Eczema Symptoms, Causes And Treatment

The word eczema is derived from the Greek word that means boiling. It is an inflammatory disease of skin in which itching and red patches or papules occur. The term eczema and dermatitis may be used interchangeably. These two diseases have the same clinical and histological entity. Eczema is an itchy condition in which an explosion of red erythematous patches occurs. Due to the progress of disease, the skin surface scratching leads to thickened and leathery. This condition is due to the continuous rubbing of the skin. Eczema is one of the forms of dermatitis. It develops in patients with serious allergic conditions such as hay fever. It is not a contagious disease. It does not spread from one person to another.

Types Of Eczema

There are six main types of eczema,

1. Contact Dermatitis

If the allergic condition occurs as a result of the reaction to a substance you are in contact with, then the condition is called contact dermatitis. There are two main types of contact dermatitis,

•  Allergic contact dermatitis (ACD)
•  Irritant contact dermatitis (ICD)

Allergic contact dermatitis is a type of intravenous hypersensitivity reaction. This reaction occurs as a result of your immune system reaction to an antigen. There are many substances that can cause this hypersensitivity reaction. For example, metals (nickel and cobalt), neomycin, hair dyes, rubber compounds, plants (poison ivory) and some fragrances. Irritant contact dermatitis is the most common form of occupational dermatitis. Because the occupation of the person is the risk factor in this type. Builders, hairdressers, gardeners, healthcare workers and chefs are more likely to get this disease. It is not caused by your immune system sensitivity. In this type, the permeability of skin epidermis is disturbed. Cell death or cell damage occurs in response to an irritant. Hand eczema is caused by irritant contact dermatitis.

2. Atopic eczema

It is the most common type of eczema in childhood. It is caused by a combination of genetic, immunological and environmental factors. People with atopic eczema develop other diseases such as hay fever and asthma. The skin epidermis has high affinity IgE receptors. These receptors have T helper cells that release cytokines and cause inflammation of skin. There are many aggravating factors such as soaps, detergents, foods, irritants, extreme temperature or cold and stress.

3. Stasis eczema

It is also called stasis dermatitis, gravitational dermatitis or varicose eczema. The most common symptom of stasis eczema is scaly red patches limited to the lower leg. It also causes skin discoloration, extreme leg discomfort and oedema. 

4. Asteatotic eczema

It is also called eczema craquele. The most common clinical features are dry or cracked skin mostly on the lower leg.  The chance of developing asteatotic eczema increases with age and low level of humidity in the atmosphere.

5. Seborrhoeic dermatitis

This type is limited to the areas in which sebum production is very high. It is due to the overgrowth of yeast Malassezia furfur. Pink yellow greasy patches develop in seborrhoeic dermatitis. It is most common in patients with other underlying diseases such as Parkinson disease and HIV infection.

6. Discoid eczema

It is also known as nummular dermatitis. In this type, diffused coin shaped red lesions develop.  It is most common in males of middle ages.

Symptoms

The most common clinical features of eczema are,

•  Itching
•  Red patches or papules
•  Thickened skin epidermis
•  Thick, lathery and scaly skin
•  Exaggerated skin markings
•  Severe rashes
•  Blisters
•  Bumps and Stings
•  Burns

Causes

The exact cause of eczema is still unknown. But there are so many factors that trigger or aggravate this condition. It is caused by the combination of genetics, environmental and immunological factors. Certain foods such as nuts, dairy products, eggs, gluten, citrus fruits and wheat can cause eczema. It is an inflammatory process in which oedema is formed in the skin epidermis. This oedema is present as fluid filled tiny blisters. The edges of these blisters grow together and form wounds or lesions.

Treatment

Emollients

First line treatment of eczema must include emollients. Emollients are used for the hydration and moisturization of skin. They contain oils or fats to soothe the skin that is aggravated by soap and bath products. Normal soaps are replaced by emollients soaps in patients with eczema.

Topical corticosteroids

Topical corticosteroids are used to reduce the inflammation of skin in eczema. There are different types of steroids that are used. These types depend upon the site, severity and type of eczema. Corticosteroids are available in the form of creams, ointments, and shower gel and shampoo formulations.  Ointments are oil based preparation while creams are water based. Ointments are preferred over creams because of its better absorption and almost no preservatives. The most common steroids used are hydrocortisone, betamethasone, fludroxycortide, mometasone, clobetasone butyrate and fluocinolone acetonide.

Antihistamines

Antihistamines are used for the sedative effect in pruritis. Pruritis is the most discomforting feature of eczema.

Imidazoles

Topical imidazoles play an effective role in the treatment of eczema and seborrhoeic dermatitis. It reduces the yeast Malassezia furfur on the skin. The most common imidazole used is ketoconazole.

Antibiotics

Your skin specialist can also prescribe an antibiotic in case of bacterial infection. Long term use of antibiotics is avoided due to the development of resistance.

Calcineurin Inhibitors

Calcineurin inhibitors are used to suppress the immune system. These drugs are effective, well tolerated and have minimal side effects in the long-term control of eczema. The most common drugs used are cyclosporine, tacrolimus and pimecrolimus.

Systemic therapies

Systemic therapies include systemic steroids, ciclosporin, methotrexate, azathioprine and mycophenolate mofetil.

Frequently Asked Questions

What are the complications of eczema?

Asthma, hay fever, skin infection and sleep disorders are the complications of eczema.

Why are children more prone to eczema?

Due to family history of asthma, hay fever and allergic conditions, children are more prone to eczema.