Here in the U.S., eczema is considered one of the most common skin conditions among adults and children alike. Maybe you've even seen the stats: Cleveland Clinic estimates that as many as 15 percent to 20 percent of children, and 1 to 3 percent of adults, develop eczema also known by its clinical name, atopic dermatitis at some point during their lifetime. People of all skin colors and ethnicities can experience it, too, and though eczema classically peaks in early childhood, there's also another spike of diagnoses around age 50.
So for dermatologists, the numbers don't lie: Identifying and treating the itchy, dry condition is just a regular part of their everyday medical routine. If the condition is, in fact, so regular, so familiar to the doctors diagnosing it, then why isn't there a cure? Simply put, atopic dermatitis is a bit of a medical mystery but there are a few key indicators that research has helped to identify over the years.
'Eczema is an inflammatory condition we don't know everything about', says Robert Finney, a board-certified dermatologist based in New York City. 'There's a strong genetic predisposition to it, and in some patients, typically kids, we've identified mutations to certain genes important in regulating the skin barrier.'
Now, this matters because eczema occurs when the skin barrier isn't working as well as it should be, leading to a chronic, relapsing rash that tends to crop up in places inside the elbows, knees, and wrists anywhere that's on the side of a joint that folds. (Fittingly, the word eczema originates from the Greek word ekzein, which roughly translates to boil over or break out.) So there may not be a permanent antidote to the so-called 'itch that rashes', but there are plenty of treatment options. It just depends on how severe the particular case may be.
'Eczema isn't as much defined by stages as it is by severity', explains Nada Elbuluk, a board-certified dermatologist based in Los Angeles. 'We often will describe eczema as being mild, moderate, or severe. The degree of severity is typically determined by how active and widespread the eczema is and how symptomatic it is for the person affected.'
Here, we tapped the expertise of five top board-certified dermatologists, including Finney and Elbuluk, to first walk us through those various levels of severity, then present practical, accessible care for each.
Eczema often starts with an area of itching that, again, typically emerges in those zones where the skin folds or is exposed to the elements, like around the hands and face. When a person starts to scratch, that's when that distinctive rash often characterized by dry, red, and cracked skin can develop.
'With mild eczema, people often have less of their body involved and have mild itching localized to those areas', says Elbuluk. And remember, eczema is a sort of enigma, so while problem patches traditionally include the aforementioned spots, like the insides of elbows and the backs of knees, any area can be affected. Finney notes that in infants, flare-ups often occur on the cheeks or torso, while in adults, the hands and eyelids can also become eczema hot-spots.
This means that treatment for mild eczema can be kept somewhat localized. 'The goal is to keep the skin barrier in as good shape as possible with moisturizers, and to help reduce inflammation with anti-inflammatory cortisone and non- cortisone cream', says Joshua Zeichner, a board-certified dermatologist based in New York City.
Marnie Nussbaum, a board-certified dermatologist based in New York City, also suggests keeping showers short like, five-minutes-short and using lukewarm water. Finally, patients with mild eczema can plan to use a gentle cleanser that's pH-balanced, followed by a moisturizing lotion with thick emollients immediately after patting the skin dry to lock in the moisture.
Unlike mild eczema, which typically doesn't stray beyond specific problem areas, moderate eczema becomes less targeted. 'It's often affecting more of their body with more severe itching, and having more significant effects on the person's quality of life', says Elbuluk.
Sometimes, Finney adds, itching can get so uncomfortable that patients who have had eczema for a long period of time will present with thickened, darker skin in these areas, a hallmark feature of rubbing. And in patients with darker skin types, dermatologists often see accentuation around the hair follicles with small bumps.
Because moderate eczema affects larger areas of the skin, Zeichner finds that it's especially important to apply potent over-the-counter moisturizers to the entire surface area of the skin, not just where patients are experiencing breakouts. 'Stick to unscented moisturizers and cleansers, as fragrances may lead to skin reactions', he says.
And while you may see flakes on the skin, resist the urge to exfoliate. 'Using manual scrubs or chemical exfoliators on an already-disrupted skin barrier can make matters worse, leading to more dryness and irritation, adds Zeichner. Instead, give your skin what it needs, which is hydration.' For a true total- body approach, Nussbaum suggests getting a humidifier, which can be useful in maintaining a hydrating environment.
In severe cases, eczema can, unfortunately, become so much more than that itch that rashes. 'Severe eczema can also get to the point of having inflamed skin that also gets infected depending on how injured the skin has become', says Elbuluk. Any infections should be treated, and at this point, professionals will often propose systemic medications that can provide patients with some relief.
'When necessary, topical corticosteroids are also helpful, and non-steroidal anti-inflammatory topical medications may also provide benefit', says Hadley King, a board-certified dermatologist based in New York City.
Finney explains that newer treatments like light therapy, immunosuppressive medications, and biologic drugs can also be used. Even in the most severe cases, dermatologists are confident they're able to keep eczema at bay particularly with breakthrough research coming out of the dermatological space. Finney mentions a new class of medications called 'JAK inhibitors' that work to mitigate the inflammatory pathways that are overstimulated and cause eczema symptoms. The treatment method, which comes available in both oral and topical dosage forms, is headed to the Food and Drug Administration (FDA) for review. 'There's no cure for eczema, says King, but there are great strategies and medications for helping to control it.'
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