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Eczema is a common skin condition that affects over 30 million Americans. It is marked by a red and itchy rash that can dry out the skin and become very painful.
The exact cause of eczema is unknown, though it is considered to be initiated by a combination of factors. Genetics and environmental triggers play a role in who is likely to experience this skin condition.
Around the eyes is a particularly sensitive location for an eczema rash. People who get eczema on their eyes or eyelids are at risk for developing certain eye conditions. They must be extra careful about which treatment methods are used.
There are three primary stages of eczema (acute, subacute, and chronic) that inform treatment options. The stages of eczema do not indicate the severity of the rash, however, as the intensity of symptoms can vary greatly within each stage.
While there is no cure for eczema, there are many well-developed treatment options. Treatments include making dietary changes, eliminating triggers, using proper and gentle skincare, and taking advantage of topical creams or prescription medications.
In addition to using various treatment options when you experience an eczema flareup, there are many techniques you can use in an attempt to prevent flareups. Prevention methods, such as keeping the skin moisturized and avoiding allergens, can greatly reduce the likelihood of experiencing a severe flareup.
What Is Eczema?
Eczema is an uncomfortable skin condition where spots on the skin become dry, red, itchy, cracked, and inflamed. In severe cases, blisters can also form. Rashes typically form on the face, inner elbows, behind the knees, and on the hands and feet.
According to the National Eczema Association (NEA), over 10 percent of people in the United States have some type of eczema.
NEA explains that people of all ages and ethnicities are affected by eczema. One in 10 people experiences some form of eczema throughout their lifetime. Most people with eczema first experienced symptoms in childhood, though one in four adults report an onset of symptoms in adulthood.
Eczema is also a relatively common condition for babies and young children. Approximately, 12 percent of children experience atopic dermatitis. Eighty percent of people who have atopic dermatitis report first experiencing symptoms before age 6. Eighty percent of these children are expected to outgrow their symptoms by adolescence or adulthood.
Symptoms & Causes of Eczema
There are some telltale symptoms of eczema, though the condition should always be officially diagnosed by a dermatologist or other physician.
General symptoms of eczema include:
- Swollen or discolored skin, including patches of white, red, or pink skin.
- Scaly patches.
- Overall dryness.
- Areas that crust or ooze.
- Skin roughness.
It is not known what specifically causes eczema. Most researchers believe that a combination of genetics and environmental factors are involved. People with eczema may have a hyper-reactive immune system that creates inflammation when certain triggers are present. Generally, this inflammation leads to redness, itchiness, and painful skin symptoms.
Researchers have found that people with eczema have an overreactive immune system that produces inflammation in the body when triggered by an internal or external factor. That inflammation response then leads to the uncomfortable symptoms of eczema.
Some people with eczema also have a gene mutation that doesn’t allow them to produce enough filaggrin, a protein responsible for maintaining a healthy skin barrier. Without a strong enough skin barrier, moisture escapes, and bacteria and viruses can enter.
NEA explains that there are a variety of environmental factors that can trigger an eczema outbreak, some of which include:
- Dry skin.
- Skin irritants, such as soaps, detergents, or cleaning products.
- Emotional stress.
- Sweating or overheating.
- Cold, dry weather.
- Infection (bacterial or viral).
- Food allergens (most commonly dairy, wheat, or nuts).
- Environmental allergens (most commonly fabrics, plants, or pets).
Types of Eczema
The seven most common types of eczema are:
- Atopic dermatitis. This type is due to problems with the immune system and skin barrier.
- Contact dermatitis. This irritation is caused by irritants or allergens touching the skin.
- Dyshidrotic eczema. This presents as an itchy blister on the feet and hands, caused by allergens.
- Thick scaly patches on the skin are caused by excessive scratching.
- Nummular eczema. These round lesions are caused by allergens or very dry skin.
- Seborrheic dermatitis. Flaky, greasy patches are caused by genetics, hormones, and organisms on the skin.
- Stasis dermatitis. This is caused by poor circulation in the legs, leading to swelling of veins and leaking of fluid. It results in swollen, red, itchy skin.
Eczema Around the Eyes
While eczema can occur virtually anywhere on the body, it is common around the eyes. This is often one of the most painful spots for eczema.
If someone has eczema elsewhere on their face, it is more likely that they will also get it around their eyes. Since the skin on the eyelids is particularly sensitive, it is especially likely to dry out and experience irritation.
Here are common types of eczema that appear around the eyes:
- Atopic eczema: Also known as atopic dermatitis, this type of eczema is signified by redness, dryness, and itchiness on the eyelids and the skin surrounding the eyes. Some people also experience a burning or tingling sensation around the eyes.
- Contact eczema: Also known as contact dermatitis, this type of eczema around the eyes is caused by an allergic reaction. Most commonly, contact dermatitis around the eyes is due to an allergic reaction to nail polish (after people rub their eyes) or makeup.
- Seborrheic eczema: Also known as seborrheic dermatitis, this type is thought to be caused by yeast. Though it rarely causes itchiness, the skin may appear yellowish and flaky.
Stages of Eczema
The stages of eczema are not a reflection of the severity of the rash; they designate how the rash is developing or subsiding. Someone with eczema may experience varying degrees of flareups at different times. Researchers have identified three primary stages of eczema based on how far the condition has progressed.
The three stages of eczema are:
- This is when an eczema rash is just beginning and itching is first noticeable. Symptoms quickly become more intense
- This is a transitional stage when symptoms typically become less severe during healing from an acute flareup, but could also be developing into a chronic rash.
- This is when flareups last more than three months, though there is no exact timeline for when a rash becomes chronic.
Although the stages of eczema typically build on one another, they do not always progress linearly. In a single flareup, a rash could go from the subacute stage back to the acute stage or back and forth between different stages. A flareup could start and stop at any stage.
Levels of Severity
The severity of an eczema flareup is not determined by the stage of the rash. Each stage presents with its own set of symptoms that all vary in severity.
Initial symptoms include itching and redness of the skin. As the rash gets worse, tiny bumps or blisters can occur, explains Harvard Medical School. Each of these symptoms can also vary in intensity.
Additional symptoms of eczema include:
- Color changes (redness or darkening of the skin).
- Thickening of the skin.
- Scaling and flaking.
- Painful itching.
As a flareup progresses, more severe symptoms include:
- Weeping sores.
- Secondary infections of the sores.
- Ulceration of the sores.
- Severe itching that interrupts sleep.
- Stinging or burning pain in dry or cracked skin.
Diagnosis & Treatment Options
Eczema is not a contagious condition. There is also no cure for it.
There are many treatment options that can help to manage eczema breakouts, reducing their severity and frequency. Eczema treatment is focused on repairing damaged skin and alleviating uncomfortable symptoms.
Current treatment options include:
- Topical corticosteroid creams and ointments. Anti-inflammatory creams target skin itchiness and inflammation.
- Systemic corticosteroids. Prescription corticosteroids can be swallowed or injected when topical creams are not effective enough.
- Antibiotics. These are prescribed when a bacterial skin infection is also present.
- Antifungal/antiviral medications. These are used to treat fungal or viral infections related to eczema.
- Antihistamines. These reduce itchiness and improve sleep.
- Topical calcineurin inhibitors. These are used to decrease inflammation of the immune system that is causing flareups.
- Skin barrier-repairing moisturizers. These help to keep moisture in and repair the skin.
- Phototherapy. Ultraviolet A or B light waves can be used to treat moderate eczema.
- Wet wrap therapy. This treatment is used for severe eczema. Three lukewarm baths per day are given, followed by the application of topical medications and moisturizers. The skin is then wrapped in wet gauze.
Home Remedies Can Help
The best way to manage eczema around the eyes is to keep the skin in the area highly moisturized.
- Avoid drying face washes. Choose leave-on emollient products that keep the skin moisturized while they cleanse it.
- Avoid fragrances. Many skincare products contain added fragrances. Choose products that are fragrance-free.
- Use gentle products. Ask your dermatologist for recommendations for gentle moisturizers. These will keep skin moist and free from irritation.
- Wear sunscreen and sunglasses. Sun exposure can make the skin on your eyes more sensitive and lead to eczema outbreaks. Aim to limit exposure.
- Avoid triggers. If you know certain allergens or products trigger an outbreak, steer clear of these. Stick to tried-and-true favorites that you know don’t irritate your skin.
Unfortunately, eczema is a persistent skin condition that is tricky to treat. For some people, eczema subsides over time as they get older. Other people, however, may have to deal with the condition throughout their lifetime.
As more information is gained on the condition, more effective treatment and symptom management options are becoming available. A combination of the above treatment options and preventative measures works best for most people.
The National Institute of Allergy and Infectious Diseases (NIAID) has many recommendations for how to care for your skin at home in order to avoid serious eczema flareups and to reduce your need for prescription medications.
NIAID’s recommendations include:
- Avoid scratching the inflamed area.
- Use a moisturizer or topical steroid to relieve itching.
- Take an antihistamine for severe itching.
- Use an ointment (petroleum jelly) to lubricate the skin two to three times per day.
- Use moisturizers free of alcohol, scents, fragrances, and other chemicals that may irritate the skin.
- Use a humidifier in your home.
- Avoid skin irritants, such as certain soaps, detergents, or fabrics.
- Stick to quick, lukewarm baths or showers rather than long exposure to hot water.
- Do not overly scrub or dry the skin.
- Apply ointments to damp skin after bathing in order to trap moisture in the skin.
- Avoid allergens, such as dairy, nuts, wheat, pollen, and pet hair.
Although eczema can be a persistent and highly uncomfortable condition, there are many treatment options and prevention methods to make the condition more manageable. A comprehensive treatment approach that focuses on reducing environmental triggers while using various treatment methods to target the rash can help to greatly reduce the negative impacts of this skin condition on your life.
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Eczema: What Is It? (February 2019). Harvard Health Publishing.
Eczema (Atopic Dermatitis) Treatment. (May 2017). National Institute of Allergy and Infectious Diseases.
Eczema Causes and Triggers. National Eczema Association.
Eczema Facts. National Eczema Association.
What Is Eczema? National Eczema Association.
Eczema Around the Eyes. National Eczema Association.
Here’s Exactly What to Do About Eczema on Your Eyelid. (July 2018). Self.