From the Guidelines
Atopic dermatitis (eczema) is characterized by a chronic, pruritic inflammatory skin disease with a relapsing course, often associated with a personal or family history of allergic rhinitis and asthma, and typically presents as red, inflamed patches of skin that are intensely itchy. These patches may be dry, scaly, and rough, or in some cases weepy and oozing, with poorly defined borders, and may develop small, fluid-filled blisters that can burst and crust over 1. Common locations include the face, neck, inside of elbows, behind the knees, and on hands and feet, though it can occur anywhere on the body. The underlying cause involves a combination of genetic factors affecting skin barrier function and immune system dysregulation, allowing moisture to escape and irritants to enter more easily, leading to inflammation and the characteristic symptoms of eczema 1.
Some key factors to consider when evaluating eczema include:
- Aggravating factors such as exposure to irritants
- Sleep disturbance
- Coexisting atopic disease
- Family history of atopic disease
- Previous treatments 1
- The appearance may vary between individuals and can change over time, with periods of flare-ups alternating with periods of relatively clear skin. In chronic cases, the skin may become thickened, leathery, and darker in color due to repeated scratching and inflammation. Eczema flares can be triggered by various factors including allergens, irritants, stress, temperature changes, and certain fabrics. A full skin examination should be carried out to record the extent and severity of eczema, look for evidence of clinical infection, and check for other potential causes of dermatitis 1.
From the FDA Drug Label
Of the key signs of atopic dermatitis, erythema, infiltration/papulation, lichenification, and excoriations The description of an atopic dermatitis (eczema) rash includes key signs such as:
- Erythema (redness)
- Infiltration/papulation (raised patches)
- Lichenification (thickening of the skin)
- Excoriations (scratches or abrasions) 2
From the Research
Description of Atopic Dermatitis (Eczema) Rash
- Atopic dermatitis is a chronic inflammatory skin disease characterized by intensely pruritic skin lesions 3
- The rash is described as having multiple-pinpoint conditions, polymorphism, and itch, with features including erythema, papule, seropapule, vesicle, pustule, scale, and crust 4
- In acute eczema, spongiosis is associated with overproduction of hyaluronic acid, secretion of self-protective galectin-7, and decreased expression of E-cadherin 4
- Chronic eczema is represented by lichenification and hyperpigmentation, and possibly by hypopigmentation 4
- The American Academy of Dermatology has created simple diagnostic criteria based on symptoms and physical examination findings, which can help identify the rash 3
Characteristics of the Rash
- The rash can appear as numerous tiny foci from which individual papules/vesicles arise 4
- It can be accompanied by symptoms such as itching, burning, and skin irritation 5
- The rash can vary in severity, with mild cases presenting with mild erythema and moderate to severe cases presenting with more intense inflammation and skin damage 5
Treatment and Management
- Topical corticosteroids are the first-line treatment for atopic dermatitis flare-ups, but can be associated with significant adverse effects when used chronically 6, 3
- Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, can be used as an alternative treatment for moderate to severe atopic dermatitis 6, 5
- Ultraviolet phototherapy is a safe and effective treatment for moderate to severe atopic dermatitis when first-line treatments are not adequate 7, 3