Causes, signs and access to care

Eczema can be itchy and dry out the skin. It is a common skin condition, affecting around 30% of the American population.

Some people may be disproportionately affected by eczema. For example, eczema may be more severe or persistent in Hispanics.

Below we will discuss more about eczema and how it affects Hispanics. Keep reading to learn more.

Eczema is a group of seven skin conditions in which areas of the skin become itchy, dry and inflamed. Atomic dermatitis is the most common type of eczema.

People with eczema may develop scaly patches on the skin, a blister-like rash, oozing, or swelling. Scratching or rubbing the affected area can make it worse.

Most of the time, a person develops eczema as a young child, usually around the age of 5. However, people can also develop eczema at a later age.

It is still unclear what exactly causes eczema. Various genetic, environmental and immune factors likely play a role.

What is known is that people with eczema have changes in the skin barrier that reduce the amount of moisture that can be retained, resulting in very dry skin. This makes the skin more likely to react to various triggers, such as:

  • dry air
  • cold temperatures
  • hormonal changes, such as during the menstrual cycle and pregnancy
  • stress
  • food allergies, such as peanut, egg, or seafood allergies
  • exposure to known allergens, such as pollen, mold, pet dander, dust mites, chemicals, and fragrances
  • certain types of skin care products
  • scented soaps or detergents
  • clothing materials like wool or synthetic fabrics

Eczema is characterized by dry, itchy patches of skin. When scraped or rubbed, the affected area will appear scaly, inflamed, and warm to the touch.

Although eczema can affect any part of the body, certain areas are more common, such as:

  • hands or feet
  • inside of the elbows
  • back of the knees
  • wrists or ankles
  • eyelids
  • folds between the buttocks and legs
  • cheeks or scalp (in infants)

Skin inflammation can also appear differently depending on skin tone. For example, in lighter skin tones, eczema may appear pink or red. In darker skin tones, it may look like:

  • ash gray
  • purple
  • dark brown
  • lighter and drier areas

It is also possible for people with eczema to have flare-ups. This is a period during which the symptoms of eczema worsen. In some people, flare-ups can occur up to two or three times a month.

Eczema symptoms can have a significant impact on a person’s quality of life. For example, itching can interfere with your daily activities or sleep. People with eczema may also have other conditions, such as asthma and allergies.

Additionally, scratching or picking at inflamed areas can lead to complications such as:

A dermatologist usually diagnoses eczema. This type of doctor specializes in diagnosing and treating health conditions that affect the skin.

Your dermatologist will start by examining your skin and getting your medical history. During this time, they will ask you questions such as:

  • when your symptoms started and how often they occur
  • where on your body the symptoms are occurring (particularly if you have fair skin when you visit)
  • how the rash feels, as if it itches or hurts
  • whether certain things make your symptoms better or worse
  • if you have a family history of conditions such as eczema, allergies or asthma
  • any other underlying health conditions you may have
  • what types of medications or supplements you take

Many times your dermatologist can diagnose eczema using your medical history and doing a skin exam. In some cases, they will want to take a skin biopsy as part of the diagnostic process.

To take the biopsy, your dermatologist will numb an area of ​​skin using localized anesthesia to reduce discomfort and pain. They will then use a small pointed tool to take a small sample of skin which will then be examined under a microscope. The skin biopsy is often sent to someone who specializes in skin pathology called a dermatopathologist.

There is currently no cure for eczema, but it can be managed. Several eczema treatment options can help reduce symptoms and improve quality of life. Treatment recommendations are similar across racial and ethnic groups.

Generally, eczema treatment options can be broken down into lifestyle changes and medications.

Lifestyle changes

There are many things you can do at home to help prevent or relieve eczema symptoms:

  • Frequently apply a fragrance-free moisturizer to your skin, especially after bathing. Ointments or creams may be more effective if you have atopic dermatitis.
  • Reduce bath time to 5-10 minutes. Use only a mild, unscented cleanser no more than once a day.
  • Gently pat the skin dry; do not rub the skin.
  • Avoid known triggers of your eczema as much as possible, such as certain foods, soaps, or fabrics.
  • Avoid tight-fitting clothes which can irritate the skin.
  • Do not scratch or scrape the inflamed areas of skin as this may lead to pigmentation changes, thickening of the skin or infection.
  • Use an over-the-counter corticosteroid cream, such as hydrocortisone, to reduce itching and swelling.
  • Try taking over-the-counter antihistamines, which can help relieve itching.
  • Take a bleach bath under the direction of your dermatologist.
  • Avoid herbal products, as they can irritate an eczema flare-up.

Medications

If over-the-counter products aren’t effective in relieving your eczema symptoms, your dermatologist may prescribe a topical anti-inflammatory medication. Here are some examples :

  • a prescription corticosteroid cream
  • a calcineurin inhibitor, such as pimecrolimus cream (Elidel) or tacrolimus ointment (Protopic)
  • crisaborole ointment (Eucrisa)

In some cases, your dermatologist may prescribe oral corticosteroids. Due to their potential side effects, oral corticosteroids are usually only taken for a short time. An example of when they can be used is during a severe eczema flare-up.

Some people with eczema may need a systemic medication that suppresses the immune system, such as:

  • JAK inhibitors, such as abrocitinib (Cibinqo)
  • ciclosporin
  • methotrexate
  • mycophenolate (Cellcept)
  • azathioprine
  • Organic Products

Skin infections can be common in people with eczema, usually from scratching or scratching the affected area. If you develop a skin infection, your dermatologist may prescribe antibiotics to treat it.

Although not a drug, phototherapy can also be used for eczema. In phototherapy, your skin is exposed to a controlled amount of ultraviolet (UV) light two to three times a week. Phototherapy can help reduce itching and inflammation.

Two big risk factors for eczema are family history of eczema and environmental exposures.

Atopic dermatitis, the most common type of eczema, is associated with an overactive immune system. It is often accompanied by asthma and allergies.

Eczema often develops in people who have a personal history of other atopic conditions. Additionally, if you have a close relative, such as a parent or sibling, with an atopic condition, you may also be at increased risk.

Environmental exposures may also play a role in eczema risk. For example, if you are already predisposed to eczema, frequent contact with one or more eczema triggers could cause the condition to develop.

Other environmental exposures that may trigger eczema include:

  • tobacco smoke
  • Pollution
  • fragrance in many skin care products and laundry detergents
  • woolen clothes

Although more studies are needed, some research has shown that factors influencing eczema risk may vary depending on race or ethnicity. A study 2016 found this:

  • eczema was less common in Hispanic children than in white children
  • the impact of parental history of atopy or eczema was bigger in Hispanic children than in white children
  • certain environmental exposures affected these two groups differently, suggesting differences in the mechanism behind the development of eczema. Specifically, exposure to mold or mildew increased the risk of eczema in:
    • white children with a parental history of atopic conditions
    • Hispanic children without a parental history of atopic conditions

Eczema may improve over time in some children. However, it is also possible for the disease to persist into adolescence and adulthood.

Studies describing the effectiveness of eczema treatments in various racial and ethnic groups are also still limited. A balance sheet 2012 of 645 eczema clinical trials found that only 59.5% of trials included information on race or ethnicity.

When this information was included, Hispanics made up only 2% of the participating population for the trials reviewed.

Moreover, few trials (10.3%) commented on race or ethnicity while discussing and interpreting their results.

Although there is currently no cure for eczema, seeking treatment can go a long way in reducing symptoms and improving quality of life. This is why it is very important to consult a dermatologist if you suspect that you have eczema.

Although eczema is less common in Hispanics, it can also be more severe or persistent in this group.

Additionally, some research has shown that Hispanic children are more likely to seek care or miss school due to eczema.

Treatment for eczema is the same for all racial and ethnic groups. This usually involves lifestyle changes and medication.

Because treatment can improve symptoms and quality of life, be sure to speak to a dermatologist if you think you have eczema.