Papular eczema, also referred to as papular dermatitis or subacute prurigo, is one of several subtypes of eczema. This type of eczema causes itchy bumps (called papules) to form on the limbs, neck, torso, and buttocks. Because of its symptoms, papular eczema is sometimes called “itchy red bump disease.”
Papular eczema is not a separate form of atopic dermatitis (general eczema). Instead, it specifies the form that the rash takes. If you’ve been diagnosed with atopic dermatitis, then what you know about that condition is also true of papular eczema.
There are seven known types of eczema, and it’s possible for you to experience more than one type at the same time. You may also develop different forms throughout your life.
Determining the type of eczema you have can be an important part of your diagnosis. Sometimes, it allows your dermatologist to determine which treatments are likely to be the most effective for you. This is particularly true of papular eczema, which is commonly misdiagnosed and confused with other conditions that are not eczema at all.
Like other forms of eczema, papular eczema may be chronic, or it may flare up and then disappear during periods of remission.
The symptom that differentiates papular eczema from other forms of eczema is the appearance of small, itchy bumps — or papules — on the skin, as opposed to the flaky patches characteristic of other types of eczema.
Aside from papules, the symptoms of papular eczema overlap with the symptoms of other types of eczema. Symptoms that may appear during a flare-up include:
Papules are most common in atopic dermatitis in infants and small children, though they are not unheard of in adults.
Papular eczema is usually diagnosed by a dermatology specialist who can examine your skin to determine the type of eczema you have.
One of the biggest difficulties with papular eczema is in differential diagnosis — that is, determining whether your symptoms are being caused by papular eczema or something else. Papular eczema often goes unrecognized or misdiagnosed because it can resemble other skin conditions.
For this reason, in order to be diagnosed with papular eczema, your dermatologist must first rule out the possibility that you have:
If a doctor is unable to provide a diagnosis following a clinical exam, they may perform a skin biopsy. This entails removing a small piece of skin to be examined under the microscope for determining the cause of your symptoms.
As with other skin conditions, several factors can result in papular eczema.
Eczema has been found to be related to inflammation in the skin, caused by an undetermined trigger. The eczema symptoms can appear when the body experiences inflammation. This is true of papular eczema, in particular, which is characterized by the presence of several types of inflammatory cells.
Eczema has several common triggers, including:
Seasonal allergies and asthma have also been found to trigger different forms of eczema. The skin condition is more common in people who have been diagnosed with asthma or seasonal allergies (hay fever) or whose close relatives have been diagnosed with these conditions. Asthma, seasonal allergies, and eczema are known collectively as the “atopic triad” and commonly appear together.
Papular eczema is generally refractory (resistant) to conventional eczema treatments. However, treatments exist that can help reduce itching, keep the condition from getting worse, and even bring on periods of remission.
While many of the treatments used for papular eczema overlap with those of general eczema, some treatments — including immunosuppressant medications and phototherapy — have been studied for use in papular eczema, in particular.
Some people diagnosed with papular eczema find that one treatment works better than all the others. Other people find that combining treatments gives them the best results. Talk with your health care provider before making any changes to your treatment plan.
Nonsteroidal treatments, such as immunosuppressants, have been found to help manage papular eczema. These medicines decrease skin inflammation by suppressing different parts of the immune system. It’s important that your doctor monitors your bloodwork and side effects if you’re taking immunosuppressants.
One study by the Journal of Dermatological Treatment tested the effects of three different immunosuppressant medications for long-term control of papular eczema on 14 individuals with the condition. The medications were:
Twelve of the participants were given low doses of methotrexate (2.5 milligrams to 10 milligrams weekly), which was found to be well-tolerated and to help eight of the participants control their papular eczema. The remaining two participants were given azathioprine and mycophenolate mofetil, both of which also helped control the condition.
If your papular eczema is persistent and continues even after other treatments, your dermatologist may recommend phototherapy. This technique exposes the affected skin to either natural sunlight, ultraviolet A light, or ultraviolet B light.
Phototherapy is a common alternative to drug treatment for papular dermatitis, as it has been proven to be highly effective and deliver longer-lasting results. However, long-term use of phototherapy can age your skin prematurely and raise your risk of skin cancer. You and your dermatologist can weigh the pros and cons of this treatment and decide if it is right for you.
Corticosteroid creams or ointments are often the first lines of defense against eczema. Stronger steroid creams will be more effective but also have the risk of thinning the skin over time.
Oral corticosteroids, such as prednisone, are also effective for managing papules and other symptoms of papular eczema in the short term, such as during a flare-up. It’s important to note that oral corticosteroids are usually reserved for short-term use, as using them in the long term can cause serious side effects — including raising your blood sugar levels and blood pressure.
Your dermatologist may prescribe a cream containing calcineurin inhibitors. These medications affect how the immune system functions, reducing outbreaks of atopic eczema. Examples include Elidel (pimecrolimus) and Protopic (tacrolimus).
These creams are generally for short-term use only. They’re also reserved for use by people older than 2. You should avoid sunlight when you’re using them.
Eucrisa (crisaborale) is a newer, nonsteroidal cream also used for eczema. It’s been found to be safe for people over the age of 2.
In some cases, people with papular eczema may develop bacterial skin infections after creating open wounds from scratching at their skin. If your dermatologist believes that you have or are at risk for an infection, they may prescribe you a topical antibacterial cream alongside your standard treatments.
The U.S. Food and Drug Administration recently approved an injectable biologic monoclonal antibody called Dupixent (dupilumab). It’s for all types of eczema, including papular eczema. However, it is only available to people with severe atopic dermatitis who have not responded to other treatments.
Hydrotherapy involves applying wet dressings — sometimes containing topical corticosteroid cream — to the affected areas or your skin. Performing this therapy on oneself or using it at home can be tricky, but your dermatologist can provide guidance.
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