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Eczema

Atopic Dermatitis

Eczema also known as dermatitis 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.

Dry Skin
  • Dry skin can lead to itchiness and leave skin irritated and flaky. Dry skin is often caused by a dry, cold climate.[aurorahealthcare.org]
  • For dry skin, lotions work as well as thick creams. Few children over age 8 or 9 like using heavy moisturizers such as thick creams, cocoa butter, and white petrolatum. However, these are best for treatment of dry skin associated with eczema.[childrenshospitaloakland.org]
  • Some people only have small patches of dry skin, but others may experience widespread red, inflamed skin all over the body.[nhs.uk]
  • Complications & Irritants Patients with eczema usually have sensitive and dry skin. Many patients find that during the winter months when the humidity is very low, the dryness and itchiness is worse.[luriechildrens.org]
  • They tend to have dry skin and the drier the skin, the more likely they are to scratch and aggravate the problem," Caplan explains.[uihc.org]
Eruptions
  • In addition, dyshidrosislike eczematous eruptions with the use of intravenous immunoglobulin infusions have been reported. Dyshidrosislike eczematous eruptions with the use of intravenous immunoglobulin (IVIG) infusions have been reported.[emedicine.medscape.com]
  • Although there is usually some inciting cause, the origin of the problem is entirely obscured by the eruption. Any of the eczematous eruptions can evolve into lichen simplex chronicus if rubbed long enough.[onhealth.com]
  • Synonym: Kaposi varicelliform eruption lichenoid eczema Eczema with thickening of the skin. eczema madidans Eczema marked by a raw, red surface covered with moisture. NUMMULAR ECZEMA nummular eczema Eczema with coin-shaped or oval lesions.[medical-dictionary.thefreedictionary.com]
  • Origin and Etymology of eczema New Latin, from Greek ekzema , from ekzein to erupt, from ex- out zein to boil — more at ex- , yeast ECZEMA Defined for English Language Learners Definition of eczema for English Language Learners medical : a skin disease[merriam-webster.com]
  • The second phase of this skin problem occurs most often between the ages of 4 and 10 years, and is characterized by circular, slightly raised, itchy and scaly eruptions on the face or trunk.[lifetimedermatology.com]
Insect Bite
  • bites or allergic reactions.[everydayhealth.com]
  • It is thought to be “triggered” by things like insect bites, reactions to skin inflammation, or dry skin in the winter.[nationaleczema.org]
  • It is caused by a localized itch, such as an insect bite. Nummular eczema : These show as circular patches of irritated skin that can be crusted, scaly, and itchy.[medicalnewstoday.com]
  • Symptoms In nummular eczema: round, coin-shaped spots form on your skin the spots may itch or become scaly Causes Nummular eczema can be triggered by a reaction to an insect bite, or by an allergic reaction to metals or chemicals.[healthline.com]
  • New patches may form where there was injury to the skin (such as an insect bite). Keeping skin moisturized can help prevent future flare-ups.[health.com]
Cradle Cap
  • 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]
  • It's sometimes confused with other skin conditions, such as seborrheic dermatitis (better known as "cradle cap"), psoriasis (a genetic disease that causes the skin to become scaly and inflamed), and contact dermatitis (caused by direct skin contact with[kidshealth.org]
  • This is different from “cradle cap” (also known as seborrheic dermatitis ), which produces redness and white or yellow flakes on the scalp. Treatment for scalp eczema may include a topical ointment applied to the rash.[health.com]
Erythema
  • 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]
  • Some common symptoms of atopic dermatitis: Dry, scaly skin Redness (erythema) Itching Cracks behind the ears A rash on the cheeks, arms and legs Open, crusted or “weepy” sores (usually during flare-ups) Read more about AD symptoms, triggers and types[nationaleczema.org]
  • Improvement in pruritus, erythema, vesicles, and hand dermatitis with fewer or no signs of relapse has been obtained after onabotulinumtoxinA injection. [ 2 ] Dyshidrotic eczema may be associated with atopy and familial atopy.[emedicine.medscape.com]

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.

Symptoms

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