Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Eczema facts
- What is eczema?
- What are the causes of eczema?
- What are risk factors for eczema?
- What are eczema symptoms and signs in babies, children, and adults?
- What are the different types of eczema?
- How is eczema diagnosed?
- What is the treatment for eczema?
- Can eczema be prevented?
- What are the possible complications of eczema?
- What is the prognosis (outlook) for eczema?
How is eczema diagnosed?
To diagnose eczema, doctors rely on a thorough physical examination of the skin as well as the patient's account of the history of the condition. In particular, the doctor will ask when the condition appeared, if the condition is associated with any changes in environment or contact with certain materials, and whether it is aggravated in any specific situations. Eczema may have a similar appearance to other diseases of the skin, including infections or reactions to certain medications, so the diagnosis is not always simple. In some cases, a biopsy of the skin may be taken in order to rule out other skin diseases that may be producing signs and symptoms similar to eczema.
If a doctor suspects that a patient has allergic contact dermatitis, allergy tests, possibly including a skin "patch test," may be carried out in an attempt to identify the specific trigger of the condition.
There are no laboratory or blood tests that can be used to establish the diagnosis of eczema.
What is the treatment for eczema?
The goals for the treatment of eczema are to minimize itching, inflammation, and worsening of the condition. Treatment of eczema may involve both lifestyle changes and the use of medications. Treatment is always based upon an individual's age, overall health status, and the type and severity of the condition.
Keeping the skin well hydrated through the application of creams or ointments (with a low water and high oil content) as well as avoiding over-bathing is an important step in treatment. It is recommended to apply emollient creams such as petrolatum-based creams to the body immediately after a five-minute lukewarm bath in order to seal in moisture while the body is still wet. Lifestyle modifications to avoid triggers for the condition are also recommended.
Corticosteroid creams are often prescribed to decrease the inflammatory reaction in the skin. These may be mild-, medium-, or high-potency corticosteroid creams depending upon the severity of the condition. If itching is severe, oral antihistamines may be prescribed to help with nighttime sedation. To control itching, the sedative type antihistamine drugs (for example, diphenhydramine [Benadryl] and hydroxyzine [Atarax, Vistaril]) are helpful.
In some cases, a short course of oral corticosteroids (such as prednisone) is prescribed to control an acute outbreak of eczema, although their long-term use is discouraged in the treatment of this non life-threatening condition because of unpleasant and potentially harmful side effects. The oral immunosuppressant drugs cyclosporine (Neoral, Sandimmune) and methotrexate have also been used to treat severe cases of eczema that do not respond to conventional treatment. Ultraviolet light therapy (phototherapy) is another treatment option for some people with eczema.
Finally, two topical (cream) medications have been approved by the U.S. FDA for the treatment of eczema: tacrolimus (Protopic) and pimecrolimus (Elidel). These drugs belong to a class of immune-suppressant drugs known as calcineurin inhibitors and are indicated only in patients over 2 years of age. The U.S. FDA has issued a black box warning stating the long-term safety of calcineurin inhibitors has not been established. Although a causal relationship has not been established, rare cases of malignancy have been reported with their use in laboratory animals. It is recommended that these drugs only be used as second-line therapy for cases that are unresponsive to other forms of treatment and that their use be limited to the minimum time periods needed to control symptoms.
Next: Can eczema be prevented?
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