|Also Listed As:
|| Atopic Dermatitis; Dermatitis,
Atopic; Skin Disorders, Eczema
Eczema, also called atopic dermatitis, is a chronic, inflammatory skin
disorder. Its main features are blisters that dry to become scaly, itchy rashes.
The skin becomes dry and itchy because too much moisture is lost from its upper
layer. This leaves the skin without protection, making it easy for bacteria and
viruses to penetrate. The disease occurs episodically; in other words, there may
be periods when symptoms are severe (flares) and times when there are no
symptoms at all (remission). Eczema is not contagious, but nevertheless 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 allergic conditions like asthma or hay fever.
There is no cure, but treatments can reduce symptoms and help prevent
|Signs and Symptoms|
Symptoms of eczema occur repeatedly. The most common signs of eczema
- Dry, extremely itchy skin
- Blisters with oozing and crusting
- Redness of the skin around the blisters
- Raw areas of the skin from scratching which may even lead to bleeding
- Dry, leathery areas with more or less pigment than their normal skin
tone (called lichenification)
Eczema in children under 2 years old generally begins on the cheeks, elbows,
or knees. In adults, it tends to be located on the inside surfaces of the knees
The cause of eczema is thought to be a combination of hereditary (genetic)
and environmental factors. This means that factors such as allergies can cause
eczema in susceptible people. Exposure to certain irritants and allergens (see
Lifestyle section for further definition
of these substances) in the environment can worsen symptoms as can dryness of
the skin, exposure to water, temperature changes, and stress.
- Young age—infants and young children are most
affected by eczema (about 65% of cases occur before age one, and approximately
90% occur before age 5)
- Skin exposure to harsh conditions
- Living in a climate with low humidity
- Personal and/or family history of allergies to plants, chemicals, or
- Deficiencies of certain vitamins and minerals (for example, zinc)
- Stress can make eczema worse
Irritants that may worsen eczema include:
- Wool or synthetic fibers
- Certain soaps and detergents as well as perfumes and some cosmetics
- Dust or sand
- Cigarette smoke
Your doctor will most likely base a diagnosis on both the appearance of the
skin and on personal and family history. For adults, he or she 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, to find the cause
of your rash. A skin lesion biopsy (removal of a small piece of skin for
examination in a laboratory) may be performed, but is not always required to
make the diagnosis.
Control of stress, nervousness, anxiety, and depression may help prevent
flares of eczema.
Mind/body techniques that have
shown some success include cognitive-behavioral therapy, autogenic training, and
these two techniques combined with learning about eczema.
Dietary restrictions that may help avoid flare ups include eggs, fish,
peanuts, and soy. This is very individual and should be discussed with your
health care provider. A doctor, dietitian, or naturopath, for example, can help
you make these dietary changes and determine if the lack of these foods in your
diet is reducing the incidence and severity of your eczema.
Although somewhat controversial, some studies have shown 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.
Similarly, recent studies suggest that babies whose mothers used probiotics
during pregnancy and while breastfeeding were less likely to have eczema up to 2
years of age. (See
Nutrition and Dietary Supplements
section for definition and more information on probiotics.)
Preliminary studies suggest that pretreatment of skin with creams containing
omega fatty acids can reduce the severity of eczema or prevent eczema
The goals when treating eczema are to heal the skin, reduce symptoms, prevent
skin damage, and prevent flares. Treatment may vary depending on age, symptoms,
and general health. Developing skin care routines, identifying factors that
trigger flares, and avoiding these triggers is a large part of any treatment
- Avoid anything that aggravates the symptoms, such as allergens
(substances to which the immune system overreacts) and irritants to the skin.
Common allergens include pollen, dust mites, and animal dander. Common skin
irritants include wool, synthetic fibers, soaps and detergents, perfumes,
cosmetics, lanolin, certain chemicals such as chlorine and solvents (including
mineral oil), cigarette smoke, dust, and sand.
- Avoid scratching or rubbing affected areas
- Protect skin from rough clothing and irritants
- Be aware of emotional stress and try stress-reducing techniques
- Keep your environment cool, with stable temperature and humidity
Dry skin often makes the condition worse. Remember to:
- Avoid hot baths or showers; lukewarm water is best
- Wash or bathe as quickly as possible to lessen water contact.
- Use a mild soap or a nonsoap cleanser, or less soapthan usual.
- Moisturize. After bathing, it is important to trap the moisture in
theskin by applyinglubricating cream on theskin while it isdamp (within 3
minutes of bathing).
Parents can help their children by:
- Providing distractions to prevent them from scratching
- Keeping fingernails short to reduce chances of infection from
- Being aware that there may well be social and emotional stress
associated with visible skin lesions; additional support and encouragement may
- Mild anti-itch lotions or topical corticosteroids--low potency
coticosteroids and over-the-counter lotions may soothe less severe or healing
areas, or dry scaly lesions
- Chronic thickened areas may be treated with ointments or creams that
contain tar compounds, corticosteroids (medium to very high potency), and
ingredients that lubricate or soften the skin.
- Systemic corticosteroids may be prescribed to reduce inflammation in
some severe cases. In very rare instances, medications that suppress the immune
system (called immunosuppressants such as cyclosporine) may be considered in
adults with extremely severe eczema who do not respond to oral steroids.
- Antihistamines may be recommended for nighttime use to prevent
nighttime scratching. These medications may cause drowsiness.
- New treatments--the latest treatment for eczema is a new class of skin
medications called topical immunomodulators (TIMs). These medications are
steroid-free. The most common are tacrolimus and ascomycin. Studies have shown
as high as an 80% success rate using these new medications.
|Surgery and Other Procedures|
Phototherapy and Photochemotherapy
Treatment with ultraviolet light waves may effectively treat mild to moderate
cases of eczema in children over age 12 and adults. If phototherapy is
ineffective alone, it may be combined with a drug called psoralen. It is then
|Nutrition and Dietary Supplements|
Paying attention (even keeping a diary) to what you (or your child) eat and
the effect it has on your skin (or your child's) may help you (or your child)
avoid foods that provoke flares of eczema. Potentially provoking foods include
peanuts, milk, soy, fish, and eggs. Foods high in saturated fats (like meat and
full fat dairy) and trans-fatty acids (such as fried foods and hydrogenated
oils) may stimulate inflammation as might sugar and highly processed foods. On
the other hand, fresh fruits (particularly dark berries) and vegetables, whole
grains, and foods rich in omega-3 fatty acids (such as nuts, flax, seeds, and
cold-water fish) may reduce inflammation in those without sensitivities to these
Supplements to consider and discuss with your healthcare provider
Gamma-linolenic acid (GLA)
GLA is an omega-6 essential fatty acid. Studies are mixed, but there is some
evidence that the metabolism of essential fatty acids is abnormal in people with
eczema, resulting in low levels of GLA. Several early studies suggested that GLA
derived from evening primrose oil (EPO) is beneficial for relieving symptoms
associated with this skin condition such as itching, redness, and scaling.
However, more recent studies have not had the same positive results. Whether or
not GLA or EPO supplements work for eczema may be very individual.
Interestingly, preliminary studies show that pretreatment of skin with fatty
acid-rich creams can reduce the severity of eczema or prevent eczema entirely.
Probiotics, or "good" bacteria, inhabit the intestines and protect against
the proliferation of "bad" organisms that can cause disease. Studies suggest
that gut bacteria in babies at high risk for allergic disorders may be different
from that of other babies. Two well-designed studies of mother-infant pairs
showed that babies of mothers who took probiotics while pregnant and
breastfeeding were less likely to have eczema in the first two years of life.
The most commonly used probiotics are Lactobacillus species.
Sulfur is found abundantly in keratin, a protein that strengthens hair,
nails, and skin. Sulfur baths, and other forms of sulfur applied directly to the
skin, seem to benefit eczema. Use of sulfur as a supplement is not currently
recommended for children.
Eczema is one of the symptoms of zinc deficiency, but there is no indication
that oral supplementation with zinc helps treat eczema.
Although evidence is limited or conflicting, the following may also be useful
Herbs, like drugs, may produce side effects or interact with other
medications. They should, therefore, be used with caution and only under the
guidance of a professionally trained and qualified herbalist.
Evening Primrose (Oenothera biennis) Oil
Evening primrose seed oil (EPO) is used primarily to relieve the itchiness
associated with certain skin conditions, including eczema. Results of studies
regarding EPO for eczema are mixed. Similar to GLA (see Nutrition and Dietary
Supplements section), an omega-6 fatty acid that is derived from EPO, whether
EPO relieves the symptoms of eczema may be very individual. Talk to your
healthcare provider to decide if it is safe and worthwhile for you to try EPO
for your eczema.
Lavender (Lavandula angustifolia)
Known mainly for its relaxing effects to aid with anxiety and insomnia, some
herbal specialists prescribe oral lavender for skin conditions like eczema. In
one study of topical lavender, however, children with eczema who received
massage with or without lavender oil applied to the skin both did well. In other
words, the improvement in the rash was related to the massage
- whether lavender oil was used or not seemed to make
no difference. To the extent that eczema is worsened by stress, it is possible
that lavender adds some benefit by helping you relax.
Herbs that have been used traditionally to treat eczema are listed below. A
naturopathic doctor or other herbal specialist might recommend one or more of
these remedies after evaluating you and your eczema.
- Burdock root (Arctium lappa) - applied
topically for skin inflammations
- German chamomile (Matricaria recutita)
- may reduce inflammation and speed wound healing
- Goldenrod (Solidago virgaurea) -
applied topically for wound healing; has anti-inflammatory properties
- Red clover (Trifolium pratense) - has
anti-inflammatory properties and has been used as an ointment for this skin
- Roman chamomile (Chamaemelum nobile) -
may ease discomfort associated with eczema
- Stinging nettle (Urtica dioica)
Although very 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 type. A constitutional type is defined as a person's 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.
- Calendula -- applied to the skin, particularly if the affected
area is inflamed; this remedy soothes but does not cure the skin condition
- Sulphur -- for redness, burning, itching, and hot skin that
tends to worsen with washing and scratching
- Urtica urens -- for large, red rashes (particularly those
related to allergies) that itch and burn intensely
- Rhus toxicodendron -- used as a remedy for inflamed skin
resulting from direct contact with an irritating substance; some homeopaths use
it to treat eczema
|Massage and Physical Therapy|
One study evaluating essential oils for treating children with eczema
concluded that massage with and without essential oils was effective in
improving the dry, scaly skin lesions. Children with this scaly, itchy skin
problem seem to experience less redness, scaling, and other symptoms if
receiving massage between flares. Massage should not be used when this skin
condition is actively inflamed. The essential oils most often chosen by the
mothers in the study were: sweet marjoram, frankincense, German chamomile,
myrrh, thyme, benzoin, spike lavender, and Litsea cubeba.
In one study it was found that regular group sporting activities improved
symptoms in those who participated for 3 weeks. The therapeutic effect of
exercise may be related to the positive impact it has on the emotions. Sports
should be avoided during the worst stages of an outbreak.
Climatotherapy is the use of 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. Studies
suggest that this is a successful treatment for eczema. One 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 and stays longer than 4
Flares of eczema are associated with anxiety and stress. Several studies have
shown that relaxation techniques to reduce stress and anxiety can successfully
decrease the number of occurrences and relieve symptoms of eczema. Biofeedback
seems to be a particularly useful technique.
Starting an infant on solid foods conservatively and gradually may help
prevent the food sensitivities that can cause eczema. Those 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|
Although Chinese herbal treatments for eczema have been gaining popularity in
both the United States and the United Kingdom, caution must be exercised when
considering such remedies for this skin condition. Many of the Chinese herbal
creams available in these two countries have been tested and high amounts of
steroid medications have been discovered. This is worrisome and potentially
dangerous because the amount of the medication in such creams is not
standardized or regulated. In a few rare instances, the use of oral Chinese
herbs (like a tea) for eczema has led to kidney damage.
|Prognosis and Complications|
Although there may be complications of eczema such as bacterial infections of
the skin and permanent scar formation, eczema is usually just an annoyance that
is easily controlled with treatment and by avoiding irritants. Call for an
appointment with your healthcare provider if it does not respond to treatment or
if signs of infection (such as fever, redness, pain) occur. Children with
eczema, after a certain period of time, often go into remission (period when
there are no symptoms) for the rest of their lives, although skin may remain
sensitive and dry.
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.
Andreassi M, Forleo P, Di Lorio A, Masci S, Abate G, Amerio P. Efficacy of
gamma-linolenic acid in the treatment of patients with atopic dermatitis. J
Int Med Res. 1997;25(5):266-274.
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 Skin Physiol. 2002;15(2):100-104.
Borrek S, Hildebrandt A, Forster J. Gamma-linolenic-acid-rich borage seed oil
capsules in children with atopic dermatitis. A placebo-controlled double-blind
study [Article in German]. Klin Padiatr. 1997;209(3):100-104.
Calder PC, Miles EA. Fatty acids and atopic disease. Pediatr Allergy
Immunol. 2000;11 Suppl 13:29-36.
Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C
based on antioxidant and health effects in humans. Am J Clin Nutr.
Cotterill JA. Psychophysiological aspects of eczema. Semin Dermatol.
Ehlers A, Stangier U, Gieler U. Treatment of atopic dermatitis: a comparison
of psychological and dermatological approaches to relapse prevention. J
Consult Clin Psychol. 1995;63(4):624-635.
Ernst E. Adverse effects of herbal drugs in dermatology. Br J
Foster S, Tyler V. Tyler's Honest Herbal: A Sensible Guide to the Use of
Herbs and Related Remedies. 4th ed. New York, NY: Haworth Herbal Press;
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.
Hederos CA, Berg A. Epogam evening primrose oil treatment in atopic
dermatitis and asthma. Arch Dis Child. 1996;75(6):494-497.
Horrobin DF. Essential fatty acid metabolism and its modification in atopic
eczema. Am J Clin Nutr. 2000;71(1 Suppl):367S-72S.
JAMA Patient Page. How much vitamin C do you need? JAMA.
Johnston CS. Recommendations for vitamin C intake. JAMA.
Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New
York, NY: Warner Books; 1996: 230-234.
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.
Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and
recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.
Lord GM, Tagore R, Cook T, Gower P, Pusey CD. Nephropathy caused by Chinese
herbs in the UK [letter]. Lancet 1999;354(9177):481-482.
McMenamy CJ, Katz RC, Gipson M. Treatment of eczema by EMG biofeedback and
relaxation training: a multiple baseline analysis. J Behav Ther Exp
Morse PF, et al. Meta-analysis of placebo-controlled studies of the efficacy
of Epogam in the treatment of atopic eczema: relationship between plasma
essential fatty acid changes and clinical response. Br J Dermatol.
National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Handout on Health: Atopic Dermatitis. Accessed at
on October 24, 2002.
Newall C, Anderson L, Phillipson J. Herbal Medicines: A Guide for
Health-care Professionals. London, England: Pharmaceutical Press;
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.
Salzer B, Schuch S, Rupprecht M, Hornstein OP. Group sports as adjuvant
therapy for patients with atopic eczema [article in German]. Hautarzt.
Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin
Putnam; 1995: 252.
Whitaker DK, Cilliers J, de Beer C. Evening primrose oil (Epogam) in the
treatment of chronic hand dermatitis: disappointing therapeutic results.
Worm M, Henz BM. Novel unconventional therapeutic approaches to atopic
eczema. Dermatology. 2000;201(3):191-195.
|Review Date: December 2002|
|Reviewed By: Participants in the review process include: Robert A. Anderson, MD,
President, American Board of Holistic Medicine, East Wenatchee, WA; Shiva
Barton, ND, Wellspace, Cambridge, MA; Jacqueline A. Hart, MD, Department of
Internal Medicine, Newton-Wellesley Hospital, Boston, Ma and Senior Medical
Editor A.D.A.M., Inc.; Richard A. Lippin, MD, President, The Lippin Group,
Southampton, PA; Leonard Wisneski, MD, FACP, George Washington University,
Copyright © 2004 A.D.A.M., Inc
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