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WHAT IS IT?
Your skin is your body’s largest organ, and one of its most hardworking. It protects you from the sun, stores water and fat, helps control your body’s temperature, and fends off assaults from invaders such as dirt, insects, smoky air, and germs.

Despite the heroic job your skin does, you probably don’t give it much thought until something goes wrong-for instance, eczema, a skin disease marked by red, crusty, itchy patches or rashes, and sometimes blistering, oozing sores. These symptoms most often stem from an allergy or other reaction to something you touch, eat, or breathe in.Eczema comes in many forms. The most common type is atopic eczema, also called atopic dermatitis. It often runs in families that have a history of allergies or asthma. You can get atopic eczema at any age, but it hits most people during infancy or childhood. It can then go away, only to flare up during the teen years and early adulthood. About 1 in 10 babies and 3 in 100 adults in the United States have atopic eczema, and most people have it for life.

Other types include seborrheic, nummular, and stasis eczema, and dyshidrosis (small blisters, typically on the hands and feet).

Most of the time eczema isn’t serious, but it can be painful, itchy, and get in the way of your daily routine. Fortunately, you and your doctor can do a lot to manage the symptoms and prevent future attacks.
WHAT IS HAPPENING?
Your skin has two main layers. The epidermis, the top layer you can see, is a thin but tough covering that protects the softer layers below. It sheds old cells that are replaced by fresh ones as the skin renews itself to remain strong. The dermis, just beneath the epidermis, contains blood vessels, hair follicles, nerve endings, and oil and sweat glands.

You have an allergy when your immune system reacts too strongly to things that don’t harm most people. To fight what it mistakes as a threat, the system sends out histamine and other substances that bring on symptoms. In some people, the allergic reactions might be hay fever. In others, it might be asthma or stomach upset. And some people have eczema. Their symptoms come on when histamine released by skin cells swells tiny blood vessels in the dermis, causing an itch and rash or blisters.
WHAT CAUSES IT?
Eczema is something of a mystery. Even the experts don’t know exactly why some people have it and others don’t. But doctors do know eczema is a reaction to something that triggers the symptoms, that a tendency to have eczema can be inherited, and that it’s not contagious. Triggers that bring on eczema can vary from person to person.

Common allergies
Triggers for allergic eczema include foods such as cow’s milk, soy products, eggs, fish, wheat, and peanuts; pollen; chemicals and fumes; lotions with scents, oils, or preservatives; certain soaps; dust; animal dander; and wool and other rough fabrics.

Your eczema is most likely caused by an allergy if:

People in your family tend to have allergies such as asthma or hay fever.
Your eczema first showed up when you were young.
You have attacks only at certain times of the year-say, in the spring.
Your eczema acts up during certain activities such as changing the bed, vacuuming, or sweeping.
Other triggers
Some people’s skin also reacts to chemical agents, dryness, heat or cold, wind, and infections. Other possible triggers include:

Exercise. Sweating and higher body temperature can bring on attacks in some people.
Emotional highs and lows. Stress can bring on attacks.
WHAT YOU CAN DO FOR YOURSELF
A tendency to eczema can’t be cured, but you can take steps to reduce attacks and to treat them when they do occur.

During an attack
Over-the-counter hydrocortisone creams can help clear up outbreaks. These creams may be too harsh for babies; use them only for children over one and adults.
Over-the-counter oral antihistamines may ease itching and help you sleep. Most can cause drowsiness, so take them before you go to bed.
Don’t scratch. If you break the skin, bacteria can enter and cause an infection.
Keep fingernails short. Wear lightweight mittens or gloves at night to prevent scratching during sleep. This is an especially good idea for children.
Avoid the triggers
You can prevent outbreaks of eczema by avoiding things you know to be triggers.

Use gentle, fragrance- and deodorant-free soaps.
Wear cotton-lined rubber gloves when you do the dishes or other tasks that put your hands in water for some time.
Take warm (not hot) showers. Water that’s too hot tends to dry out your skin and make you itch more.
Take cool baths and lounge in the water for up to 30 minutes. Dry skin likes to soak.
Pat yourself dry (don’t rub) with a clean towel after bathing.
Keep your skin supple by using a fragrance- and preservative-free moisturizer after bathing. Put it on right after you towel off so that you trap moisture next to your skin. Cover your entire body. You may need to try several brands until you find the one that’s best for you.
Avoid aftershaves, perfumes, deodorants, and other scented products.
Try using a humidifier in your house. This helps keep the air from getting too dry, above all during the winter. Dry air prompts eczema outbreaks in some people.
Don’t wear scratchy or coarse fabrics such as wool, linen, and polyester.
If you wear makeup, keep an eye on how your skin reacts. If you’re prone to atopic eczema, your skin may react to something in the makeup.
Don’t eat foods that seem to make your eczema flare up.
The right clothes
Wear loose-fitting clothes that reduce sweating and don’t rub your skin.
When you can, wear clothes made of natural fibers, chiefly untreated cotton. They bother skin less and also keep you cool so you sweat less.
Wash clothes with mild, fragrance-free laundry soap. Rinse twice. Don’t use fabric softener.
Reduce stress
Your natural response to stress-any problem or demanding event-causes changes in your body. In some people, it can trigger eczema.

Here are some tips for reducing stress:

Relax through yoga, deep breathing, stretching exercises, or meditation.
Get some exercise. Studies show that people who exercise often feel less anxious and more relaxed.
Laugh more. Use humor to ease tense moments. Studies show that laughter releases stress-busting hormones.
Don’t try to be perfect. Set goals you can meet. Ask yourself if every single thing you do has to be the best.
When you’re angry, ask yourself three questions: Is this problem important? Is my anger justified? Can I do anything to fix the problem? If the answer to any of them is “no,” take a few deep breaths and tell yourself to calm down. If the answer to any of them is “yes,” don’t seethe silently; do something to change the situation.
Take breaks during a hectic day to calm down. It doesn’t matter what you do as long as it’s a time-out. Aim for at least 20 minutes a couple of times a day.
Keep a pet if it doesn’t make your eczema worse. They may shed and slobber, but studies show their owners have fewer health problems.
WHAT YOUR DOCTOR CAN DO FOR YOU
Doctors don’t always know why some treatments for eczema work and others don’t. Still, working with your doctor to find out what’s best for you is the key to getting over an outbreak. Your doctor may advise prescription lotions or pills if over-the-counter products don’t help.

Hydrocortisone lotions or ointments
These drugs work to relieve the redness, swelling, and itching of many skin problems, including eczema.

Pro
Prescription forms are much stronger than over-the-counter forms.
Con
Side effects may include a stinging or burning feeling where lotion is applied.
Coal tar creams
You apply these creams or ointments made from coal tar to the rash area at night before bed. In the morning, you wash off the cream and, depending on your doctor’s advice, may expose your skin to natural or artificial sunlight.

Pro
Can make patches go away for a long time.
Con
Coal tar creams and ointments are smelly and can stain clothes.
Oral hydrocortisone
This form, which you take in pills or capsules, is used for more severe cases that need stronger doses than those provided by creams, lotions, or ointments.

Pro
These are strong drugs that can work well to provide relief for inflamed skin.
Con
Side effects may include change in skin color, indigestion, nervousness, trouble sleeping, and stunted growth in children and weakened bones in adults.
Antihistamines
These drugs, most often taken as pills or capsules, help relieve allergy symptoms common to eczema, such as itching and swelling. They work by blocking the effects of histamine.

Pro
Work well to relieve itching.
Con
Side effects may include drowsiness, thick mucus, dizziness, feeling faint, and faster heartbeat.
Ultraviolet light therapy
Long-lasting eczema that doesn’t respond well to drugs may improve with ultraviolet A (UVA) treatment. An expert trains rays on the affected areas. Depending on how severe your eczema is, you may need to be treated a few times a week or only once a month.

Pro
Can help severe cases not helped by other treatments.
May help if you can’t avoid the cause of your dermatitis.
Con
Can cause itching and may raise the risk of skin cancer.