Eczema (Atopic Dermatitis)
Symptoms
Eczema causes intense itching, dry patches, and red, scaly plaques that may ooze or crust. Common sites include flexural areas like behind the elbows, knees, wrists, and neck. Scratching often leads to skin thickening (lichenification) and secondary infections. Sleep disturbance is frequent during flares. In infants, lesions often affect the face and extensor surfaces.
Cause
Atopic dermatitis arises from a defective skin barrier and immune dysregulation. Genetic mutations in filaggrin and other proteins reduce barrier integrity. Environmental allergens, irritants, and microbes penetrate easily, triggering inflammation. Climate, stress, and sweating can worsen symptoms. Patients often have a personal or family history of allergies, asthma, or hay fever.
Treatment
Regular use of fragrance‑free emollients restores the skin barrier. Topical corticosteroids or calcineurin inhibitors calm inflammation during flares. For moderate to severe disease, systemic options include phototherapy, oral JAK inhibitors, or biologics targeting IL‑4/IL‑13 or IL-31 (e.g., dupilumab). Antihistamines may reduce nighttime itching, though evidence is mixed. Identifying and avoiding irritants, using gentle cleansers, and maintaining humidity help prevent relapses.
Dr. Beth Schulz-Butulis
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