Eosinophilic Esophagitis and Eczema: 5 Things You Need To Know

Medically reviewed by Todd Eisner, M.D.
Written by Emily Wagner, M.S.
Posted on March 1, 2023

Eosinophilic esophagitis (EoE) is an inflammatory disease characterized by an excess of eosinophils — specialized immune cells — in the esophagus, the tube that connects the mouth to the stomach. Eosinophils also play a role in other inflammatory conditions, including eczema.

Eczema is a skin condition that causes dry, scaly patches, rashes, or blisters. These symptoms come and go in flare-ups that last several days to weeks. The most common form of eczema is atopic dermatitis, which is caused by an overactive immune system. Studies have found that eosinophils are present in the skin of people with atopic dermatitis.

If you are living with EoE or eczema — or both — it’s important to understand how they’re connected. This article will discuss five important things to know about these conditions.

1. Eosinophilic Esophagitis Is Less Common Than Eczema

Doctors and researchers only started recognizing and diagnosing EoE in the 1990s. As a result, they are still learning more about it every year, with more and more people receiving a diagnosis. Current estimates show that EoE affects around 1 in 2,000 people in the United States, but researchers believe the condition may be far more common than these numbers suggest.

Eczema, on the other hand, is known to be a very common condition, affecting more than 31 million people in the United States. Specifically, atopic dermatitis affects around 16.5 million adults and 9.6 million children, according to the National Eczema Association.

2. Eosinophilic Esophagitis or Eczema Can Develop at Any Age

Although some conditions tend to affect people after a certain age, both EoE and eczema can develop at any point in a person’s life. However, some factors increase your chances of developing these conditions and influence what symptoms you may experience.

Who Develops Eosinophilic Esophagitis?

EoE may be diagnosed during infancy, childhood, or adulthood. In children, the average age of diagnosis is around 8.6 years — for adults, the average age is 38. EoE is most common in white males, according to findings published in the journal Gastroenterology.

EoE symptoms change with age as well. Children and teenagers with EoE typically experience:

  • Acid reflux (stomach acid flowing back into the esophagus)
  • Abdominal pain
  • Nausea
  • Vomiting
  • Dysphagia (trouble swallowing)
  • Food impaction (food stuck in the esophagus)

Acid reflux may make it difficult for infants and children to eat, keeping them from getting the nutrients they need to grow. As a result, many of them lose weight and are diagnosed with the medical condition of failure to thrive.

Adults typically don’t show signs of weight loss or failure to thrive, but they do experience many of the same symptoms as children and teenagers, including those listed above.

Who Develops Eczema?

Eczema can also be diagnosed from infancy through adulthood, but it’s more common in infants. Atopic dermatitis typically develops within six months after birth. For some children, symptoms eventually improve, Others have flare-ups throughout their adult lives. Additionally, studies show that atopic dermatitis is slightly more common in women than it is in men, according to International Journal of Women’s Dermatology.

Less commonly, atopic dermatitis may first arise in adulthood. According to the American Academy of Dermatology Association, a person is most likely to develop adult-onset atopic dermatitis in their 50s.

Like EoE, atopic dermatitis symptoms tend to vary with age. Infants may have dry, scaly patches of skin on the outside of their knees and elbows and on their cheeks, scalp, and neck. Children and adults are more likely to have these patches on the face, inside the elbows, or at the back of the knees or neck. Adults are also more likely to develop darker, thicker, itchy skin around their eyes.

Other common symptoms of atopic dermatitis include:

  • Gray, ashen, darker brown, or purple skin in people with darker skin tones
  • Reddened skin in people with lighter skin tones
  • Raised bumps that crust over and may leak fluid
  • Thickening of skin

Studies show that atopic dermatitis is more common in Black children than in white or Asian children, according to the National Eczema Association. Adult-onset atopic dermatitis may be more common in Asian countries as well.

3. Having Eosinophilic Esophagitis or Eczema Makes You More Likely To Develop the Other

An overactive immune system plays a role in the development of both EoE and eczema. While eosinophils in the esophagus are a defining feature of EoE, the blood and skin of people with eczema may contain a higher-than-normal number of eosinophils. These white blood cells have several helpful functions, such as assisting your body in fighting off parasitic infections by creating inflammation. However, in EoE and eczema, eosinophils can lead to unwanted symptoms.

Many people with EoE and eczema have atopy, or the genetic tendency to end up with allergic conditions. EoE, atopic dermatitis, asthma, environmental allergies, and food allergies are all considered atopic conditions.

Having EoE also increases your chances of developing eczema and vice versa. Research shows that up to 55 percent of children with EoE also have atopic dermatitis. Adults with EoE are nearly three times as likely to develop eczema.

4. Allergists Can Treat Both Eosinophilic Esophagitis and Eczema

If you or a loved one begins experiencing symptoms of EoE or eczema, you’ll likely first see your primary care physician. Depending on your case, your doctor may refer you to a specialist who can better treat your condition. Allergists can help treat both EoE and eczema, while other specialists may focus on just one of them.

Allergists are doctors who specialize in treating allergic conditions. Because many people with EoE and eczema also have allergies, an allergist can help identify what may be contributing to the cause of these conditions.

For example, more than 90 percent of people with EoE see their symptoms improve when they begin following a special diet to avoid common food allergens (foods that cause an allergic reaction). Between 20 percent and 40 percent of children with atopic dermatitis have food allergies as well, according to the National Eczema Association. An allergist can help people with both conditions learn which foods may be causing their symptoms.

Gastroenterologists Treat Eosinophilic Esophagitis

EoE is typically managed by a gastroenterologist who specializes in treating conditions that affect the esophagus and digestive tract. A gastroenterologist can help determine whether you have EoE or a similar condition, such as gastroesophageal reflux disease (GERD).

A gastroenterologist can help make a final diagnosis by performing an endoscopy to take a closer look at your esophagus. This entails inserting an endoscope — a long, flexible tube with a camera at the end — down a person’s throat into their esophagus. They may also take a biopsy (a small piece of tissue) to look for eosinophils. Once they confirm you have EoE, they will develop a treatment plan, which typically starts with high-dose proton pump inhibitors and a six-food elimination diet.

Dermatologists Treat Eczema

If your eczema is severe enough that a general physician recommends seeing a specialist, you’ll typically go to a dermatologist. Because atopic dermatitis can look like other forms of eczema, it’s important to find a specialist who can properly diagnose your condition. During a physical exam, the dermatologist will inspect your skin and ask questions about your symptoms and what may be triggering them.

5. Eosinophilic Esophagitis and Eczema May Share Treatments

Because inflammation is a big part of both EoE and eczema, they’re sometimes treated with similar medications. For example, the U.S. Food and Drug Administration (FDA) has approved dupilumab (Dupixent) for treating both EoE and atopic dermatitis. This biologic drug is made from proteins that block certain parts of the immune system to reduce inflammation.

Doctors also prescribe corticosteroids to treat EoE and atopic dermatitis. EoE may be treated with topical steroids that coat the lining of the esophagus. One example is budesonide (Entocort EC), which is taken as a mixture with honey or applesauce. Another is fluticasone (Flovent), which is swallowed from an inhaler.

Topical steroids are treatment options for eczema as well. They come as creams, lotions, or ointments that are applied to dry, scaly patches. You may find these over the counter in pharmacies or grocery stores, or your dermatologist may write you a prescription.

Talk to Your Doctors About Eczema and Eosinophilic Esophagitis

If you believe you or a loved one has EoE, eczema, or both conditions, talk to your doctor. They may refer you to one or more specialists who can help give you a diagnosis. Together, your gastroenterologist, dermatologist, and/or allergist can make treatment recommendations to help you better manage these conditions.

Find Your Team

On myEoEcenter, the site for people with eosinophilic esophagitis and their loved ones, people come together to learn about EoE and share their stories with others who understand life with EoE.

Do you have eczema and EoE? Do you have questions or tips regarding managing these two conditions together? Share your experience in the comments below.

  1. Eosinophilic Esophagitis: What People With Eczema Need To Know — National Eczema Association
  2. What Is Eczema? — National Eczema Association
  3. Eosinophils in Skin Diseases — Seminars in Immunopathology
  4. EOE — American Partnership for Eosinophilic Disorders
  5. Eosinophilic Esophagitis in Children and Adults: A Systematic Review and Consensus Recommendations for Diagnosis and Treatment — Gastroenterology
  6. Eosinophilic Esophagitis — Johns Hopkins Medicine
  7. Eosinophilic Esophagitis — Mayo Clinic
  8. Atopic Dermatitis — National Eczema Association
  9. Novel Systemic Treatments in Atopic Dermatitis: Are There Sex Differences? — International Journal of Women’s Dermatology
  10. Can You Get Eczema as an Adult? — American Academy of Dermatology Association
  11. Eczema (Atopic Dermatitis) — Nemours KidsHealth
  12. Atopic Dermatitis in Children — Stanford Medicine
  13. Eczema in Skin of Color: What You Need To Know — National Eczema Association
  14. Eosinophils in Skin Diseases — Seminars in Immunopathology
  15. What Is an Eosinophil? — Cincinnati Children’s
  16. Atopy Defined — American Academy of Allergy Asthma & Immunology
  17. Association Between Atopic Manifestations and Eosinophilic Esophagitis: A Systematic Review and Meta-Analysis — Annals of Allergy, Asthma & Immunology
  18. The Role of Food Allergy in Eosinophilic Esophagitis — Journal of Asthma and Allergy
  19. Eczema, Atopic Dermatitis and Allergies: What Is the Connection? — National Eczema Association
  20. Atopic Dermatitis (Eczema) — Mayo Clinic
  21. FDA Approves First Treatment for Eosinophilic Esophagitis, a Chronic Immune Disorder — U.S. Food and Drug Administration
  22. FDA Approves New Eczema Drug Dupixent — U.S. Food and Drug Administration
  23. Topical Steroid Therapy for Eosinophilic Esophagitis — Gastroenterology & Hepatology
  24. Treatment Options for Atopic Dermatitis — American Family Physician

Posted on March 1, 2023
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How Do You Know For A Fact That You Have Eczema?
January 7, 2024 by Christal 1 answer
Todd Eisner, M.D. has 32 years of experience in gastroenterology and internal medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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