What Is Eczema?
Eczema is a descriptive term for a chronic skin condition that
usually begins in early childhood. It is seen most commonly in
individuals who have family members who have asthma and hay fever. This
is not to say that eczema is a classical allergic disease. There seems
to be general agreement that this condition is inherited because of the
complete loss or relative lack of a skin protein.
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Who Can Get Eczema?
There are criteria that must be met before the diagnosis of eczema
is considered. In most patients, the condition began in childhood.
Patients develop plaques of weeping, oozing skin that are very itchy. A
personal or family history of asthma and/or inhalant allergies is
helpful. In older children or adults, the lesions of eczema tend to
occur in the folds of the skin in front of the elbows and in the folds
of skin behind the knees. Eczema tends to improve in most patients as
they get older.
What Are the Causes of Eczema?
The belief that the cause of eczema seems to be a defect in the
production of a particular skin protein (filaggrin) is currently quite
popular. All of the other problems that seem to be present in those
afflicted include dry skin, hyper-reactivity to wool, itching during
sweating, colonization by pathogenic staph, predisposition to
disseminated herpes simplex infections, and a variety of immunologic
abnormalities.
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Eczema Symptoms
There is a debate about which comes first in atopic eczema, the
itching or the rash. This is analogous to the chicken and egg
controversy. It really does not matter. When the rash is in an acute
stage, it is weepy and oozy. Later after the patient has been rubbing
and scratching for some weeks, it becomes a plaque of thickened skin.
This is called lichenification.
Signs in Babies, Children & Adults
Atopic eczema has a typical distribution on the surface of the
skin; this can be quite helpful in making the correct diagnosis. In
crawling children in diapers, the rash is frequently seen on the elbows
and knees but spares the diaper area. In older children and adults, the
rash is often present in the folds of skin opposite to the elbow and
kneecap but spares the armpits. Other areas commonly involved include
the cheeks, neck, wrists, and ankles.
Types of Eczematous Dermatitis
Atopic eczema (atopic dermatitis) is one of a number of eczematous
eruptions that need to be distinguished. This is important because
treatment depends on the correct diagnosis. We'll take a look at the
listed types on the picture below
Atopic Dermatitis
Atopic eczema is an inherited skin condition more common in
individuals with a personal or family history of inhalant allergies like
asthma or hay fever. Patients develop weeping, oozing, itchy lesions in
a characteristic distribution. The severity depends to a great extent
on the amount of moisture in the skin. Atopic eczema is less common in
very humid environments and is harder to control in arid areas in the
wintertime. It often begins in infancy and improves in most people as
they reach adulthood.
Contact Eczema
Contact dermatitis is an eczematous dermatitis that occurs in
response to exposure to an irritant or allergenic substance. Irritants
cause skin damage by producing direct toxic damage to the skin cells.
Contact allergens are not necessarily irritating or toxic but are
recognized by the immune system. Once the immune response is stimulated,
an eczematous dermatitis occurs at the site of exposure.
Seborrheic Eczema
Seborrheic dermatitis is a chronic recurrent dermatitis, and it is
probably the most common of all rashes in adults. The rash
characteristically appears on the scalp, forehead, brows, ears, the
folds that extend from the nose to the lips (nasolabial folds), middle
of the chest, and middle of the back. It occurs in infants as cradle
cap. Its course is distinguished by periods of improvement followed by
flares.
Nummular Eczema
With nummular eczema, round plaques of eczematous skin often appear
on the lower legs. It often is seen in the elderly and seems to be
associated with dry skin.
Neurodermatitis
Lichen simplex chronicus is a thickened area of skin caused by
itching and rubbing. Although there is usually some inciting cause, the
origin of the problem is entirely obscured by the eruption. Any of the
eczematous eruptions can evolve into lichen simplex chronicus if rubbed
long enough.
Stasis Dermatitis
Stasis dermatitis almost always occurs on the lower legs of
patients who have sustained damage to the valves present in the large
veins responsible for returning blood to the heart. These valves, along
with muscular contractions of the leg muscles, help propel venous blood
from the periphery to the lungs and heart. Damage to these valves causes
a long column of blood to produce enough hydrostatic pressure on the
wall of the vein so small leaks occur. The lower legs swell and brownish
blood pigment is deposited in the skin from degradation of hemoglobin.
An eczematous dermatitis often occurs, and skin ulcers are common.
Dyshidrotic Eczema
Dyshidrotic eczema (pompholyx) is a common but poorly understood
condition in which very itchy small blisters occur on the lateral
surface of the fingers, toes, hands, and feet. Many patients note
exacerbations during periods of high stress (for example, finals week).
Diagnosis of Eczema
In order to make an accurate diagnosis of eczema, it is important
for your physician to take a complete history and examine all of the
areas of skin that are affected. Occasionally, certain laboratory tests
can be helpful in distinguishing various types of eczema. A pathologist
may need to examine skin scrapings and even a small piece of biopsied
skin.
Eczema Treatment: Basic Therapies
Once the diagnosis of atopic eczema is established, there are
certain well-established approaches to treating this condition. One of
the most important is to keep the skin well moisturized. There are many
inexpensive approaches to maintaining the moisture content of the skin.
Once the skin is wet, a thin layer of a cream or ointment is applied to
prevent the moisture from evaporating. Judicious use of such substances
(emollients) can be very effective in limiting flares of atopic eczema.
Eczema Treatment: Medications
Corticosteroid and ketoconazole creams are very effective at controlling the
inflammatory component of atopic eczema. The thickened, itchy, weepy
lesions respond well to the applications of such creams. In addition,
oral antihistamines are effective in suppressing the itching sensation
as well as acting as a sleep aid during flares.
Eczema Treatment: Immunomodulators and UV Therapy
Newer drugs have become available for the treatment of atopic
eczema; they claim to be devoid of the side effects of topical steroids.
These newer medications inhibit the immune response by inhibiting
calcineurin, an enzyme necessary for a normal inflammatory response.
Though they are quite effective, they are also quite expensive and seem
to lack potency when compared to the strongest topical steroids.
Ultraviolet light exposure can effectively control eczema in certain
patients because of its effect on inflammatory cells in the skin.
Can Eczema Be Prevented?
Applying a good moisturizer to damp skin is the most effective
method for limiting flares of atopic eczema. Try the measures listed on
this and the following slide to control and help prevent outbreaks of
eczema. Since the condition is inherited, it would be very difficult to prevent
its development entirely. Living in a warm, humid environment seems to
limit flares of atopic dermatitis. Sleeping with a humidifier in the
bedroom can be of some help. In some patients, adding chlorine bleach to
bathwater can be quite helpful (1/2 cup of bleach to a bathtub of warm
water). It is important to rinse off before applying an emollient.
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medicinenet.com(source)
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