2009 Sep;98(9):1461-7.
Habif. Clinical Dermatology. 5th ed. St. Louis, Mo: Mosby, An Imprint of Elsevier; 2009.
Harari M, Shani J, Seidl V, Hristakieva E. Climatotherapy of atopic dermatitis at the Dead Sea: demographic evaluation and cost-effectiveness. Int J Dermatol. 2000;39(1):59-69.
Horrobin DF. Essential fatty acid metabolism and its modification in atopic eczema. Am J Clin Nutr. 2000;71(1 Suppl):367S-72S.
Kalliomaki M, Kirjavainen P, Eerola E, Kero P, Salminen S, Isolauri E. Distinct patterns of neonatal gut microflora in infants in whom atopy was and was not developing. J Allergy Clin Immunol. 2001;107(1):129-134.
Kalliomaki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomized placebo controlled trial. Lancet. 2001;357(9262):1076-1079.
Karamfilov T, Elsner P. Sports as a risk factor and therapeutic principle in dermatology [article in German]. Hautarzt. 2002;53(2):98-103.
Kim JY, Kwon JH, Ahn SH, et al. Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema: a double-blind, randomized, placebo-controlled trial. Pediatr Allergy Immunol. 2010;21(2Pt2):e386-93.
Kramer U, Sugiri D, Ranft U, et al. Eczema, respiratory allergies, and traffic-related air pollution in birth cohorts from small-town areas. J Dermatol Sci. 2009;56(2):99-105.
Langan SM, Williams HC. What causes worsening of eczema? A systematic review. Br J Dermatol. 2006;155(3):504-14.
Linde K, Hondras M, Vickers A, ter Riet G, Melchart D. Systematic reviews of complementary therapies - an annotated bibliography. Part 3: homeopathy. BMC Complement Altern Med. 2001; 1:4.
Magin PJ, Adams J, Heading GS, Pond DC, Smith W. Complementary and alternative medicine therapies in acne, psoriasis, and atopic eczema: results of a qualitative study of patients' experiences and perceptions. J Altern Complement Med. 2006;12(5):451-7.
Meding B, Alderling M, Wrangsjo K. Tobacco smoking and hand eczema: a population-based study. Br J Dermatol. 2010;163(4):752-6.
Morse NL, Clough PM. A meta-analysis of randomized, placebo-controlled clinical trials of Efamol evening primrose oil in atopic eczema. Where do we go from here in light of more recent discoveries? Curr Pharm Biotechnol. 2006;7(6):503-24.
Oien T, Storrø O, Johnsen R. Do early intake of fish and fish oil protect against eczema and doctor-diagnosed asthma at 2 years of age? A cohort study. J Epidemiol Community Health. 2009 Aug 13. [Epub ahead of print]
Osborn DA, Sinn J. Soy formula for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev. 2006;(4):CD003741.
Prescott SL, Bjorksten B. Probiotics for the prevention or treatment of allergic diseases. J Allergy Clin Immunol. 2007;120(2):255-62.
Rautava S, Kalliomaki M, Isolauri E. Probiotics during pregnancy and breast-feeding might confer immunomodulatory protection against atopic disease in the infant. J Allergy Clin Immunol. 2002;109(1):119-121.
Schmitt J, Schakel K, Schmitt N, Meurer M. Systemic treatment of severe atopic eczema: a systematic review. Acta Derm Venereol. 2007;87(2):100-11.
Schram ME, Tedja AM, Spijker R, Bos JD, Williams HC, Spuls PI. Is there a rural/urban gradient in the prevalence of eczema? A systemic review. Br J Dermatol. 2010;162(5):964-73.
Schulz P, Bunselmeyer B, Brautigam M, Luger TA. Pimecrolimus cream 1% is effective in asteatotic eczema: results of a randomized, double-blind, vehicle-controlled study in 40 patients. J Eur Acad Dermatol Venereol. 2007;21(1):90-4.
Sezer E, Etikan I. Local narrowband UVB phototherapy vs. local PUVA in the treatment of chronic hand eczema. Photodermatol PhotoimmunolPhotomed. 2007;23(1):10-4.
Simopoulos AP. Evolutionary aspects of diet, the omega-6/omega-3 ratio and genetic variation: nutritional implications for chronic diseases. Biomed Pharmacother. 2006;60(9):502-7.
Vlaski E, Stavric K, Isjanovska R, Seckova L, Kimovska M. Overweight hypothesis in asthma and eczema in young adolescents. Allergol Immunopathol (Madr). 2006;34(5):199-205.
Williams HC. Established corticosteroid creams should be applied only once daily in patients with atopic eczema. BMJ. 2007;334(7606):1272.
Williams HC, Grindlay DJ. What's new in atopic eczema? An analysis of the clinical significance of systematic reviews on atopic eczema published in 2006 and 2007. Clin Exp Dermatol. 2008 Nov;33(6):685-8. Review.
Wisniewski J, Nowak-Wegrzyn A, Steenburgh-Thanik E, Sampson H, Li X. Efficacy and Safety of Traditional Chinese Medicine for Treatment of Atopic Dermatitis (AD). J Allergy Clin Immunol. 2009 Feb;123(2):S37.
Worm M, Henz BM. Novel unconventional therapeutic approaches to atopic eczema. Dermatology. 2000;201(3):191-195.
Review Date: 9/10/2011
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.