What is eczema?
Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition that has a repulsive appearance. It can affect anyone from children to older people, though you see it more commonly in children. Adult eczema most commonly develops in the 20s or over the age of 50 years.
The skin becomes dry and inflamed and itches a lot. There are scaly patches and blisters that can get infected. It is not contagious.
Many people with eczema often have comorbid conditions including hay fever, allergic asthma, and food allergies.
This skin condition is characterized by intervals of remission and flare-ups. Home remedies and medical treatment can help manage and prevent flares.
Eczema is fairly common and affects more than 31 million Americans. Even infants can get eczema and you see it in 10% to 20% of them. However, in nearly half of all infants diagnosed with eczema, the condition significantly improves, as they get older.
Types of eczema
Eczema is of several types:
- Atopic dermatitis. Atopic dermatitis, or atopic eczema, is the most common type. It is characterized by dry skin patches that become red and inflamed and itch a lot. You mostly find them in the creases of the elbows and knees and on the face, neck, and wrists.
- Contact dermatitis. This is an allergic skin reaction that occurs due to contact with an allergen, which the body’s immune system recognizes as foreign. It is characterized by dry, red, and itchy skin accompanied by a burning sensation.
- Dyshidrotic eczema. This skin condition causes small painful, deep-seated blisters on the palms of the hands and soles of the feet. It begins with itching and burning sensations at first. If not treated, the blisters can get infected.
- Neurodermatitis. Neurodermatitis is a skin condition characterized by scaling, raised and rough, itchy areas of skin. It typically occurs on the neck, wrists, forearms, legs, or groin area. It can be triggered by anything that irritates the skin, such as an insect or bug bite.
- Discoid eczema. This type manifests as circular patches that are crusted, scaly, and itchy. Though the cause of discoid eczema is unknown, it is attributed to having dry skin.
- Stasis dermatitis. Stasis dermatitis is a fairly common type of eczema that develops due to poor blood flow. Since poor blood flow usually develops in the lower legs, you will often find stasis dermatitis near the ankles. There is swelling of the legs that can cause redness and itchiness.
Causes
Medicine still does not know what causes eczema, but many medical experts believe that it develops due to a combination of genetic and environmental factors.
Children are more likely to develop eczema if a parent has it. The risk is higher if both parents have this condition.
Some environmental factors that can be responsible for this condition include:
- Irritants such as harsh soaps, detergents, shampoos, and disinfectants.
- Common allergens such as dust mites, pet animals, pollens, and mold
- Bacteria, viruses, and certain fungi. The most common bacteria to trigger eczema is Staphylococcus aureus.
- Extreme weather and humidity conditions can cause eczema. They include very hot and very cold weather, high and low humidity,
- Common foods that can cause this condition include dairy products, eggs, nuts and seeds, soy products, and wheat.
- Certain fabrics like wool or polyester
- Contact with metals, especially nickel, used in jewelry or utensils
- Hormonal changes in females can cause aggravation of eczema symptoms such as during pregnancy and at certain times in the menstrual cycle.
- Emotional stress can trigger an eczema flare-up but is not a cause.
Symptoms of eczema
Eczema symptoms are different for everyone. Although the two conditions are different, people often mistake symptoms of psoriasis for those of eczema.
Eczema almost always includes itchy skin, which can range from mild to moderate. Sometimes the itch is so severe that people scratch it until it bleeds. This is called the “itch-scratch cycle.”
Symptoms of eczema often include:
- Itching
- Dry and sensitive skin
- Inflammation and discoloration of the skin
- Scaly patches on the skin
- Oozing or crusting
- Swelling on the affected part
You might have all of these symptoms of eczema or only just some of them. The symptoms could go away or you could have flare-ups or your symptoms could go away entirely.
Diagnosis
To diagnose atopic dermatitis, your dermatologist will ask about your symptoms, examine your skin lesion, and take your medical history.
He will do tests to identify allergies and rule out other skin diseases such as psoriasis.
Patch testing
In patch testing of your skin, small amounts of different allergens are applied to your skin and then covered with patches for 48 hours. The patches are then removed, and the areas are examined for signs of a reaction. The dermatologist again checks the areas two days later for signs of a reaction.
Patch testing can help diagnose specific allergens that are causing your dermatitis.
How is eczema treated?
You should first try and identify the triggers that cause your eczema to flare up and you should avoid them. Your dermatologist will initiate treatment of atopic dermatitis with regular moisturizing and other skin-care tips.
If these don’t work, he will recommend medicated creams to control the itching and other symptoms.
Atopic dermatitis is chronic. You may need to try various treatments over months or years to control the symptoms. Treatment does not cure and even if it is successful, symptoms may flare up again.
Medications
Medicated creams for topical application to the skin. Various products are available in different strengths as creams, gels, and ointments. You apply them as directed, usually twice a day, before you moisturize. Do not use steroid products for too long as it can cause side effects, such as thinning skin. An ointment is preferred over a cream due to the high content of oil to water in lotions.
- Oral steroids. If topical treatments are not effective, the dermatologist may prescribe oral or injectable corticosteroids or immunosuppressants for short periods.
- Antibiotics. Your doctor may prescribe antibiotics if the eczema has become infected.
- Antihistamines: These meds are used at bedtime to control night-time itching but tend to cause drowsiness in some people.
- Topical calcineurin inhibitors. This drug suppresses the immune system, which reduces inflammation and helps prevent flares. Apply as directed before you moisturize and avoid strong sunlight after using these products. Examples include tacrolimus (Protopic) and pimecrolimus (Elidel).
- Phototherapy: This treatment is indicated in people whose eczema does not respond to topical treatments or experience flare again soon after the treatment. It involves exposure of the affected skin to UVA or UVB waves. Phototherapy is used to treat moderate dermatitis. It is also used in the treatment of psoriasis.
- Wet dressings. This therapy involves applying a corticosteroid ointment and wrapping the part with wet gauze covered with a layer of dry gauze. It is an effective therapy for severe eczema and is usually done in a hospital because it requires nursing expertise.
- The USA Food and Drug Administration (FDA) has approved two systemic biologics, dupilumab (Dupixent) and tralokinumab-ldrm (Adbry) to treat moderate to severe eczema. Biologics include a combination of topical and systemic treatments. They reduce exzema symptoms by blocking the action of specific proteins in the immune system that produce inflammation. For topical use, the FDA has approved topical JAK inhibitors and topical PDE4 inhibitors to treat eczema.
