One of the most common forms of dermatitis is eczema, which occurs more in children than adults. This skin condition presents as dry, itchy skin that leads to rashes due to itching, rubbing and irritation. When the person continues to itch and rub their skin, the skin will thicken causing lichenification. Genetic, environmental and lifestyle factors play a role in this condition. A common gene mutation observed in atopic dermatitis is Filaggrin, which is responsible for making the skin’s outer layer by forming corneocytes. People with eczema have a dysfunctional and unorganized skin barrier which causes dry skin since there is water and moisture loss. In addition, they have a decreased number of beta-defensins, which are host defense peptides so they are more prone to infections. The damaged skin provides less protections against irritants, allergens, viruses and bacterias. They are more prone to Staphylococcus aureus infections which can make eczema worse and need to be treated with antibiotics. Eczema herpeticum, a medical emergency, can also occur caused by the ****** simplex virus-1. Treatment and management of eczema are skin hydration and topical anti-inflammatory medications. Moisturizing products such as emollients and ointments are used to hydrate the skin and keep it from drying out. Steroid creams or topical pimecrolimus and tacrolimus can be used to treat flare-ups. Topical steroids shouldn’t be used daily because there are numerous long term side effects including atrophy, telangiectasia and rebound dermatitis. Oral antihistamines can be taken at bedtime to help with disturbed sleep caused by itching. It is essential to educate patients on eliminating and avoiding triggers and allergens that might cause flare-ups.
References
Nemeth V, Evans J. Eczema. [Updated 2020 Mar 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538209/
InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Eczema: Overview. 2013 Sep 26 [Updated 2017 Feb 23].Available from: https://www.ncbi.nlm.nih.gov/books/NBK279399/
Eczema, also known as atopic dermatitis, is a chronic skin condition that affects millions of people worldwide, causing dry, itchy, and inflamed patches of skin. It often begins in childhood but can occur at any age, with symptoms that last into adulthood. Eczema can be a result of genetic predisposition, environmental factors, and immune system dysregulation. Individuals with eczema often have a weakened skin barrier, making their skin more vulnerable to irritants, allergens, and infections. Common symptoms include dry, sensitive skin, redness, thickened or scaly patches, and intense itching, which can lead to scratching and further skin damage. Triggers such as harsh soaps, detergents, certain fabrics, allergens like dust mites and pollen, extreme weather conditions, and emotional stress can exacerbate symptoms. Treatment for eczema focuses on relieving symptoms, repairing the skin barrier, and preventing flare-ups. Moisturizers are a big part of disease management. Products containing petrolatum or lanolin such as, Eucerin,or Aquaphor can be particularly effective in maintaining hydration and protecting the skin. Topical corticosteroids are widely used during flare-ups to reduce inflammation and itching. For sensitive areas such as the face and neck, non-steroidal alternatives like topical calcineurin inhibitors, including tacrolimus and pimecrolimus, may be prescribed. Systemic treatments like oral corticosteroids, immunosuppressants such as methotrexate, and biologics like dupilumab are reserved for severe or refractory cases. With all topical products it is important to keep in mind to “Wash hands after application, apply a thin layer only to the affected are twice a day, and use the smallest amount needed to control symptoms.” (RxPrep UWorld) Lifestyle adjustments are also important in managing eczema. Patients are encouraged to use gentle, fragrance-free cleansers, take lukewarm baths, and avoid over-scrubbing or using harsh towels. Patients can “look for products with the National Eczema Association Seal of Acceptance™ to find moisturizers free of fragrances, dyes, and other common allergens." (National Eczema Association). Wearing soft, breathable fabrics like cotton instead of wool or synthetic materials can prevent irritation. Stress management techniques, such as meditation, yoga, or deep-breathing exercises, may help reduce flare-ups triggered by emotional stress. Additionally, some patients benefit from antihistamines may be used to alleviate nighttime itching and improve sleep, although they do not directly address the underlying inflammation.
Preventive measures are equally important in controlling eczema. Identifying and avoiding specific triggers, such as certain foods or environmental allergens, can significantly reduce the frequency of flare-ups. Maintaining a consistent skincare routine that includes moisturizing multiple times a day is crucial for keeping the skin barrier intact. In severe cases, regular follow-up with a dermatologist or allergist can help tailor treatments and monitor progress. While eczema cannot be cured, with proper management, many individuals can effectively control their symptoms and lead more comfortable lives.
UWorld RxPrep NAPLEX Review 2025 Chapter 39 Common Skin Conditions Page 521
https://nationaleczema.org/eczema-management/