Eczema

Synonyms: Atopic dermatitis, Dermatitis.

Symptoms: Itching, dry cracked skin, itchiness, redness, rash, thickened lesions, and darkening of skin around the eye.

Risk Factors: Insects, allergens, irritants, gene variation, family history, autoimmunity, lifestyle changes.

Severity: Mild to Severe.

Gender affected: Both male and female populations can get affected but more common in men.

Which doctor to consult: A general physician, or dermatologist.

Overview: 

Eczema, also known as atopic dermatitis, is a chronic skin condition characterized by dry, itchy, and inflamed patches of skin. It’s not contagious and can affect individuals of any age, though it often begins in childhood. The exact cause of eczema is unknown, but it’s linked to an overactive immune system response and various risk factors, such as genetic predisposition, environmental factors, stress, and allergies to chemicals or metals.

The symptoms of eczema include dry, cracked, scaly skin, painful lesions, thickened skin in affected areas, redness, etc. Eczema can be a lifelong condition. However, by maintaining healthy, moisturized skin, symptoms can be avoided and controlled using at-home treatments.

Eczema patients frequently have long stretches of symptom-free remission interspersed with sometimes severe, short-lived flare-ups. The treatment of this condition includes medications (antihistamines, corticosteroids), therapy (light therapy using sunlight/UV light), diet management and lifestyle management.

Remember, if you’re experiencing new, severe, or persistent symptoms, it’s important to seek medical attention. For a more detailed understanding and personalized advice, it’s best to consult a dermatologist.

Types of Eczema:

Eczema is a group of conditions that cause inflammation of the skin, typically resulting in redness, itching, and sometimes blisters. There are several types of eczema, each with its own set of characteristics and triggers. Here’s a brief overview of the different types:

Atopic Dermatitis: The most common form of eczema, often starting in childhood. It’s characterized by dry, itchy skin and rashes on the face, inside the elbows, behind the knees, and on the hands and feet.

Contact Dermatitis: Occurs when the skin comes into contact with an allergen or irritant, leading to a red, itchy rash. It can be caused by many substances, including metals, adhesives, cosmetics, and plants.

Dyshidrotic Eczema: Causes small blisters to form on the hands and feet, especially on the edges of the fingers, toes, palms, and soles.

Neurodermatitis: Leads to thickened, scaly patches of skin, usually on the head, lower legs, wrists, or forearms due to a localized itch (such as an insect bite).

Nummular Eczema: Presents as circular patches of irritated skin that can be crusted, scaling, and itchy. It’s more common in men and usually appears after an injury to the skin.

Seborrheic Dermatitis: Affects areas of the body with a lot of oil-producing glands like the scalp, nose, and upper back. It can cause scaly patches, red skin, and stubborn dandruff.

Stasis Dermatitis: Usually found on the lower legs of older adults and is related to circulatory problems. It can cause swelling, itching, and pain, and may lead to ulcers.

Each type of eczema may require a different approach to treatment and management. It’s important to consult with a healthcare professional for a proper diagnosis and treatment plan.

Symptoms

Eczema, or atopic dermatitis, can present a range of symptoms that vary in severity and may fluctuate over time. Here’s a detailed look at the symptoms:

Common Symptoms:

• Dry, cracked skin: The skin may become so dry that it cracks and bleeds.
• Itchiness (pruritus): This can be intense and may worsen at night, leading to sleep disturbances.
• Redness: The affected areas may appear reddened on lighter skin tones, while on darker skin tones, eczema can present as brown, purple, grey, or ashen.
• Rash: It often appears on swollen skin and varies in colour depending on your skin colour.
• Small, raised bumps: These may leak fluid and crust over when scratched, particularly on brown or Black skin.
• Thickened skin: Chronic scratching can lead to thickened, leathery patches of skin, known as lichenification.
• Oozing and crusting: Especially when the skin is infected.
• Darkening of the skin around the eyes: Due to inflammation and rubbing.

Less Common Symptoms:

• Painful lesions: In severe cases, the skin may develop painful sores.
• Change in color where skin rashes appear: This can be a temporary or more persistent skin discoloration.
• Fluid-filled blisters: These can occur, particularly with dyshidrotic eczema, which affects the hands and feet.

Symptoms in Infants:

• Rash on the scalp and cheeks: This can bubble up before leaking fluid.
• Skin infections: Due to excessive scratching, infants are prone to skin infections.

Symptoms in Children:

• Rashes that bubble up and then leak fluid: Common in children suffering from eczema.
• Rashes that may lighten or darken the skin: These can leave behind a permanent change in skin colour.

It’s important to note that eczema symptoms can be triggered or worsened by various factors, including environmental irritants, stress, and allergens. If you or someone you know is experiencing these symptoms, it’s advisable to consult a healthcare professional for an accurate diagnosis and appropriate treatment plan

Causes and Risk factors:

Eczema, particularly atopic dermatitis, is a complex condition where multiple factors contribute to its development and flare-ups. Here’s a detailed look at the causes of eczema:

Genetic Factors:

• Family History: A strong genetic link exists, especially if there’s a family history of eczema, allergies, hay fever, or asthma.
• Gene Variations: Certain gene mutations can affect the skin’s barrier function, making it more vulnerable to irritants and allergens.

Immune System Dysfunction:

• Overactive Response: The immune system can overreact to harmless substances, leading to inflammation and eczema symptoms.
• Autoimmunity: In some cases, the body’s immune system may attack its own cells, contributing to skin inflammation.

Skin Barrier Defects:

• Moisture Retention: Problems with proteins that maintain the skin’s barrier can lead to moisture loss and dry skin.
• Protection Against Irritants: A compromised skin barrier allows irritants and allergens to penetrate the skin more easily.

Environmental Factors:

• Irritants: Exposure to certain chemicals, fabrics, and soaps can trigger eczema symptoms.
• Allergens: Pollen, dust mites, pet dander, and mold can provoke an eczema reaction.
• Climate: Extreme temperatures, low humidity, and sudden changes in weather can worsen eczema.

Lifestyle and Triggers:

• Stress: Emotional stress is known to exacerbate eczema symptoms.
• Occupational Factors: Jobs that involve frequent hand washing or exposure to chemicals can increase the risk of eczema.
• Diet: Certain foods may trigger an eczema flare-up, especially in people with food allergies.

Microorganisms:

• Bacteria: Staphylococcus aureus on the skin can cause infection and exacerbate eczema symptoms.
• Viruses and Fungi: These can also infect eczematous skin and worsen the condition.

Climate and Geography:

• Weather Conditions: Living in cold, damp areas or hot, swampy areas can affect the skin and potentially lead to eczema.

Understanding the specific causes and triggers of eczema is crucial for effective management and treatment. It’s often a combination of factors, and what affects one person may not affect another. 

Complications:

Eczema can lead to several complications, both directly related to the skin and in broader health aspects. Here are some of the potential complications associated with eczema:

Skin Infections:

The broken skin from eczema can allow bacteria, viruses, or fungi to enter, leading to infections. Common infections include:

• Staphylococcus aureus: Often colonizes eczema lesions and can worsen the condition
• Eczema herpeticum: A serious viral infection caused by the herpes simplex virus
• Fungal infections: Such as those caused by dermatophytes or yeast like Malassezia

Skin Damage:

Chronic scratching and rubbing can lead to:

• Lichenification: Thickened, leathery skin due to constant scratching
• Scarring: Permanent marks on the skin after repeated scratching and healing

Pigmentation Changes:

Eczema can cause areas of lighter (hypopigmentation) or darker (hyperpigmentation) skin, which may be temporary or permanent

Eye Complications:

Eczema around the eyes can lead to eye problems, including:

• Conjunctivitis: Inflammation of the membrane lining the eyelids.
• Keratoconus: A condition where the clear outer layer of the eye (cornea) bulges outward.

Psychological Impact:

The visibility and discomfort of eczema can affect mental health, leading to:

• Low self-esteem: Especially in children who may face bullying due to their skin appearance.
• Depression and anxiety: Due to the chronic nature and symptoms of the condition.

Sleep Disturbances:

Intense itching can lead to difficulty sleeping, which can affect overall health and quality of life.

Impact on Quality of Life:

Eczema can interfere with daily activities, work, and social interactions due to discomfort and self-consciousness.

Other Health Conditions:

People with eczema may have a higher risk of developing other allergic conditions such as asthma and hay fever.

It’s important to manage eczema effectively to minimize these complications. Treatment plans often include skincare routines, medications to control symptoms and infections, and strategies to identify and avoid triggers.

Prevention:

Preventing eczema involves a combination of avoiding triggers and taking care of your skin. Here are some strategies that may help prevent eczema flare-ups:

• Moisturize Regularly: Keeping skin hydrated is crucial. Use fragrance-free moisturizers, especially after bathing, to lock in moisture.
• Gentle Skincare Products: Choose mild, fragrance-free soaps and detergents. Avoid products with irritants or allergens that can trigger eczema.
• Avoid Triggers: Identify and steer clear of substances that irritate your skin or cause an allergic reaction.
• Protect Your Skin: Wear gloves when handling irritants or allergens, and dress in soft, breathable fabrics like cotton.
• Control Temperature and Humidity: Try to avoid extreme temperatures and sudden changes in humidity. Use a humidifier in dry environments.
• Stress Management: Stress can trigger eczema, so engaging in relaxation techniques or stress-reducing activities may help.
• Healthy Diet: Some people find that certain foods can trigger their eczema, so maintaining a balanced diet and avoiding known food allergens is beneficial.
• Avoid Scratching: Keep nails short and consider wearing gloves at night to prevent scratching, which can worsen eczema and lead to infection.
• Regular Bathing: Take short, lukewarm baths or showers to help hydrate the skin. Pat dry gently and apply moisturizer immediately afterward.
• Water Intake: Stay hydrated by drinking plenty of water throughout the day.

Remember, these are general tips, and what works can vary from person to person.

When to visit a doctor:

It’s important to visit a general physician or dermatologist if you experience any symptoms that could indicate eczema, especially if they persist. It’s important to consult a doctor for eczema if you or your child are experiencing:

• Discomfort and pain that prevents you from sleeping or functioning normally.
• Excessive eczema symptoms even after trying over-the-counter or home treatments.
• Worsening skin infections — especially if they include pus, red streaks, or yellow scabs.

Additionally, if the eczema is persistent and causing significant distress or if you notice any signs of infection, it’s advisable to seek medical advice. A healthcare professional can provide a proper diagnosis and treatment plan tailored to your specific condition.

Diagnosis:

The diagnosis of eczema, also known as atopic dermatitis, typically involves a combination of a physical examination and medical history evaluation. Here’s a detailed look at the process:

Physical Examination

A healthcare provider will examine the skin to check for the characteristic signs of eczema, which may include:

• Dry, cracked, scaly skin
• Redness and inflammation
• Itching, which can be intense
• Painful lesions
• Changes in skin color where rashes appear
• Thickened skin patches
• Fluid-filled blisters

Medical History

The doctor will inquire about:

• The duration and pattern of symptoms
• Family history of eczema or other allergic conditions like hay fever and asthma
• Any known triggers that worsen the condition

Additional Tests

While there’s no specific test for eczema, the following may be conducted to rule out other conditions or identify triggers:

• Allergy skin tests: To check for allergies that might be causing symptoms.
• Skin biopsy: In some cases, to examine the affected skin under a microscope.
• Patch tests: To identify specific irritants or allergens causing flare-ups.

Treatment:

Eczema is a chronic skin condition that requires a comprehensive treatment approach to manage symptoms and prevent flare-ups. Here’s a detailed overview of the treatment options available for eczema:

Medications

• Antihistamines: Drugs like diphenhydramine help control itching, especially at night.
• Corticosteroids: Oral drugs, creams, or ointments such as betamethasone, prednisolone, triamcinolone, and methylprednisolone reduce swelling and itch.
• Calcineurin Inhibitors: Topical medications like tacrolimus and pimecrolimus help control the immune response causing symptoms.
• Antibiotics: Used to treat skin infections if there are signs of bacterial involvement.

Skin Care and Therapies

• Cleansing and Moisturizing: Keeping the skin clean and well-moisturized is fundamental in managing eczema. Use gentle, fragrance-free cleansers and moisturizers.
• Steroid Ointments: Topical steroids are often prescribed to reduce skin inflammation during flare-ups.
• Light Therapy: Exposing the skin to controlled amounts of natural sunlight or artificial ultraviolet light can help treat rashes.

Dietary Considerations

• Anti-inflammatory Foods: Incorporating foods rich in omega-3 fatty acids, like fatty fish, and quercetin-containing foods such as broccoli, blueberries, and cherries may be beneficial.
• Avoiding Allergens: It’s important to avoid food allergens that can trigger symptoms, such as soy and dairy products.

Lifestyle and Home Remedies

• Avoid Triggers: Identify and steer clear of substances that worsen your symptoms.
• Moisturize Frequently: Apply ointments and creams as suggested by the doctor to keep the skin hydrated.
• Protective Measures: Wear gloves and clothing when handling irritants and chemicals.
• Stress Management: Stress can exacerbate eczema, so finding ways to manage stress is helpful.