Eczema
Characterized by recurrent flares and periods of remission, eczema is associated with impaired skin barrier function and chronic inflammation, leading to increased water loss and heightened skin sensitivity. The condition results from a complex interaction between genetic predisposition, immune dysregulation, and environmental triggers, and typically requires ongoing management to maintain barrier integrity and control inflammation.
What Is Eczema?
Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition characterized by skin barrier dysfunction and immune dysregulation. This leads to dry, itchy, and inflamed skin, with increased susceptibility to irritants, allergens, and microbes due to impaired barrier function.
Eczema commonly begins in childhood but can develop or persist at any age, often following a relapsing–remitting course.
Professional Experience
While eczema is common nationwide, patients at Core Dermatology often experience more frequent or severe flares due to Denver’s dry climate and high altitude, which can worsen skin barrier dysfunction and increase moisture loss. Our practice treats a high volume of eczema patients each year, giving us extensive experience in developing effective, individualized treatment plans to control flares and maintain long-term skin health.
Common Symptoms of Eczema
Symptoms of eczema can vary by age and severity, but the most distinctive signs include:
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Intense itching (pruritus), which often worsens at night.
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Red or inflamed patches on the skin (brownish-gray in darker skin tones).
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Dry, cracked, or scaly skin.
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Small, raised bumps that may leak fluid and crust over when scratched.
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Thickened, leathery skin (lichenification) resulting from chronic scratching.
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Swollen or sensitive skin from scratching.
What Causes and Triggers Eczema?
Eczema develops from a combination of genetic predisposition, immune dysregulation, and environmental factors. Genetic changes affecting the skin barrier such as reduced ability to retain moisture and protect against external irritants can lead to increased water loss and easier penetration of allergens and microbes. In addition, people with eczema have altered immune responses in the skin that promote chronic inflammation.
Common triggers of eczema flares include:
- Environmental Factors: Dry air, exposure to tobacco smoke, pollen, and extreme or rapid temperature changes.
- Irritants: Soaps, detergents, shampoos, fragrances, and household cleaning products.
- Allergens: Dust mites, pet dander, pollens, and molds.
- Stress: High emotional or physical stress levels can worsen inflammation and itch.
- Food Allergies: particularly in children (e.g., eggs, milk, peanuts, soy).
The Colorado Factor
Eczema is more common in dry climates (including Colorado) and in the winter. The dry air and hard water common in the Denver metro area are significant triggers for eczema patients. Hard water contains high mineral content that can leave a residue on the skin and alter its pH, leading to irritation. In Denver, symptoms often present with extreme dryness and “winter itch” due to low humidity levels. If over-the-counter medications aren’t working, Core Dermatology can prescribe stronger barrier-repair solutions.
Core Dermatology specializes in identifying these specific environmental stressors to create a tailored prevention plan for our local patients.
Types of Eczema
“Eczema” is an umbrella term used to describe a group of inflammatory skin conditions that share similar features such as itching, redness, dryness, and flaking, but have different causes and triggers. Think of eczema as a category rather than a single diagnosis. Identifying the specific type helps guide treatment and prevention strategies.
Atopic Dermatitis
The most common form of eczema. It is a chronic condition related to a combination of genetic skin-barrier dysfunction and immune system overactivity. It often starts in childhood and is associated with asthma or seasonal allergies.
Contact Dermatitis
Caused by direct skin exposure to a substance.
- Irritant contact dermatitis results from repeated exposure to harsh substances (soaps, detergents, chemicals).
- Allergic contact dermatitis is an immune reaction to a specific allergen (such as fragrances, preservatives, or metals like nickel).
Dyshidrotic Eczema
Causes intensely itchy, small blisters on the palms, sides of the fingers, and soles of the feet. Stress, sweating, and metal sensitivities can be triggers.
Nummular (Discoid) Eczema
Characterized by coin-shaped patches of itchy, inflamed skin, often on the extremities. It is commonly triggered by dry skin or skin injury.
Medical Treatment Options for Eczema
Treatment of eczema is individualized and depends on disease severity, distribution, chronicity, and impact on quality of life. Management typically follows a stepwise approach, beginning with skin-barrier repair and topical anti-inflammatory therapies. Systemic treatments are reserved for moderate to severe disease that is refractory to appropriate topical management.
Topical Treatments
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Prescription-Strength Corticosteroids
These medications help calm active eczema flares by reducing inflammation, redness, and itching. Different strengths are used depending on the location and severity of the rash.
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Topical Calcineurin Inhibitors (Non-Steroidal Options)
These creams and ointments reduce skin inflammation by targeting immune signals involved in eczema. They are especially helpful for sensitive areas like the face, eyelids, and skin folds, and can be used for long-term control without causing skin thinning.
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Barrier Repair Creams and Moisturizers
These advanced moisturizers help repair and protect the skin barrier by improving hydration and restoring essential lipids. Although they don’t treat inflammation directly, they are a core part of eczema care, helping reduce flares and improve the effectiveness of prescription treatments.
Systemic and Advanced Treatments
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Biologic Therapies
Biologic medications, such as dupilumab, are injectable therapies that target specific immune pathways involved in atopic dermatitis. They are used for moderate to severe eczema when disease is not adequately controlled with optimized topical therapy or when topical treatments are not appropriate due to extent or location of disease.
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Oral Immunomodulatory Medications
Oral agents may be used in severe or refractory cases to suppress immune-driven inflammation. These medications are typically prescribed for limited durations or carefully monitored courses due to potential side effects and are often used as bridge therapy or when other options are not suitable.
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Patch Testing
When allergic contact dermatitis is suspected or when eczema is chronic, recurrent, or treatment-resistant, patch testing can help identify specific allergens that may be contributing to skin inflammation. Identifying and avoiding these triggers is an important part of long-term management.
Eczema Management Tips for the Colorado Climate
To maintain healthy skin in our high-altitude environment, follow these best practices:
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Use a Humidifier
Given Denver’s average humidity is often below 30%, we recommend using a cool-mist humidifier in the bedroom to maintain skin hydration while you sleep. Aim for indoor humidity around 40–50% to support skin barrier function.
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Short, Lukewarm Showers
Limit showers to 5-10 minutes using warm (not hot) water to prevent drying out the skin barrier. Hot water strips the skin of natural oils and can worsen inflammation and itching.
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Moisturize Immediately After Bathing
Apply a thick cream or ointment within a few minutes of showering, while the skin is still slightly damp. This helps reduce skin water loss and improves overall hydration.
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Install a Water Softener
Hard water may worsen eczema in some individuals by leaving mineral residue on the skin and reducing soap rinsability. A water softener may be helpful for patients with sensitive or treatment-resistant eczema, though results can vary
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Wear Breathable Fabrics
Choose soft, breathable fabrics such as cotton or bamboo. Avoid rough materials like wool and tight or non-breathable synthetics, which can increase friction, sweating, and irritation.
Frequently Asked Questions (FAQ) About Eczema
Is there a permanent cure for eczema?
There is currently no permanent cure for eczema. However, with a personalized treatment plan from a board-certified dermatologist, symptoms can be successfully managed and long term remission is possible.
Why is my eczema worse in the winter in Denver?
Denver winters combine freezing temperatures with indoor heating, creating an extremely dry environment that dehydrates the skin barrier, leading to increased flares.
Does Core Dermatology offer eczema treatment for children?
Yes, Core Dermatology provides pediatric dermatology services. We specialize in gentle, effective treatment plans for infants and children struggling with atopic dermatitis.