Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition characterized by intense itching and skin lesions, requiring a comprehensive and personalized approach to management.

Eczema, also known as atopic dermatitis (AD), is a chronic inflammatory skin condition that can significantly impact a person's quality of life [1, 4]. It is characterized by intense itching, skin pain, and visible lesions, which can lead to sleep disturbance and psychological distress [1, 4]. While atopic dermatitis is a common form, eczema encompasses various types, including irritant and allergic contact dermatitis, hand dermatitis, asteatotic dermatitis, and nummular or discoid dermatitis [2]. Hand eczema, in particular, is highly prevalent and often challenging to treat, affecting an estimated 14.5% of the general population and leading to missed work or school days and reduced productivity [3, 5, 6].

Diagnosing Eczema and Assessing Severity

Accurate diagnosis of eczema involves a thorough clinical history and physical examination by a healthcare professional [2]. For certain types, such as contact dermatitis or chronic hand and foot eczema, patch testing is considered a standard investigation to identify potential irritants or allergens that may be triggering or worsening the condition [2, 3]. It is also important to differentiate eczema from other skin conditions, including scabies, psoriasis, fungal infections, bullous pemphigoid, and mycosis fungoides [7, 8].

Assessing the severity and impact of eczema is crucial for guiding treatment decisions. Tools like the SCORing Atopic Dermatitis Index (SCORAD) quantify disease severity and itch, while the Dermatology Life Quality Index (DLQI) assesses the condition's impact on a person's quality of life [4]. A DLQI score of 10 or higher often indicates moderately symptomatic disease, suggesting a need for more potent treatments [3]. The Atopic Dermatitis Control Tool helps evaluate long-term disease control [4].

Foundational Treatments for Eczema

The management of eczema typically begins with skin-directed approaches, focusing on reducing inflammation and restoring the skin barrier [1, 2].

Moisturizers (Emollients): Regular and consistent use of moisturizers is a cornerstone of eczema management, helping to hydrate the skin and maintain its barrier function [2, 7].
Topical Corticosteroids: These anti-inflammatory creams or ointments are often the first-line treatment for active eczema flares. Potent or super-potent topical corticosteroids may be prescribed for moderately symptomatic patients [2, 3]. However, their use, especially in vulnerable populations like the elderly, requires careful consideration due to potential side effects such as skin atrophy, diabetes, and hypertension [7].
Topical Calcineurin Inhibitors: These non-steroidal medications help reduce inflammation and can be used in areas where corticosteroids might be less suitable, such as the face [2].
Crisaborole: Another non-steroidal topical option that works to reduce inflammation [2].

Beyond topical medications, phototherapy, which involves controlled exposure to ultraviolet light, can be an effective treatment option for some individuals [2, 7].

Advanced Therapies for Moderate to Severe Eczema

When eczema cannot be adequately controlled with topical preparations and/or phototherapy, especially in cases of moderate to severe disease, systemic therapy may be required [1, 2, 3]. Early consultation with dermatology specialists is recommended to explore these options [1].

Recent advancements have introduced several new therapeutic options:

Biologics: These injectable medications target specific parts of the immune system involved in the inflammatory process of atopic dermatitis [2, 6].
Janus Kinase (JAK) Inhibitors: Available in both topical and oral forms, JAK inhibitors work by blocking specific pathways within cells that contribute to inflammation [4, 5, 6].
PDE4 Inhibitors: These medications, available topically or orally, help reduce inflammation by inhibiting phosphodiesterase-4 [4].

Other systemic treatments, such as low-dose methotrexate, may also be considered, particularly for elderly patients [7]. When initiating new treatments, healthcare providers often consider them as additive or overlapping to existing therapies to achieve optimal control [3]. The primary goal of treatment is to restore function and improve quality of life, with clearing the skin being a secondary, though important, outcome [3].

Special Considerations in Eczema Management

Eczema in Pregnancy: Eczema is common during pregnancy, and effective treatment is crucial, especially for moderate to severe cases. Systemic therapy may be necessary and should involve early input from dermatology specialists [1].
Chronic Hand and Foot Eczema: This form is particularly challenging and can severely impact daily activities and work [3, 5]. A detailed history regarding potential exposure to irritants and allergens is vital, and patch testing is a standard investigation [3]. New therapeutic targets are emerging, offering hope for better management [5, 6].
Eczema in Elderly People: Eczema is a frequent reason for consultation in older adults [7]. Diagnosis requires careful differentiation from other conditions. While emollients and topical corticosteroids are helpful, local corticosteroids must be used cautiously due to the potential for adverse effects like skin atrophy, diabetes, and hypertension in this vulnerable population. Phototherapy and low-dose methotrexate can be beneficial options [7].

A Holistic Approach to Living with Eczema

Effective management of eczema extends beyond pharmacological treatments and requires a comprehensive approach [3]. This includes identifying and actively avoiding causative factors, such as specific irritants or allergens, once identified through patch testing or careful history [3]. Behavioral changes, such as modifying daily routines to minimize triggers, and access to social support are also integral components of long-term management [3]. Open communication with your healthcare team is essential to develop a personalized treatment plan that addresses your specific needs and helps you achieve better disease control and an improved quality of life.

Sources

The management of severe eczema in pregnancy. https://pubmed.ncbi.nlm.nih.gov/39733910/
Diagnosis and Management of Dermatitis, Including Atopic, Contact, and Hand Eczemas. https://pubmed.ncbi.nlm.nih.gov/34059241/
Management of chronic hand and foot eczema. An Australia/New Zealand Clinical narrative. https://pubmed.ncbi.nlm.nih.gov/32776537/
Expert opinion on management of moderate-to-severe atopic dermatitis in Qatar. https://pubmed.ncbi.nlm.nih.gov/37700510/
A Review of Existing and New Treatments for the Management of Hand Eczema. https://pubmed.ncbi.nlm.nih.gov/37496489/
Hand eczema: treatment. https://pubmed.ncbi.nlm.nih.gov/31860736/
Eczema in elderly people. https://pubmed.ncbi.nlm.nih.gov/33258454/
Hand eczema. https://pubmed.ncbi.nlm.nih.gov/9782961/

This article summarises published research for a general audience. It is not medical advice — talk to a qualified clinician about your own situation. Need help finding one? Browse doctors.