Eczema

Alternative Names

Eczema, Eczema dermatitis, Atopic dermamtitis

What is Eczema

The term Eczema is used to describe any sort of dermatitis (inflammatory skin conditions). Not all dermatitis is eczematous. All eczematous dermatitis has a similar appearance. Acute lesions are composed of many small fluid-filled structures called vesicles that usually reside on red, swollen skin. When these structures break, the fluid leaks out, causing characteristic weeping and oozing. When the fluid dries, it produces a thin crust. In older lesions, these vesicles may be harder to appreciate, but an examination of the tissue under the microscope will reveal their presence. Eczematous dermatitis has many causes. One of the most common is a condition called atopic dermatitis. Often those using the term eczema are referring to atopic dermatitis.

Signs and symptoms

The most common causes of Eczema include dry, reddened skin that itches or burns, although the appearance of eczema varies from person to person and varies according to the specific type of eczema. Medical professionals sometimes refer to eczema as "the itch that rashes." While any region of the body may be affected by eczema, in children and adults, eczema typically occurs on the face, neck, and the insides of the elbows, knees, and ankles. In infants, eczema typically occurs on the forehead, cheeks, forearms, legs, scalp, and neck

Usually, the first symptom of eczema is intense itching.

The rash appears later and is red and bumpy.

The rash itches or burns.

If it is scratched, it may ooze and become crusty.

In adults, chronic rubbing produces thickened plaques of skin.

Some people develop red bumps or clear fluid-filled bumps that look "bubbly" and, when scratched, add wetness to the overall appearance.

Painful cracks can develop over time.

Although the rash can be located anywhere on the body, in adults it is most often found on the neck, flexures of the arms (opposite the elbow) and flexures of legs (opposite the knee). Infants may exhibit the rash on the torso and face. As the child begins to crawl, the rash involves the skin of the elbows and knees. The diaper area is often spared.

Possible complications

Possible complications include the following:

Infection

As atopic eczema can cause your skin to become dry and cracked, the risk of getting a skin infection is increased. The risk is higher if you scratch your eczema and if you do not use treatments as advised.

Bacterial infections can cause more severe symptoms. The most common type of bacteria that infects atopic eczema is Staphylococcus aureus. If your skin becomes infected with Staphylococcus aureus, it can make your eczema worse, causing:

• increased redness
• fluid that oozes out of the cracked skin and crusting where the fluid dries
• a high temperature and a feeling of being unwell
• Your skin will be unable to heal naturally from this type of infection and you will need to take antibiotics

Eczema herpeticum

It is possible to have an infection caused by the herpes simplex virus, which normally causes cold sores. This can develop into a serious condition called eczema herpeticum. Symptoms of eczema herpeticum include:

• areas of painful eczema that quickly get worse
• groups of fluid-filled blisters that break open and leave open sores on the skin
• a high temperature and generally feeling unwell, in some cases

What causes

The exact cause of eczema is still unknown, but a defect of the skin that impairs its function as a barrier, possibly combined with an abnormal function of the immune system, are believed to be important factors. Studies have shown that in people with atopic dermatitis there are gene defects that lead to abnormalities in certain proteins (such as filaggrin) that are important in maintaining the barrier of normal skin.

Some forms of eczema can be triggered by substances that come in contact with the skin, such as soaps, cosmetics, clothing, detergents, jewelry, or sweat. Environmental allergens (substances that cause allergic reactions) may also cause outbreaks of eczema. Changes in temperature or humidity, or even psychological stress, can lead to outbreaks of eczema in some people.

Prevention

While there is no cure for eczema, you can take steps to manage your symptoms and lessen the severity of outbreaks. Such measures include

• avoidance of over-bathing;
• applying moisturizer frequently, especially after bathing;
• bathing in warm, not hot, water and using a mild soap;
• limiting or avoiding contact with known irritants like soaps, perfumes, detergents, jewelry, environmental irritants, etc.;
• wearing loose-fitting clothing (cotton clothing may be less irritating for many people than wool or synthetic fibers);
• the use of cool compresses to help control itching;
• avoiding foods that cause allergic reactions;
• wearing protective gloves for activities that require frequent submersion of the hands in water;
• avoiding activities that make you hot and sweaty as well as abrupt changes in temperature and humidity;

Treatment

Once your doctor is sure you have atopic dermatitis, the mainstays of therapy are anti-inflammatory medications and relief from the itching.

Prescription-strength steroid cream and antihistamine medications are the usual treatments.

If your doctor determines that you have a secondary bacterial infection complicating your rash, an oral antibiotic may be prescribed.

For severe cases not responding to high-potency steroid cream, alternate treatments may be tried. These include coal tar, PUVA (psoralen + ultraviolet A light), and chemotherapeutic agents.

Allergy shots (immunotherapy) usually do not work in eczema.