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Eczema is a medical condition where the subject’s skin becomes red, inflamed, and itchy. It is also referred to as ‘dermatitis’. Dermatitis is an inflammation of the skin. It is a ‘noncontagious’ disease, meaning it cannot be spread through contact. It is not just a skin disorder but an immune system over-reaction. It is an incurable disease but with known measures to help manage them. It is a very common disease, with 10.1 per cent of the population suffers from some form of eczema in the US. It is more common in women than in men. There are several types of eczema, atopic eczema being the most common. Almost 7.2 per cent or 18 million adults suffer from atopic eczema. While the exact cause of eczema is still known, but researchers believe it is a combination of genes and external trigger.
Some known types of eczema include:
1. Atopic dermatitis
It is caused by malfunction of the immune system and lack of a protective barrier on the skin.
2. Contact dermatitis
It is usually caused by contact of skin with known allergens and irritants.
3. Dyshidrotic eczema
It is caused by exposure to allergens, generally near feet and hands.
4. Nummular eczema
It is caused by extremely dry skin and oozes fluid. Generally caused by the older
5. Stasis dermatitis
It is caused due to poor circulations to legs, resulting in swelling and leaking of
6. Seborrheic dermatitis
White or yellow flaky, greasy patches in places with more oil-producing glands, caused by a combination of genetics, hormones, and microorganisms on the skin.
Signs and Symptoms of Eczema
The symptoms can vary depending on age and type of eczema. However, they are consistent with itchiness, rashes, swelling of the skin. Children below the age of 5 are most susceptible to eczema due to low immunity. Almost half the people who develop eczema as a child continue to show symptoms as an adult. The symptoms generally occur in a cycle where it worsens and then reduces in severity.
- Symptoms in infants (less than two years old):
Rashes on cheeks and scalps, which inflate and release fluid.
- Symptoms in children
Rashes on creases of elbows, knees, neck, wrists, and between legs. Rashes can thicken in time, called lichenification, which develops knots and permanent itch.
- Symptoms in adults
Rashes appear on creases of the elbows, knees, and the nape of the neck. The skin becomes extremely dry and develops a permanent itch.The rash can also lead to skin infections.
Although the above symptoms are true for most cases, there are some symptoms which may occur in case of uncommon forms of eczema.
- Symptoms of dyshidrotic eczema
Deep-set blisters on the edges of the fingers, toes, palms,and soles of the feet. It also causes itching,redness,flaking, scaly, cracked skin, and pain.
- Symptoms of nummular eczema
Coin-shaped lesions on arms, legs, torso and/or hands which cause itching and burning. Red, scaly and inflamed skin around the lesions.
- Symptoms of seborrheic dermatitis
Greasy swollen red skin. It develops white or yellowish crusty flakes and causes itching.
- Symptoms of stasis dermatitis
Swelling of skin along with scaling and redness. It also develops an itch and in extreme cases may cause oozing and infections.
Causes of Eczema
Eczema is believed to be caused by an extreme reaction of the immune system to external factors causing inflammation. This reaction can also be due to a mutation in genes responsible for creating a protein called filaggrin. Filaggrin helps build a protective layer on top of our skin, sealing moisture and protecting from viruses and bacteria. The absence of which can cause dryness and itching. However, genetic mutation alone is not enough to cause eczema. Environmental factors also play a key role in causing this disease. Here are some external/environmental factors which may trigger a reaction:
1. Dry skin
When the skin becomes too dry, it leads to scaly, brittle, and tight skin which can flare up eczema.
These are everyday products which can cause an allergic reaction like dryness, burning, and inflammation. Some of the common irritants include cigarette smoke, soaps, handwashes, perfumes, household disinfectants, shampoos, and dyes.
Although unclear but emotional stress can also cause an eczema trigger. Increase in stress can cause eczema to flare up.
4. Climate and Sweating
Sweating and heat can also cause eczema to flare up in some cases. The increased dryness of air during winter or increased humidity during monsoons can also be a potent trigger.
Bacteria such as Staphylococcus aureus, certain kinds of fungi like ringworm, and viruses can cause eczema trigger.
Dust mites, pets, pollens, dandruff can also lead to eczema. Eczema flares up when one comes in contact with everyday materials which might cause an allergic reaction.
Certain hormones released by the body can also lead to eczema. Women during pregnancy or at certain times in the menstrual cycle release hormones which cause eczema.
Any food product which may cause an allergic reaction also leads to eczema. These may include dairy, eggs, nuts and seeds, soy, and wheat.
It is important to remember that just external factors will not cause eczema. The genetic mutation must also be present to cause it. External factors help in triggering eczema due to lowered skin immunity.
Diagnosis of Eczema
Medical consultation is extremely important to distinguish a case of eczema from common allergies and skin infections. Diagnostic tests include:
- Medical history:
History of symptoms, family, and personal history are studied to identify eczema. An allergist or dermatologist will inquire about the history of allergic conditions, including hay fever and asthma. They may also study the exposure to irritants, sleep habits and any causes of increased stress.
- Blood and Skin tests
Medial history may help in reaching a conclusion, blood and skin tests help in confirming and identifying the form of eczema. These tests include studying blood sample for high levels of antibodies and eosinophils, cells responsible for the immune reaction. A portion of the skin may be collected and studied to rule out other skin infections. Sometimes, a patch containing selected substances is applied to the back and studied after a period of 72 -96 hrs.
- Allergy tests
If eczema is confirmed, various tests are conducted to identify possible triggers that may cause a severe reaction. Patients are then advised to avoid such substances.
Treatment of Eczema
The holygrail of eczema treatment is good skincare practices such as bathing, moisturising, using prescribed medicines at specified intervals and avoiding triggers. Due to variations in eczemain different, there is no singular treatment or medicine for eczema, causing one to undergo several treatments and medications. Patience is key as treating eczema can extend throughout weeks or more. Some effective treatments include:
- Bathing and Moisturizing- Regular baths with a mild cleansing agent and moisturising right after, to lock the moisture in, is very important. Moisturized skin helps combat dryness and prevents eczema to flare up. The higher content of oil in a moisturiser, the more effective it is. Moisturising should not be limited to bath times, and one must moisturise the skin in regular intervals.
- Bleach Baths
Bleached baths can calm inflammation and reduce skin infections in people with moderate to an extreme case of eczema. Adding half a cup of standard, unconcentrated bleaching to about 40 gallons of lukewarm water is enough to prepare a bleach bath. However, one must consult with their healthcare provider to confirm the use of bleach baths. People with bleach sensitivities and allergic asthma which might aggravate due to chlorine fumes must be careful of bleach baths as it might flare up eczema.
- Wet Wrap Therapy
Wet wrap therapy helps to calm inflammation and rehydrate dry skin. They are best done after bathing and moisturising. To perform wet wrap therapy, dampen a clean cloth with warm water and wrap on the infected area. Then gently wrap a dry layer of cloth over the wet wrap and leave wrap for several hours or overnight.
- Topical medication
Topical steroids work by reducing skin inflammation. They also decrease redness by tightening the blood vessels near the skin. Topical steroids must be taken under strict guidance and should not be applied to sensitive areas like eyelids and genitals. Routine use of such steroids should be reserved for specials circumstances only. Prescription skin barrier protection medications help in retaining moisture and are made up of lipids and ceramides. They guard against irritants and prevent them from entering the skin.
Photo or light therapy is done by exposing infected are to ultraviolet B light using a walk-in or hand-held machine. It is believed to reduce inflammation and cell division.
- Immunosuppressant medication
Immunosuppressants work by suppressing the immune system and slowing down eczema symptoms by reducing inflammation. They are generally taken in the form of pills but can also be injected. However, these medications are not approved by the US Food and Drug Administration (FDA), labelling them as ‘off-books’ drugs.
Biological drugs or biologics are engineered from proteins derived from living cells or tissues and are taken by injection. They target a part of the immune system responsible for inflammation, reducing symptoms and redness.
Although eczema is itself incurable, there are specific treatment plans tailored for each case of eczema to help keep the disease in check. Even after the affected area appears to be healed, one must take care as it can become irritated again.