What Is Flexural Eczema?

Eczema is a group of skin conditions that cause uncomfortable symptoms. One type, called flexural eczema, specifically affects the skin where your joints bend, such as the crease of your elbows and the back of your knees.

Learn more about the symptoms, causes, treatment, prevention, and prognosis for flexural eczema in this article.

Flexural Eczema Symptoms

Eczema—also called atopic dermatitis—causes the same types of symptoms in any part of the body that is affected. These can include:

• Itching
• Red, irritated skin
• Dry skin
• Scaly patches
• Oozing fluid
• Crusted skin
• Pain
  

Babies often develop eczema on their scalp and face, while older children are more likely to have eczema in their creases.

Babies and very young children don't have the ability to tell you their skin is itchy, but you might notice them rubbing against the sides of the crib or the carpet to try to scratch the itch. This discomfort also makes it more difficult for the child to sleep.

Repeatedly scratching the affected skin can lead to bleeding and increase the risk of infection. With time, the skin can also become thickened and/or leathery.

Symptoms of flexural eczema can come and go. When a person's symptoms are present, they are experiencing a "flare-up."

Causes

The exact cause of flexural eczema is not known. However, certain risk factors can increase a child's risk of developing eczema, such as genetic factors or having parents with other immune system disorders, including asthma or allergies.

Genetic defects in a person's skin barrier can lead to atopic dermatitis. A primary function of your skin is to provide a physical barrier to the rest of your body. It helps to keep allergens (substances that can trigger an allergic reaction) from entering your body. It also helps to keep your skin hydrated by preventing water from leaving the cells.

One genetic defect identified as a risk factor for atopic dermatitis is the lack of a protein called filaggrin. This protein is important for strengthening the skin barrier. When filaggrin is lacking, water can escape from the skin and dry it out. Allergens can more easily enter the body and cause a flare-up in symptoms.

Even if the exact cause of a child's flexural eczema can't be identified, several things are known to increase the risk of a flare-up. These can include:

• Irritants: Skin irritants cause symptoms when they come in direct contact with the skin. Ingredients found in household cleaners, detergents, and soaps can often be irritants. Tight clothing or fabrics that are abrasive (like wool) can also increase symptoms.
• Allergens: Exposure to allergens in the environment, such as dander, pollen, dust mites, grass, trees, and mold, can trigger flexural eczema. Other allergens can include metals such as nickel, latex, rubber, and ingredients in skin products.
• Weather: Changes in the weather can trigger a flare-up. Symptoms are particularly common in the winter months when the air is cold and dry. However, flexural eczema can also be triggered by hot weather if the skin becomes dried out or if a person sweats a lot.

Treatment

There is no cure for flexural eczema, but some kids "outgrow" the condition as they get older. Others will continue to have flare-ups throughout adulthood. However, there are several treatments that can reduce symptoms during a flare-up.

The affected skin can be treated with topical creams that contain steroids to reduce inflammation.

Doctors may prescribe topical calcineurin inhibitors (TCIs) that block one of the chemicals produced by the immune system. These help reduce symptoms during a flare-up. Protopic (tacrolimus) and Elidel (pimecrolimus) are examples.

Janus kinase inhibitors may be prescribed. These medications interfere with an enzyme that promotes inflammation. These include:

• Cibinqo (abrocitinib)
• Opzelura (ruxolitinib)
• Rinvoq (upadacitinib)

Dupixent (dupilumab) was approved in 2017 for cases of moderate-to-severe eczema. It is an injectable monoclonal antibody. It blocks a receptor to inhibit inflammation. Adbry (tralokinumab-ldrm) and Ebglyss (lebrikizumab-lbkz) are other biologic medications approved for eczema.

There are also several home remedies you can use for better comfort during a flare-up:

• Follow a bathing routine. Bathe in lukewarm water and avoid taking extremely long baths. Use cleansing products free of common irritants such as fragrances, dyes, or preservatives. Add some oatmeal to the bath to help reduce itching. Wash the skin very gently and pat dry—rubbing with a towel can cause further skin irritation.
• Lock in moisture. Apply topical medications or moisturizers right after the bath while the skin is still damp. Use creams or petroleum-based products rather than lotions, which can evaporate quickly from the skin.
• Dress appropriately. Choose clothing that covers the affected areas. Because flexural eczema occurs where joints bend, irritated skin could rub against other irritated skin as the child or adult moves around. Dress in loose-fitting, 100% cotton, long-sleeved shirts or pants.

Prevention and Prognosis

Flare-ups in flexural eczema can't always be prevented, but you can decrease the risk of having severe symptoms. Make sure to stay well hydrated and dress in breathable fabrics, particularly when the weather is hot.

Avoid triggers whenever possible. An allergist (doctor who specializes in treating allergies, asthma, and other immune system disorders) may do testing if you think you have an allergic trigger for your eczema.

Summary

Flexural eczema affects the skin where your joints bend, such as inside your elbows and behind your knees, especially in babies and children. The skin can be red and itchy. It may have an underlying genetic risk factor, and people with it often have allergies.

Treatment includes topical creams and prescriptions, as well as lifestyle measures to keep the skin hydrated and avoid triggers.

Flexural eczema can be stressful, especially for babies and young children who can't understand why they are uncomfortable. This can be equally stressful for the adult caring for the baby or child who isn't feeling well. Talk to your doctor about resources, and consider talking with other parents or caregivers for support.