Test Your Knowledge

In most cases, eczema begins as intense itchiness, followed by a patchy skin rash that is red, inflamed, dry and scaly. The rash most often appears on the face, arms, and legs, and particularly affects the creases of the hands and feet. The rash often itches or burns and may ooze or become crusty when scratched.

Rashes in children under age 2 tend to begin on the cheeks, elbows and knees because these areas are easy to scratch and rub. Eczema rarely occurs in the area covered by a diaper. In older children and adults, rashes are more likely to begin on the inside surfaces of knees and elbows. These age groups are also more likely than younger children to have patches that appear brownish, scaly and thickened. Some people with eczema develop red or clear, fluid-filled bumps that look bubbly. Painful cracking also may occur. Scarring may develop due to patients scratching the intensely itchy rash.

In some cases, eczema may cause other associated skin conditions. These may include:

• Infection. Eczema is often so itchy that children will scratch themselves until they break the skin and bleed. Open sores and cracks associated with eczema frequently are the source of secondary infections of the skin. For instance, a form of infection called impetigo may be caused by Staphylococci bacteria. It is often associated with atopic dermatitis.
  
  
• Cellulitis. Bacterial infection of tissues beneath the skin. Cellulitis manifests as red streaks of skin that are swollen, tender and warm to the touch. It often spreads and has indistinct margins. Cellulitis occurs when a patient’s immune system has been compromised, making it a potentially life-threatening condition that demands prompt medical attention.
  
  
• Lichen simplex chronicus. A toughening of the skin that appears as small skin patches that become thickened and leathery with a dull red to brown color. It is caused by repeated scratching of the skin.

Parents should consult a physician if their child experiences any of the following in relation to their eczema:

• Discomfort that causes the child to lose sleep or become distracted from daily routines
  
  
• Extremely painful skin
  
  
• Indications that the skin may be infected (e.g., fever, redness or warmth of skin, pus-filled bumps, areas that look like cold sores or fever blisters)
  
  
• Failure to see improvement in eczema despite self-care measures