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What Causes Eczema?

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What Causes Eczema?

Eczema is a common skin condition that affects millions of people in the U.S. How do you know if you might have eczema, and does having diabetes put you at risk? Read on to learn more.

What is eczema?

Also known as atopic dermatitis, “eczema is an inflammatory skin condition that causes dry skin, itchy skin, rashes, scaly patches, blisters, and skin infections,” according to the National Eczema Association. While it’s common in children, people of any age can get eczema. This is a chronic skin condition that can flare up periodically.

There are actually several types of eczema, including:

  • Atopic dermatitis
  • Contact dermatitis
  • Dyshidrotic eczema
  • Hand eczema
  • Neurodermatitis
  • Nummular eczema

However, atopic dermatitis is the most common type, affecting more than 9.6 million children and 16.5 million adults in the U.S.

Eczema in adolescents and adults tends to occur on the hands, neck, inner elbows, ankles, knees, feet, and around the eyes. It’s not contagious and there is no cure for eczema.

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What are the symptoms of eczema?

Symptoms of eczema can vary from person to person, but they almost always include itching. Scratching the itch then causes a rash to appear. Other symptoms of eczema can be:

  • Very dry skin
  • Sensitive skin
  • Bumps on the skin
  • Inflamed, discolored skin
  • Rough, leathery skin that can appear as scaly patches
  • Oozing, bleeding, or crusting
  • Swelling

Someone who has had eczema for years may have skin that is permanently thickened and has a leathery texture due to scratching, says the American Academy of Dermatology Association. The skin may always itch, as well.

Chronic eczema can also lead to anxiety and depression as a result of constant itching, discomfort, and trouble sleeping. A person with eczema may be embarrassed or ashamed of their condition and may isolate themselves as a result.

What causes eczema?

Several factors are thought to cause eczema:

  • A family history of eczema
  • A family or personal history of allergens, asthma, or hay fever
  • Environmental irritants such as tobacco smoke, pollutants, harsh soap, wool fabric, and dry air
  • Stress
  • Food allergies (in children)

The National Eczema Association states that research shows that some people have a mutation of the gene that creates filaggrin. Filaggrin is a protein that helps maintain a protective barrier on the top layer of the skin (called the epidermal barrier). If there isn’t enough filaggrin, moisture can easily escape, and bacteria and viruses can enter. This explains why many people with eczema have very dry and infection-prone skin.

Dry skin, irritants (such as harsh soap or laundry detergent), and emotional stress can trigger eczema flare-ups.

How is eczema diagnosed?

Your health care provider can diagnose eczema by examining your skin, looking for common signs such as dry skin and redness. They may do an allergy skin test, certain blood tests, or a skin biopsy to rule out other causes of your symptoms. Sharing your family history with your provider can also lead to a quicker diagnosis.

How is eczema treated?

While there is no cure for eczema, there are a number of ways to treat this condition. These include lifestyle changes, over-the-counter remedies, and prescription medication.

Lifestyle treatments for eczema include:

  • Using a humidifier if the air is dry
  • Bathing or showering in lukewarm water
  • Taking an oatmeal bath
  • Using a gentle, unscented cleanser
  • Lightly patting dry the skin with a towel
  • Using a cream, lotion, or ointment to seal in moisture
  • Identifying and avoiding triggers, such as detergents, soaps, dust, or pollen
  • Limiting and managing stress

Over-the-counter remedies for eczema include:

  • Cortisone creams and ointments
  • Antihistamines

(Always check with your provider before using these remedies).

Prescription medications for eczema include:

  • Topical calcineurin inhibitors (TCIs), including tacrolimus (brand name Protopic) and pimecrolimus (Elidel)
  • Crisaborole (Eucrisa), a topical PDE4 inhibitor
  • Topical steroids
  • Oral steroids
  • Antibiotic creams
  •  Injectable biologics, such as dupilumab (Dupixent)
  • Abrocitinib (CIBINQO)
  • Upadacitinib (RINVOQ)
  • Tralokinumab-ldrm (Adbry)
  •  Orismilast

Other treatments that your provider may recommend include wet dressings (wrapping affected areas with topical steroids and wet bandages), light therapy (exposing the skin to sunlight or artificial ultraviolet light), relaxation and behavior modification techniques, and counseling.

How does having diabetes impact eczema?

A study looking at more than 61,000 adults, published in the Journal of Allergy and Clinical Immunology in 2015, found that people with eczema:

  • Were 54% more likely to be severely obese
  • Were 48% more likely to have high blood pressure
  • Were one-third more likely to have high cholesterol
  • Were more likely to have sleep problems

In addition, the researchers discovered that people with eczema were also more likely to have prediabetes or diabetes compared with people without eczema. People who have diabetes are more prone to developing skin conditions, which can include eczema, as well as psoriasis, and skin infections.

Aiming to keep blood sugars within your target range as much as possible may help prevent or reduce flare-ups of eczema, as well as other skin issues.

To learn more about eczema and ways to treat it, visit the National Eczema Association’s website.

Want to learn more about diabetes and skin care? Read “Skin Cancer: Types, Risk Factors, Prevention, and More,” “Diabetes and Your Skin,” “The Prescription for Dry Winter Skin” and “Summertime Skin Care.”

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES on social media

A Registered Dietitian and Certified Diabetes Educator at Good Measures, LLC, where she is a CDE manager for a virtual diabetes program. Campbell is the author of Staying Healthy with Diabetes: Nutrition & Meal Planning, a co-author of 16 Myths of a Diabetic Diet, and has written for  publications including Diabetes Self-Management, Diabetes Spectrum, Clinical Diabetes, the Diabetes Research & Wellness Foundation’s newsletter, DiabeticConnect.com, and CDiabetes.com

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