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Eczema

Atopic Dermatitis

Eczema is inflammation of the skin characterized by pruritic, edematous, erythematous skin rashes. It is a common condition affecting millions of individuals across the globe.


Presentation

Eczema is of several types and the signs and symptoms vary with each condition [6]. However, there are certain common manifestations of eczema that remain the same irrespective of the type of condition. Some of the common signs include redness of the skin, inflammation and pruritus. In some cases, the lesions may ooze and scarring can occur. The rashes that develop turn extremely itchy combined with dry and flaky skin making condition worse for individuals. The areas that are mostly affected include the face, hands, and folds of arms and back of knees.

Eruptions
  • In the eczematous drug eruptions, 3 the situation in regard to testing is much[jamanetwork.com]
  • Clinicians should be aware of the possibility for more extensive cutaneous eruption related to coxsackievirus A6 infection and the diagnostic methods required to determine the diagnosis. 2016 Wiley Periodicals, Inc.[ncbi.nlm.nih.gov]
  • […] oozing vesicular lesions which become scaly, crusted, or hardened ec·zem·a·tous play \ig-ˈze-mə-təs\ adjective See eczema defined for English-language learners See eczema defined for kids Origin of eczema New Latin, from Greek ekzema, from ekzein to erupt[web.archive.org]
  • But of all the local means for the removal of limited eczematous eruptions, none are equal to blistering them.[books.google.ro]
  • Dyshidrosislike eczematous eruptions with the use of intravenous immunoglobulin (IVIG) infusions have been reported.[emedicine.medscape.com]
Erythema
  • Skin examination revealed diffuse erythema, dander, itchy rash, and scratch. Chest contrast-enhanced computed tomography showed a heterogeneously enhanced irregular mass in the right lung.[ncbi.nlm.nih.gov]
  • Daily symptom scores that described the extent of itching, sleep disturbance, erythema, dryness, oozing, and edema were recorded on a scale of 0 to 4.[ncbi.nlm.nih.gov]
  • Generic term for inflammatory conditions of the skin, particularly with vesiculation in the acute stage, typically erythematous, edematous, papular, and crusting; followed often by lichenification and scaling and occasionally by duskiness of the erythema[medical-dictionary.thefreedictionary.com]
  • Outcome measures included change in itching from baseline (day 1) to study days 4-8 and 9-15, and change in otoscopic signs (erythema, oedema, and scaling) from baseline to the end of treatment (day 8) and end of follow-up (day 15).[ncbi.nlm.nih.gov]
  • Eczema (dermatitis): A particular type of inflammatory reaction of the skin in which there is erythema (reddening), edema (swelling), papules ( bumps ), and crusting of the skin followed, finally, by lichenification (thickening) and scaling of the skin[medicinenet.com]
Cradle Cap
  • Infantile seborrhoeic dermatitis Infantile seborrhoeic dermatitis causes cradle cap (diffuse, greasy scaling on scalp). The rash may spread to affect armpit and groin folds (a type of napkin dermatitis ).[dermnetnz.org]
  • In infants younger than 1 month of age, seborrheic dermatitis may produce a thick, yellow, crusted scalp rash (cradle cap) and sometimes yellow scaling behind the ears and red pimples on the face.[merckmanuals.com]
  • People of any age can develop seborrheic dermatitis including infants (known as “cradle cap”). It is slightly more common in men than women.[nationaleczema.org]
  • 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.[onhealth.com]
Insect Bite
  • Nummular dermatitis is a coin-shaped scaly patch or sore that may occur after an injury such an insect bite, abrasion, or burn . Seborrheic dermatitis ( seborrheic eczema ) causes yellow, flaky patches, usually on the scalp .[emedicinehealth.com]
  • […] of irritated skin most commonly on the arms, back, buttocks, and lower legs that may be crusted, scaling, and extremely itchy Neurodermatitis -- scaly patches of skin on the head, lower legs, wrists, or forearms caused by a localized itch (such as an insect[medicinenet.com]
  • The primary itch can be due to: Atopic eczema Contact eczema Venous eczema Psoriasis Lichen planus Fungal infection Insect bite Neuropathy (radiculopathy) eg brachioradial pruritus Itch due to neuropathy appears to be due to hyperexcitable sensory nerve[web.archive.org]
  • The primary itch can be due to: Atopic eczema Contact eczema Venous eczema Psoriasis Lichen planus Fungal infection Insect bite Neuropathy ( radiculopathy ) eg, brachioradial pruritus.[dermnetnz.org]
  • It is thought to be “triggered” by things like insect bites, reactions to skin inflammation, or dry skin in the winter.[nationaleczema.org]
Dermatologic Disorder
  • Dermatologic disorders. In: McPhee SJ, et al. Current Medical Diagnosis and Treatment. 49th ed. New York, N.Y.: McGraw-Hill Medical; 2010. . Accessed March 17, 2010. Witch hazel. Natural Medicines Comprehensive Database. . Accessed March 17, 2010.[web.archive.org]
  • Our clinicians provide comprehensive, expert care for common childhood skin diseases, as well as rare dermatologic disorders. Eczema Care for your child that has eczema with this Helping Hand.[nationwidechildrens.org]
  • Herbal Treatment for Dermatologic Disorders. In: Benzie IFF, Wachtel-Galor S, editors. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. Boca Raton (FL): CRC Press/Taylor & Francis; 2011. Chapter 18.[dermnetnz.org]
  • Philip Shenefelt, Herbal Treatment for Dermatologic Disorders, Herbal Medicine, 10.1201/b10787-19, (383-403), (2011). S. M. Breathnach, C. H. Smith, R. J. G. Chalmers and R. J. Hay, Systemic Therapy, Rook's Textbook of Dermatology, (1-53), (2010).[doi.org]
  • Implications for Clinical Practice Occupational health nurses should encourage workers to discontinue smoking because smoking contributes to irritant dermatitis as well as other dermatological disorders such as psoriasis, which impairs the skin’s barrier[doi.org]

Workup

Diagnosis of eczema initially begins with collecting past medical history of the affected individual followed by careful physical examination of the skin rashes. Many a times, diagnosis of eczema is mistaken for food allergies and it is therefore required that more methods need to be carried out for arriving at a definite conclusion. In view of this, the practice of conducting skin biopsy for diagnosing eczema is widely accepted [7].

Treatment

Eczema cannot be cured; the symptoms however can be controlled with appropriate treatment regime. The following are the various methods administered for treating eczema and its several forms:

  • Maintaining hygiene: Affected individuals are recommended to keep themselves clean and dry. Bathing regularly once or twice day is advised. It is also necessary to avoid application of soap or other cleaning agents on the affected area as these would further aggravate the existing condition by drying the skin.
  • Moisturizers: Individuals suffering from eczema are advised to apply moisturizers once or twice day to keep their skin moisturized and hydrated all day long. This would prevent drying of the skin which in turn would prevent flare ups [8].
  • Medications: Medications such as corticosteroids are recommended only when there are flare ups. If the condition can be well managed with moisturizers then corticosteroids may not necessary. Depending on the severity of the condition, potency of the drugs is adjusted.
  • Immunosupressants: These are given for short periods to control the skin condition. FDA has warned against use of such medications for prolong periods as these are known to have adverse side effects [9].
  • Phototherapy: Phototherapy or light therapy using ultraviolet rays have also been used for effective management of eczema [10].

Prognosis

The prognosis of the disease condition is favorable with topical ointments and ultraviolet therapy. Children, who develop eczema often, undergo complete recovery by the time they reach adolescence. However, in about 2% of cases, treatments with topical ointments and ultraviolet light therapy do not work.

Etiology

The exact etiology behind the development of eczema still remains unclear. However, researchers have postulated the fact that interplay of both environment and genetic factors can play a major role in causation of eczema [2]. Exposure to unhygienic or dirty environment can trigger the development of skin rashes. Individuals who are allergic to dust mites can also suffer from eczema. Several genes have been identified to play foul in development of eczema; the important one being filaggrin [3].

Epidemiology

Eczema is the most common type of skin disease in children. It is known to affect 5 – 20% children across the globe. About 11% of the population of United States suffers from atopic dermatitis, a form of eczema [4]. In the year 2010, eczema affected as much as 230 million individuals across the globe.

Sex distribution
Age distribution

Pathophysiology

The actual mechanism that triggers the epidermal layer of the skin to develop rash is not yet clear. The epidermis is the primary line of defense that safeguards the body from various forms of irritants and pollutants. When this layer is intact, no type of allergens can do any harm to the body [5].

In the condition of eczema, the skin loses its natural ability to retain moisture causing the skin to become dry and flaky. Such a development can cause the epidermal layer to get damaged by pollutants and allergic components. Certain immunity factors can also cause eczema. It has been seen that individuals with eczema have elevated levels of serum IgE.

Prevention

So far no guidelines have been designed for preventing eczema. There have been several misconceptions that mother’s diet during pregnancy has some effects on children with eczema. However, there is no such evidence proving that changing one’s diet during pregnancy can prevent development of eczema in children.

Individuals suffering from eczema are advised against receiving the small pox vaccination as they are prone to develop fatal complication of eczema known as eczema vaccinatum.

Summary

Eczema is not a contagious disease condition and can be easily managed and controlled by following a proper treatment regime. Sometimes eczema is used for describing atopic dermatitis as well as atopic eczema. In certain language, eczema is used interchangeably with dermatitis; but in some other cases, eczema means a chronic condition, whereas dermatitis refers to an acute one. However, both eczema and dermatitis are skin conditions wherein the skin develops pruritic rashes that tend to turn red and swell in course of time [1].

Patient Information

Definition

Eczema is a skin disease characterized by dry and red, itchy skin. The disease is also known as dermatitis and is not contagious in nature. Atopic dermatitis is one of the most common forms of eczema. Such a type of skin condition cannot be cured; but the symptoms can be managed well by following a proper treatment regime.

Cause

The exact factors that trigger the development of eczema are yet to be figured out. It is however thought that environment and genetic factors have major role to play in causation of this skin condition. Unhygienic conditions and certain allergens are known to play foul in causation of eczema.

Symptoms

Symptoms of eczema include dry and flaky skin that gets extremely itchy and becomes red and swollen over a period of time. Areas most commonly affected include back of the knees, folds of the arms, face and the neck region.

Diagnosis

Many a times a thorough physical examination is enough for diagnosing eczema. However, in certain cases skin biopsy may also be required for confirming the skin disease.

Treatment

Maintaining appropriate hygiene can help prevent eczema flare ups. In addition, application of moisturizers on the affected area goes a long way in managing the symptoms of eczema. In severe cases, corticosteroids and immunosupressants may also be administered to control the symptoms.

References

Article

  1. Langan SM, Williams HC. What causes worsening of eczema? A systematic review. Br J Dermatol 2006; 155:504.
  2. Wu Chang M. Journal Watch, Review of Atopic Dermatitis. Apr 2 2008.
  3. McGrath JA, Uitto J. The filaggrin story: novel insights into skin-barrier function and disease. Trends Mol Med. Jan 2008;14(1):20-7.
  4. Shaw TE, Currie GP, Koudelka CW, Simpson EL. Eczema prevalence in the United States: data from the 2003 National Survey of Children's Health. J Invest Dermatol 2011; 131:67.
  5. Hon KL, Leung AK, Barankin B. Barrier Repair Therapy in Atopic Dermatitis: An Overview. Am J ClinDermatol. Jun 12 2013
  6. Williams H, Robertson C, Stewart A, et al. Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. J Allergy ClinImmunol 1999; 103:125.
  7. Brenninkmeijer EE, Schram ME, Leeflang MM, et al. Diagnostic criteria for atopic dermatitis: a systematic review. Br J Dermatol 2008; 158:754.
  8. Miller DW, Koch SB, Yentzer BA, et al. An over-the-counter moisturizer is as clinically effective as, and more cost-effective than, prescription barrier creams in the treatment of children with mild-to-moderate atopic dermatitis: a randomized, controlled trial. J Drugs Dermatol 2011; 10:531.
  9. Grimalt R, Mengeaud V, Cambazard F. The steroid-sparing effect of an emollient therapy in infants with atopic dermatitis: a randomized controlled study. Dermatology. 2007;214(1):61-7.
  10. Meduri NB, Vandergriff T, Rasmussen H, Jacobe H. Phototherapy in the management of atopic dermatitis: a systematic review. PhotodermatolPhotoimmunolPhotomed 2007; 23:106.

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Last updated: 2018-11-14 08:27