Your skin is your body’s first line of defense against the elements, but it’s more than just a physical barrier. It is a site where the immune cells fight microbes and eliminate potentially harmful foreign substances. But sometimes, the immune reaction can become so strong that it damages the skin, and eczema is one of its manifestations.
There are different types of eczematous lesions. Some resolve quickly and never come back, while others last years and flare up in the presence of a trigger. So eczema recovery can vary from patient to patient.
This article discusses the various eczema forms, their treatments and what you can do to speed up your healing and keep the lesions from coming back.
Eczema: What’s in a Name?
Eczema is a Greek word that means “to boil over.” In medical parlance, it is a term for a group of non-contagious skin disorders that start as red, itchy, lumpy or blister-like lesions. They may linger in vulnerable patients but disappear over time in others. Doctors may also call eczema “dermatitis,” which means “skin inflammation,” highlighting the immune system’s role in its evolution.
Most non-medical people think of eczema to be no different from atopic dermatitis. But the National Eczema Association recognizes several forms of this skin condition, which differ based on their clinical features, i. e. trigger factors, patient characteristics, disease course, etc.
Eczema is not contagious, so you cannot pass it on to others by physical contact. But the lesions can become infected by transmissible microorganisms like herpes simplex virus and some fungi.
What Are the Different Stages of Eczema Rash Formation?
Speaking of disease course, the appearance of an eczema rash can clue you in on how long a patient has had it.
An acute eczema rash is only hours to a few days old. The skin usually appears red and lumpy or with multiple blister-like lesions. Most people experience intense itching during this stage. Scratching the area breaks the skin, releasing fluid that can crust later on. The skin break makes the lesion prone to infection.
If the rash persists after a week, the small lumps can merge into larger, raised and scaling lesions. The eczematous skin condition then enters the subacute phase. Scratch marks may also be evident.
A lesion that fails to resolve after several weeks has entered the chronic state. The affected skin thickens, darkens, toughens up and becomes rough.
Not every eczema patient will see all the above phases. Some heal after a week or two if the cause is quickly identified and controlled. However, chronic dermatitis can flare up when triggered, producing new lesions. Doctors call this kind of episode “an acute exacerbation of a chronic illness.” Many chronic eczema patients have rashes of various stages occurring simultaneously in different body areas.
Chronic eczema can also produce complications in other organs.
What Are the Different Types of Eczema, and How Can You Manage the Symptoms?
There are various ways to classify eczema, e. g. by their appearance, causative factors, etc. Here, we talk about the most common clinical forms.
Atopy is the hereditary tendency to develop allergies. Patients with atopic eczema usually have a personal or family history of asthma, food allergy, hay fever, allergic rhinitis and similar disorders. Kids born to parents who have had atopic dermatitis are more likely to get it than those who are not.
Individuals with this condition have genetically impaired skin barrier function and immunity. The skin is dry and breaks easily, so it is constantly vulnerable to the entry of allergens and irritants. Heightened immune responses contribute to the formation of the characteristic lesions.
Atopic dermatitis can manifest as early as infancy, and 80% of patients would have had eczema symptoms by the age of five. It can disappear in some kids, but most will experience flares until adulthood. Flare triggers include food and environmental allergens, changes in temperature and humidity, excessive sweating and skin infection.
The condition improves with age. Many children eventually outgrow atopic dermatitis, while adults with persistent symptoms usually have long periods of remission.
Baby eczema lesions are typically found on the face, neck and outer joint surfaces (extensor surfaces). Older children, adolescents and adults normally have them on inner joint surfaces (flexural surfaces).
What Options Do You Have for Atopic Eczema Treatment?
The mainstays of atopic dermatitis treatment are topical corticosteroids and emollients. Steroids curb abnormal immune and skin cell proliferation, suppressing inflammation and excessive tissue thickening. Emollients trap water in the skin, improve its barrier function and enhance steroid penetration.
Skin infection must be treated with the appropriate antimicrobial agent. Scalp dermatitis may improve by combining a low-potency topical steroid cream with a coal tar shampoo. Antihistamines relieve itchy skin and help control the urge to scratch.
People who do not respond to the above therapies may benefit from topical calcineurin inhibitors like tacrolimus and pimecrolimus, which modulate immune responses. Phototherapy is another option for these patients. Systemic immunosuppression, e. g. oral methotrexate or IV steroid treatment, is usually reserved for severe atopic dermatitis exacerbation.
How Long Does an Atopic Eczema Flare Last?
The duration of a flare episode depends on the time it takes you to get rid of the trigger factor, the severity of your symptoms and the treatment you use. For example, a seven-day antibiotic course can lead to healing in a week or two. Meanwhile, inappropriate or delayed treatment can worsen the symptoms and prolong the recovery period.
How Can You Fix Your Skin After an Atopic Dermatitis Flare?
Moisturizing the skin and refraining from scratching help you heal fast from an atopic eczema breakout.
Your doctor may teach you how to use wet wrap therapy and colloidal oatmeal to moisturize itchy, dry skin. Wet wrap therapy rehydrates the affected area, alleviates itchiness and enhances the effectiveness of topical steroids. Colloidal oatmeal has anti-inflammatory as well as moisturizing properties. It reduces the need for topical steroids, sparing patients from the risk of excessive skin thinning.
Additionally, you may be advised to use the ceramide-rich BHSkin Ultralight Moisturizer. Ceramides are lipids that trap moisture and boost the skin’s barrier function. They are good for patients with atopic dermatitis, as they typically have low skin ceramide content.
Suppressing the scratching urge also helps you heal faster because this skin condition produces “an itch that rashes.” Scratching introduces irritants into your skin and can cause new eczema symptoms. You may be advised to take sedating antihistamines or antidepressants at night, as skin itching can persist or worsen during sleep.
Meanwhile, avoiding triggers prolongs remissions. Emotional stress, dust mites, pollens, toxins, molds, infections and many others can precipitate a relapse. Some patients may not be able to identify their breakout triggers, but a patch test performed by a board-certified dermatologist can help.
What Are the Complications of Chronic Atopic Dermatitis?
Eyelid lesions can scar or deform the cornea, making chronic atopic dermatitis patients prone to eye problems. They are also more susceptible to skin infections. Severe bacterial or viral infection may exacerbate the condition and lead to widespread skin exfoliation (exfoliative dermatitis). Though rare, it is potentially life-threatening.
However, keep in mind that timely intervention can help you avoid these complications.
Contact dermatitis results from skin exposure to an irritant or allergen. People of any age can develop it, and not everyone has a history of atopy.
This condition has two forms.
A substance that directly injures the skin produces irritant contact dermatitis. Jewelry, fragrances, acids, alkalis and certain topical medicines are some agents that can cause this skin problem.
By comparison, allergic contact dermatitis stems from an allergic reaction to a foreign substance. Latex allergy is an example. Plants like poison ivy and poison oak are also common culprits because they secrete the allergen urushiol. Atopic adults are generally more likely to develop occupational hand eczema, a unique form of allergic dermatitis, from detergent use.
The rash of contact dermatitis evolves in the same way that other eczematous lesions do. Red, itchy lumps or blisters form initially, becoming scaly, thickened plaques later on if treated inadequately.
Its distribution usually follows the pattern of substance exposure. Irritant dermatitis inflames only the sites directly in contact with the trigger substance. But urushiol may stick to furniture or pet fur and induce allergic reactions even in areas untouched by the plant that released it.
What Can You Use for Contact Dermatitis Treatment?
The most important part of contact dermatitis management is removing the irritating substance. As in atopic eczema, patch testing helps identify unrecognized allergens.
Acute, weeping rashes may be treated with topical corticosteroid preparations, non-steroidal anti-itch medications and drying agents like aluminum sulfate.
Chronic, thickened ones may improve with the combination of emollients and topical corticosteroids. Topical calcineurin inhibitors may be used if topical steroids do not work.
People unresponsive to topical treatment or unable to avoid environmental triggers can benefit from phototherapy. Systemic steroids are reserved for resistant, severe eczema.
How Long Does It Take for Contact Dermatitis to Resolve?
Acute lesions normally clear up days after eliminating the irritant and starting the treatment regimen. Chronic blemishes take more time to heal and may require combined light-based and drug therapies. Infection, atopy and repeat exposures to triggers may prolong recovery.
How Can You Heal Your Skin After Contact Dermatitis?
Avoiding exposure to known allergens and irritants allows you to recover quickly and prevent recurrences. Emollients keep the skin supple and reduce itching and scratching.
The main distinguishing feature of this type of eczema is the greasy, scaly appearance of the rash. The body parts typically involved are the scalp, face, outer ears, trunk, armpits, groin, and skin folds, all of which are rich in oil glands (sebaceous glands).
Seborrheic dermatitis may present in newborns as oily, scaly lesions of the scalp (cradle cap), face and diaper area. It is easy to treat in infants and becomes rare in older children. Susceptible patients may see a recurrence when they mature. Adult seborrheic eczema can become more widespread, treatment-resistant and marked by relapses.
The cause of seborrheic dermatitis is unclear, though it is thought to stem from increased oil gland activity or abnormal sebum production. Breakouts may be precipitated by the following:
- Fungal or bacterial infection
- Immune deficiency
- Certain drugs, e. g. gold, methyldopa, cimetidine, etc.
- Neurologic disorders
- Changes in temperature and humidity
- Abnormal skin cell growth (similar to psoriasis)
- Nutritional deficiencies
- Food allergy
Many patients do not have an atopic history, though some genetic changes are linked to the development of seborrheic eczema. The condition is more common among individuals with HIV, Parkinson’s disease and stroke. It evolves into psoriasis in vulnerable people.
What Is Effective for Seborrheic Dermatitis Treatment?
Topical corticosteroids and antifungals are applied to the affected sites. Antibiotics and anti-parasitic drugs may be prescribed if needed.
Crusting on a child’s scalp, which may appear like severe dandruff, may be removed using mild baby shampoo, salicylic acid and emollients. Adults can use selenium sulfide and coal tar on top of these treatments. Eyelid scales may be taken out by applying a hot compress followed by cleansing with a mild shampoo. Drying agents like clioquinol may be used on greasy sites.
Treatments for resistant cases include the following:
- Topical calcineurin inhibitors
- Vitamin-D-like drugs
- Topical lithium, which acts as an antifungal
- Topical metronidazole, which may treat concomitant rosacea
Your dermatologist may also use isotretinoin off-label, or without FDA approval, if the affected area is hard to treat.
How Long Does It Take for Seborrheic Dermatitis to Go Away?
Among infants, the condition may last weeks to months, becoming rare after the 12th month of age. Adolescents and adults may experience a chronic course and relapse from time to time. Flare episodes may last for several weeks.
What Can You Do to Quickly Get Rid of Seborrheic Dermatitis?
Aside from the above treatments, your healthcare provider may advise you to avoid alcohol-containing skincare products, hair tonics, soaps and other substances that can irritate the skin. Greasy ointments may likewise worsen the condition and must not be used.
Stasis dermatitis most commonly affects adult patients with severe varicose veins and usually occurs in the lower limbs. Gravity pulls blood from the swollen blood vessels, causing red blood cells to leak into the skin. The pigment hemosiderin can accumulate from an excess of damaged red blood cells, resulting in severe discoloration. The initial rash is itchy, red, and scaly, later turning into thick, dark plaques if left untreated.
What Are the Complications of Stasis Dermatitis?
Without intervention, the skin can ulcerate and become prone to infection. In older patients, infection of a stasis ulcer is potentially life-threatening.
Contact dermatitis can aggravate a stasis rash. Additionally, vein stasis releases pro-inflammatory chemicals in the blood, which may spread and irritate the skin covering distant body parts. This condition is known as “auto-sensitization dermatitis.”
How Do You Treat Stasis Dermatitis?
The treatment of stasis dermatitis depends on symptom severity, focusing on alleviating vein swelling.
If diagnosed early, you may treat the condition conservatively by using compression stockings and sleeping with your legs elevated. If they don’t work, your dermatologist can remove the dilated veins using skin surgical techniques like sclerotherapy and Vbeam laser.
Emollients and topical corticosteroids can eliminate acute rashes within days once the vein stasis is relieved. Chronic lesions do not respond as readily and may need a more complex regimen to resolve completely.
Infected stasis ulcers require surgical removal of the infected tissue, vein surgery and multi-specialty care. Healing usually takes a few weeks, though a patient’s age and physical status can impact the duration of the recovery period.
What Can Help Stasis Dermatitis Heal Fast?
Relieving vein stasis is your best move to get rid of the lesions quickly. But your doctor may also advise you to avoid trauma to the area, allergen and irritant exposure and scratching.
Dyshidrotic eczema is an adult dermatitis usually limited to the hands and feet. The skin rash may form on the palms, soles or sides of the fingers and toes. Patients frequently have an atopic history and are prone to allergic hand dermatitis.
Patch testing can help identify allergens. The treatment and recovery process are similar to contact and atopic eczema.
Nummular eczema is another skin disorder that mainly affects adults and is more common among men. The typical rash starts as an outbreak of small, crusting bumps and blisters. If left untreated, they form scaly coin-like plaques, hence the condition’s name (“nummular” means “resembling a coin”). Frequently affected body areas include the trunk and extensor surfaces.
Skin itching varies in intensity from patient to patient. The skin surrounding the blemishes is uninflamed but dry.
Most people with this condition do not have an atopic history. The cause of nummular dermatitis is unclear, although it may be linked to the following:
- Greater moisture loss in aging skin
- Infection inside the body, e. g. the mouth and breathing passages
- Environmental allergens
- Isotretinoin or gold therapy
- Some hepatitis C medications
- The use of mercury amalgam
Nummular eczema treatment is similar to that of atopic and contact dermatitis. The condition is chronically relapsing, but exacerbations respond well to therapy.
Lichen Simplex Chronicus
Lichen simplex chronicus is an end-stage dermatitis, developing after years of skin inflammation. It is an adult skin condition manifesting as thick, dark plaques with well-defined borders. It usually affects the scalp, nape, extensor surfaces and groin area.
Some lichen simplex chronicus cases arise from other forms of chronic skin disease like atopic eczema. But others result from a combination of immune dysfunction and heightened nerve sensitivity. Together, these defects can set off a vicious itch-scratch cycle that repeatedly injures the skin. That is why it is also referred to as “neurodermatitis circumscripta” or simply “neurodermatitis.”
Patients do not always have atopy, but the itch-scratch cycle is usually precipitated by heat, sweat, irritation and emotional distress.
Lichen simplex chronicus improves with therapy, though it is a lifelong condition. Treatment focuses on breaking the itch-scratch cycle and includes the following:
- Topical steroid cream under occlusive dressing
- Steroid solutions injected into thick plaques
- Non-steroidal topical medication for itching, e. g. menthol
- Emollients for thick, dry skin areas
- Sedating antihistamines
- Sedating and non-sedating antidepressants
- Antimicrobials if necessary
Asteatotic eczema affects adults, especially the elderly. It is also called “xerotic eczema,” appearing in body parts with extremely dry skin, most commonly the shins. The rashes are red and are more scaly than blister-like. Asteatotic eczema is also known as “winter itch,” as it usually occurs during the winter season.
The condition is thought to arise from the changing composition of aging skin, increasing its vulnerability to irritants. Chronic nerve damage contributes to the itchy feeling by reducing the skin’s sensory threshold.
Standard treatment consists of moisturizers and topical steroids. Patients are advised to avoid irritant exposure and overbathing. Asteatotic dermatitis responds excellently to therapy but can recur during the winter months.
Many factors determine eczema recovery time. But early identification and treatment are the only sure ways to shorten its course, irrespective of the type. Seeing an eczema specialist helps you do both.
Why Should You See a Dermatologist for Eczema?
Eczema is a skin disorder that falls within the realm of medical dermatology. Board-certified dermatologists are experts in this field. Consulting with a bona fide skin care specialist for this condition assures the following advantages:
When we say this, we are not just talking about patch testing. Many skin lesions can look like eczema, including possibly life-threatening ones like basal cell skin cancer. Trusting your skin care needs to a board-certified dermatologist helps avoid such a risk.
Timely and Appropriate Treatment
Different eczema types have different patterns of progression. The wrong treatment may prolong recovery or worsen the illness. Dermatologists have specialized knowledge of this skin condition, helping them treat it efficiently and prevent complications.
The Benefits of Quick Restoration of Healthy Skin
With a speedy recovery, you can expect to get your skin’s radiance back just as fast. For most people, having healthy skin is important because of its protective function and positive effect on mental health and quality of life. Taking care of your skin is part of a healthy lifestyle.
The Many Roads to Eczema Recovery and Remission
Eczema is a nonspecific term for a number of skin issues with different underlying causes and clinical features.
Recovery depends on many factors, but timely disease recognition and appropriate management are the most important. The mainstays of treatment are emollients and topical corticosteroids, though resistant cases may need more sophisticated dermatologic therapies. Identification and avoidance of trigger factors speed up the healing process and prevent recurrences.
If you think you have an eczematous lesion, your best course of action is to see a board-certified dermatologist. Only a true skin care expert can help restore your skin’s health in the shortest time possible.
Get Clearer Skin with the Help of LA’s Best Dermatologists
Sensitive skin is prone to eczema, an itchy condition with various forms. Your usual eczema cream may work on some but not on others. You must seek help right away if you think you have this problem. Inadequately treated lesions can become increasingly difficult to remove over time.
At BHSkin Dermatology, our medical dermatology specialists have a variety of ways to clear up eczematous rashes effectively. Visit us soon at our Glendale or Encino office for a face-to-face consultation, or use our telederm portal for a remote checkup.
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