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Understanding Eczema in St. Louis

Woman scratching her neck, experiencing discomfort due to eczema flare-up.

Living with eczema can be a challenging and frustrating experience. The relentless itching, redness, and inflammation can not only affect your physical well-being but also take a toll on your emotional health. At Mid-County Dermatology located at Missouri Baptist Medical Center in St. Louis, MO, we understand the impact that eczema can have on your daily life, and we are here to provide the support and expert care you need.

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In this article, we will delve into the world of eczema, exploring its causes, symptoms, and available treatment options. Whether you or a loved one are struggling with this common skin condition, our goal is to empower you with knowledge and practical advice to effectively manage and alleviate the symptoms of eczema.

 

As a leading dermatology practice in St. Louis, we have helped countless individuals find relief from eczema and regain control over their skin health. Our dedicated team of St. Louis skin specialists are equipped with the latest advancements in eczema treatment and are committed to delivering personalized care tailored to your specific needs.

Overview of Eczema

What is eczema?

Eczema, a condition characterized by inflammation of the skin, manifests in various ways, presenting symptoms such as itching, dryness, rashes, scaly patches, blisters, and infections. Itching is the most prevalent indication of eczema. There are different types of this condition, namely atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, seborrheic dermatitis, and stasis dermatitis.

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In the United States, over 31 million individuals suffer from some form of eczema. It can onset during childhood, adolescence, or adulthood, and its severity ranges from mild to severe. Newborn babies may develop eczema symptoms within weeks or months after birth. Young children with eczema often experience excessively dry patches of skin, intense itching leading to blisters, and skin infections resulting from constant scratching.

Unveiling the Causes of Eczema

 Eczema arises due to an overactive immune system, leading to dry and itchy skin. This condition can manifest on any area of the body and presents with diverse symptoms. Eczema development is influenced by a combination of genetic factors and environmental interactions. When the immune system is triggered by irritants or allergens from either external or internal sources, it initiates an inflammatory response, resulting in a flare-up on the skin's surface.  

Eczema Risk Factors

People with a family history of eczema, asthma, or allergies are more prone to developing the condition.

Eczema Triggers

    • Extended exposure to dry air, extreme heat, or cold

    • Certain types of soap, shampoos, bubble bath products, body wash, and facial cleansers

    • Laundry detergents and fabric softeners with chemical additives

    • Fabrics like wool or polyester in clothing and sheets

    • Surface cleaners and disinfectants

    • Natural liquids like fruit, vegetable, and meat juices

    • Fragrances in candles

    • Metals, especially nickel, in jewelry or utensils

    • Formaldehyde found in household disinfectants, some vaccines, glues, and adhesives

    • Isothiazolinone in personal care products like baby wipes

    • Cocamidopropyl betaine used to thicken shampoos and lotions

    • Paraphenylene-diamine in leather dyes and temporary tattoos

    • Dust mites and living in unclean spaces

    • Emotional stress can also potentially trigger eczema flare-ups

Who does eczema affect?

Eczema can manifest in individuals of all age groups. Typically, symptoms tend to emerge during childhood and may persist into adulthood. The prevalence of eczema is significant, affecting more than 31 million Americans. It is particularly common among infants, with approximately 10% to 20% experiencing the condition. However, it is worth noting that nearly half of all infants diagnosed with eczema eventually outgrow the condition or witness significant improvement as they grow older.

Is eczema contagious?

Eczema is non-contagious, meaning it cannot be transmitted from one person to another. It is not possible to "catch" eczema from someone else. Although the exact cause of eczema remains unknown, researchers have established that its development involves a complex interplay between genetic factors and environmental triggers.

Signs and Symptoms of Eczema

What are the symptoms of eczema?

Itching, scientifically referred to as "pruritus," is a hallmark symptom of eczema. The intensity of itchiness can vary from mild to moderate, and in severe cases, it may lead to excessive scratching and subsequent bleeding. This cycle, known as the "itch-scratch cycle," can exacerbate the condition and prolong the healing process.

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Other common symptoms of eczema include:​

  1. Dryness and sensitivity

  2. Inflammation and discoloration

  3. Rough, leathery, or scaly skin

  4. Oozing or crusting

  5. Swelling

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It's important to note that individuals may experience all or only some of these symptoms. Additionally, the severity and frequency of flare-ups can vary significantly from person to person. Some individuals may find relief from their symptoms, while others may experience persistent or recurring eczema. The appearance of eczema can also differ depending on skin tone. Lighter skin may present redness, while individuals with darker skin tones may notice ashen, grey, darker brown, or purple discoloration. 

What does eczema look like?

The appearance of an eczema rash can vary from person to person. It is important to note that eczema can look different for each individual diagnosed with the condition. For individuals with a dark skin tone, an eczema rash may appear as shades of purple, brown, or gray. Conversely, those with a light skin tone may observe a rash that is pink, red, or purple in color.

Where is eczema most commonly located?

When it comes to the areas where symptoms of eczema appear on the body, they can manifest anywhere on the skin. However, certain areas are more commonly affected. These include the hands, neck, elbows, ankles, knees, feet, face (especially the cheeks), in and around the ears, and the lips.

Diagnosing Eczema in St. Louis 

How is eczema diagnosed?

Our St. Louis dermatology team at Mid-County Dermatology excels in the accurate diagnosis of eczema. Their expertise is invaluable when it comes to identifying and confirming the presence of eczema. Here is the process employed by the dermatology team at Mid-County Dermatology for eczema cases.

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  1. Initial Consultation: The first step in diagnosing eczema at Mid-County Dermatology is scheduling an initial consultation. During this visit, patients can discuss their symptoms, medical history, and any concerns they may have. Providing comprehensive information ensures that our dermatology team has a clear understanding of the individual's specific situation.

  2. Physical Examination: Following the consultation, a thorough physical examination is conducted. The dermatologists at Mid-County Dermatology meticulously examine the affected areas of the skin. They assess the appearance, texture, and any accompanying symptoms such as dryness, redness, rashes, or itching. This examination plays a vital role in determining whether eczema is present and aids in differentiating it from other skin conditions with similar symptoms.

  3. Medical History Review: Alongside the physical examination, our dermatologists review the patient's medical history in detail. They look for any previous eczema flare-ups, allergies, or other relevant medical conditions. 

  4. Diagnostic Tests (if necessary): In some cases, we may perform additional diagnostic tests to confirm the diagnosis or rule out other potential skin conditions. These tests can include skin biopsies, patch testing, or allergy testing. The dermatologists carefully analyze the results to obtain a conclusive diagnosis.

  5. Expert Diagnosis and Treatment Plan: Based on the comprehensive evaluation, including the physical examination and medical history, the dermatologists at Mid-County Dermatology will conclude whether the patient has eczema or a different skin condition. They inform the patient of their findings, explaining the condition, its potential triggers, and any specific characteristics related to the individual case. 

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St. Louis Eczema Treatment Options

How is eczema treated?

Due to its chronic and recurring nature, we recommend a proactive approach to eczema that includes long-term maintenance therapy.

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Currently, our St. Louis dermatology team at Mid-County Dermatology recommends:

  1. Avoidance of trigger factors: This involves identifying and avoiding irritants, relevant allergens, and microbial agents that can exacerbate the condition.

  2. Skin care: The goal of skin care is to compensate for the impaired epidermal barrier function determined by genetics. Special attention is given to maintaining the skin's moisture and protective barrier through the use of appropriate products.

  3. Anti-inflammatory therapy: In addition to managing obvious flare-ups, it is crucial to control subclinical inflammation. Anti-inflammatory treatments play a significant role in achieving this.

  4. Adjunctive or complementary modalities: Depending on individual cases, additional treatments or approaches may be considered alongside the primary management strategies.

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The severity of the disease should dictate the approach to management. For mild cases, continuous use of emollients (moisturizers) and intermittent application of low-potency topical corticosteroids during flare-ups are typically sufficient. Moderate AD may require proactive maintenance with anti-inflammatory agents in order to effectively manage the condition. In more severe and stubborn cases, phototherapy (light therapy) and systemic drugs may be necessary to gain control over the disease.

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Furthermore, an essential component of AD management is the implementation of an appropriate educational program for patients and their parents or caregivers. This program helps increase understanding of the condition, its triggers, and the importance of adhering to the recommended management strategies.

Daily Skincare Routine for Eczema-Prone Skin

  • Emollients should be applied twice daily to the entire skin surface.​

    • Ointments (Vaseline) are more occlusive and cause less burning and stinging compared to creams and lotions. However, some patients find ointments greasy and unacceptable.

    • Allergy-provoking ingredients like perfumes, lanolin, and herbal extracts should be avoided in emollients.

    • Adding moisturizing factors that retain water (glycerol, urea) enhances epidermal hydration. 

    • Emollients containing specific combinations of lipids naturally found in the outermost layer of the skin (stratum corneum), such as cholesterol, fatty acids, and ceramides, can optimize barrier repair.

  • Eczema patients should use mild, non-alkaline cleansers (Dove, Cetaphil).

  • Bubble baths and scented salts or oils should be avoided.

  • Applying an emollient to the skin within 3 minutes of bathing, especially after a lukewarm bath or shower, helps skin hydration. Pat dry with a towel instead of rubbing dry.

  • For flare-ups, 10- to 20-minute soaks in lukewarm bathwater or tap water compresses, followed by a moisturizer application can help calm and soothe the skin.

  • Scalp care should involve using a gentle shampoo (Johnson & Johnson).

Understanding Eczema Medication Options

​If your eczema is not well-controlled with a gentle skin care program, one of our St. Louis dermatologists located at Missouri Baptist Medical Center may recommend one of the following topical, oral, or injectable medications. 

  • Topical JAK inhibitor:

    • Opzelura (ruxolitinib 1.5%) cream

  • Topical calcineurin inhibitors (TCIs):

    • Tacrolimus ointment (Protopic® and generic options)

    • Pimecrolimus cream (Elidel® and generic options)

  • Topical PDE4 inhibitors:

    • Crisaborole (Eucrisa®) ointment

  • Topical steroids:

    • Various types and concentrations of topical corticosteroids (Hydrocortisone, Triamcinolone, Clobetasol)

  • Prescription Injectables - Biologics:

    • Dupixent® (dupilumab)

    • Adbry (tralokinumab-ldrm)

  • Prescription Oral Immunosuppressants - JAK inhibitors:

    • Cibinqo (abrocitinib)

    • Rinvoq (upadacitinib)

  • Prescription Oral Immunosuppressants - Traditional systemic medications:

    • Azathioprine

    • Cyclosporine

    • Methotrexate

    • Mycophenolate mofetil

  • Prescription Oral Steroids:

    • Prednisone

    • Dexamethasone

  • Prescription Phototherapy:

    • Narrowband ultraviolet B (NB-UVB) light therapy and other recommended options

Is there a cure for eczema?

There is no known cure for eczema.

Minimizing Eczema Risk & Flare-Ups

While it may not be possible to completely prevent eczema, there are certain measures you can take to reduce the risk of developing the condition or minimize its severity. Here are a few strategies that may help:

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  • Moisturize regularly: Keeping your skin well-hydrated can help prevent dryness and reduce the likelihood of eczema flare-ups. Use a moisturizer that is gentle and free from irritating ingredients.

  • Avoid triggers: Identify and avoid triggers that may worsen your eczema symptoms. Common triggers include certain fabrics, harsh soaps or detergents, certain foods, stress, and environmental factors like pollen or pet dander.

  • Practice good skin care: Use mild, fragrance-free soaps and cleansers when bathing or washing your hands. Pat your skin dry gently and avoid excessive scrubbing. Avoid hot showers or baths as they can strip the skin's natural oils.

  • Choose appropriate clothing: Opt for loose-fitting, breathable clothing made from soft fabrics like cotton. Avoid materials that can irritate the skin, such as wool or synthetic fibers.

  • Manage stress: Stress can sometimes trigger or worsen eczema symptoms. Find healthy ways to manage stress, such as practicing relaxation techniques, engaging in regular exercise, reading, writing, or meditation.

Exploring the Long-Term Outlook for Eczema

What can I expect if I have eczema?

Eczema and other forms of dermatitis do not pose harm to the rest of your body. They are not life-threatening conditions. In fact, almost half of children with eczema either outgrow it or see improvement by the time they reach puberty. While some individuals may continue to experience some form of eczema throughout their lives, for adults, the condition can be effectively managed with a proper skincare routine.

How long does eczema last?

Most children with eczema will naturally "outgrow" the condition, and their symptoms will typically resolve by the time they reach adulthood. However, children who have already experienced persistent eczema, those who develop it later in life, or those with more severe cases may experience longer-lasting symptoms.

Eczema is a chronic skin condition that can greatly affect your quality of life. By learning about its causes, symptoms, and available treatment options, you can effectively manage eczema and reduce its impact on your daily life. It's important to consult with one of our St. Louis dermatologists at Mid-County Dermatology to receive an accurate diagnosis and a personalized treatment plan. With the right strategies, lifestyle adjustments, and ongoing support, you can regain control and live confidently with eczema.

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