Eczema

ECZEMA

What is eczema?

Eczema is a medical condition in which the skin or patches of the skin become red, itchy and irritated. Person also may have tiny bumps or blisters. Eczema is not contagious. Dermatitis is a skin inflammation. Eczema is the most common type of dermatitis. Eczema is also referred to as atopic dermatitis. Eczema is common in all age groups but more common in children.


Types of eczema

Different types of eczema have different symptoms and causes. The following are the types of Eczema.


Atopic dermatitis:   This type is the most common type of eczema. Atopic dermatitis affects more than 18 million adults in the United States only. This is a widespread condition and thus commonly termed ‘eczema’.


Contact dermatitis:   This type is caused when the skin comes into contact with an irritant such as:

  Sweat

  Saliva

  Urine

  Medications

  Cosmetic products

  Detergents

  Bubble bath

  Harsh soap

  Fragrances

  Building materials


This dermatitis is also caused due to skin allergies from material such as:

  Poison oak

  Poison ivy

  Poison sumac

  Nickel in earrings


Hand eczema:   This type is developed only on the hands. It can be related to atopic eczema. It can result from exposure to strong detergents or certain soaps or hand washing liquids. Occasionally it can result from an allergy.


Nummular eczema:   This type develops oval or coin sized patches of irritated skin. Generally it develops on the arms, legs or chest. It usually occurs in adults with dry skin.


Stasis dermatitis:   This type is developed on the calves, ankles and lower legs. It’s caused by weak veins in the lower legs and thus weak blood circulation. These poor veins cause blood to collect in the legs (stasis) which can result in leg swelling and can lead to the signs of stasis dermatitis such as itching, fine red bumps, skin redness or darkening, weeping sores etc.


Asteatotic eczema:   This type is typically developed on the legs during winter months or in overly dry environments. It can cause the skin to dry resulting in fine cracks. It commonly occurs in the elder people.


Seborrheic dermatitis:   This type typically affects the scalp, face and neck. It commonly appears as a cradle cap on the scalp of infants and as dandruff on the scalp of adults.


Lichen simplex chronicus (LSC):   This type is caused as a reaction of repeated scratching of the skin. The skin may become thickened, discolored and scaled over time.


Causes of eczema

This is not fully known yet what are the exact causes of eczema. Eczema is a reaction to multiple health conditions and it’s most likely caused by a combination of genetic factors, overactive immune systems and environmental triggers that can make your skin become red, itchy and inflamed. Possible causes of eczema are listed below.


Defective skin barrier:   People with eczema tend to have dry skin due to a defect in their skin barrier. Research suggests that people with eczema may have mutated genes that produce a protein named filaggrin gene (FLG) that’s responsible for creating the tough cells that make the outermost protective layer of the skin. With gene defects, less filaggrin is produced which is leading to a haphazard organization of these skin cells instead of tightly packed organization. In this condition, water doesn’t stay in leakey skin and makes skin dried and dehydrated.


Decreased Beta-defensins:   People with eczema may have decreased numbers of Beta-defensins proteins in the skin. Beta-defensins are important for fighting off certain bacteria, viruses, and fungi. A decreased Beta-defensins leads to skin infections.


Immunological causes:   People with eczema may have imbalance between the two main types of T helper lymphocytes Th-1 and Th-2 those are types of white blood cells. Th-2 cells and their associated chemical messengers (cytokines) are excessed. In some kids, high levels of the immunoglobulin E (IgE) antibodies and eosinophils (the white blood cells associated with allergy) are also found. These conditions may lead to eczema.


Irritants and Allergens:   Eczema may be triggered when the skin comes into contact with an irritant. It may also be triggered due to skin allergies from allergens. Some of crucial irritants and allergens are as below:

  Sweat

  Saliva

  Urine

  Medications

  Cosmetic products

  Harsh soap, strong detergents, hand washing liquids.

  Perfumes, fragrances, deodorants

  Building materials

  Poison oak, poison ivy, poison sumac

  Metals such as nickel, chromium, cobalt, mercury

  Climate changes

  Pollution


Symptoms of eczema

Eczema symptoms can vary from person to person. Age, health complications and severity of the disease are the factors that determine the severity of the symptoms. The most common symptoms of eczema include:

  Dry and red itchy skin

  Swollen skin

  Intense itching or irritation

  Rashes

  Hives

  Crusts or scabs

  Red or brown-gray patches of skin

  Small, itchy, fluid-filled bumps on the skin

  Thickened, scaly or cracked patches on the skin


How is eczema diagnosed?

There is no specific test to diagnose eczema. However doctors may diagnose eczema in different ways such as:

  By doing the physical examination of the affected area

  By knowing about person's symptoms

  By knowing about medical & allergy history of patient

  By knowing about allergy history of family members

  By knowing about exposure to irritants and allergens


Patch test:   This test is helpful to find out allergens that are causing eczema in a person. Patch testing with various allergens may be necessary. This helps doctors to plan the right treatment for the allergies. Patch test is essential when the dermatitis becomes resistant to treatment.


Blood tests:   Blood tests might be performed to rule out other medical conditions as well as to check for causes of rashes that may be unrelated to dermatitis.


Treatment of eczema

Currently there isn’t a cure for eczema. Depending on symptoms and the severity of eczema, doctors may recommend a variety of medications, therapies and other treatment options that can help to successfully manage the symptoms of eczema and make eczema flare-ups easier to control.


Medications:   Here are some of the medications that are prescribed by doctors for the treatment of the symptoms of eczema.

Corticosteroid creams and lotions:   These are anti-inflammatory medicines that give relief from inflammation and itchiness.

   Prednisolone

   Hydrocortisone


Topical calcineurin inhibitors:   These medications help to reduce inflammation and prevent flares.

   Tacrolimus   ( Protopic )

   Pimecrolimus   ( Elidel )


Topical PDE4 inhibitors:   These medications block the effects of the enzyme Phosphodiesterase 4 or PDE4 which plays an important role in producing the inflammatory response that’s common in people with eczema.

   Eucrisa


Immunosuppressants:   These medications suppress the body's immune system. This will help patients from scratching affected skin areas and thus help skin to recover and reduce the risk of certain skin infections.

   Azathioprine   ( Azasan, Imuran )

   Cyclosporine   ( Restasis )

   Methotrexate, Methotrexate Sodium


Antibiotics:   These medications prevent bacterial infections that might develop along with eczema.

   Erythromycin   ( Ery-Tab )

   Penicillin


Barrier repair moisturizers:   These moisturizers repair the natural moisture barriers of the skin and enable faster healing and hydration of the skin.

   Eucerin Eczema Relief

   Cerave Moisturizing


Dandruff shampoo:   This is helpful when the scalp is affected by seborrheic dermatitis. For severe seborrheic dermatitis, a prescription facial cream or rinse may be recommended.


Therapies:  

Light therapy:   This therapy may be helpful when topical medications don’t respond well. The affected skin area is exposed to either natural sunlight or artificial UV radiation to treat eczema.


Wet wrapping:   The affected skin areas are wrapped in wet bandages and topical steroids in this therapy. This is typically used for people with large areas of eczema that itch and cause discomfort.


Lifestyle management:   Person should take the following steps to reduce symptoms as well as risks related to eczema:

  Take your prescribed medications regularly.

  Take vitamin and mineral supplements to control skin infections.

  Avoid scratching to prevent risk of developing infections.

  Eliminate all the harsh soaps, shampoos, body wash and hand washing liquids.

  Take lukewarm showers while avoiding hot water showers during winters.

  Do not scrub but dab dry with the towel to wipe away the moisture.

  Moisturize the skin using gentle body lotions or moisturizers or emollients (Ceramide).

  Use coconut oil to soften the dry skin that heals bacterial infections of the skin.

  Add household bleach to your bath water to kill the bacteria that cause the infections in eczema.

  Use skin-friendly fabrics like cotton, silk and linen.

  Avoid tight clothing that could irritate skin.

  Use a humidifier to maintain a normal humidity level at home.


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