Eczema

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eczemaEczema (atopic dermatitis) is a common, non-contagious, long-term skin condition that causes recurrent and extremely itchy rashes. It affects people of all ages worldwide, including infants and young children. The skin barrier plays an important function in the human body. It prevents loss of water from the body and protects it from external threats such as allergens, chemicals, and infectious agents. However, eczema damages this skin barrier and makes the skin prone to dryness and infection. Eczema does not occur because of the presence of dirt or infection in the skin. The condition usually does not harm the body. There is no cure for this condition; however, there are many treatments that can help people manage the symptoms of the condition.

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Symptoms

In general, eczema begins with an itchy skin that turns onto a rash on itching. The common signs and symptoms of eczema are as follows:




  • Deep lines in the palms appear red, particularly in people with lighter skin.

  • Bleeding or fluids oozing out of the skin because of constant scratching.

  • Pus-filled bumps or yellow crusts on the skin because of skin infections.

  • Trouble sleeping.

  • Depression and anxiety as people with eczema may feel ashamed or become self-conscious when other people look at the rash.


Although eczema can appear anywhere in the body, people typically develop unique rashes in specific areas at certain ages. The most common rashes and their symptoms at each stage of life are discussed below:


Infants


Dry, scaly, itchy rashes usually appear on the cheeks in infants. Moreover, the skin may develop bubbles that break out and ooze fluids. Because of rashes, the baby may act fussy because of discomfort. Moreover, they may have trouble sleeping and develop skin infections because of constant rubbing.


Children


The common areas in the skin in children that are prone to develop eczema-induced itchy, scaly rashes are as follows:




  • Creases of knees and elbows

  • Creases between the legs and buttocks

  • Wrists

  • Ankles

  • Neck


The affected area of the skin develops itchy, scaly patches. The skin may gradually thicken (leathery appearance), lighten, darken, get bumpy or develop knots.


Adults


Usually, adults with eczema have had the condition since childhood. It is very rare for eczema to begin after 18 years of age. Usually, adults develop relatively fewer rashes because of eczema. Unlike in infants and children, adults may have eczema around the eyes, which results in itchy, darker, and thickened skin around the eyes. The affected area of the skin in adults, who have had the condition for years, develops a leathery texture because of permanent thickening of the skin. The affected part of the skin may look lighter or darker than the surrounding healthy skin.

Causes And Risk Factors

Causes


According to research, eczema is possibly caused by one or a combination of the following factors:


Family history: People with a family history of eczema, hay fever, and asthma are at a higher risk of eczema. Moreover, genetics plays a role in causing eczema because changes in genes that control the production of a protein required to keep the skin healthy can cause eczema.


Immune system: Studies reported that the immune system in people with eczema overreacts to everyday things such as pollution and pollen. It leads to inflammation of the skin and flare-ups.


Place of stay: Climate does not cause eczema; however, it can be a contributing factor, especially in high-risk people. High-risk people who either live in mountainous regions with low temperature or places that turn cold and damp for a few months in a year are more prone to develop frequent cases of eczema. People living in warm, humid areas are less likely to develop eczema.


Environment: Substances in the environment do not directly cause eczema. However, people at high risk of developing eczema because of genetic factors are more likely to have eczema if they are frequently exposed to substances that can irritate the skin and trigger an allergic reaction.


Risk Factors


The following people are at an increased risk of eczema:




  • Females

  • Those diagnosed with asthma or hay fever

Prevention

There are no preventive measures as the exact cause of eczema is unclear. However, people who are prone to allergic reactions can reduce the chances of having eczema by avoiding substances or triggers that cause flare-ups.


Few studies have demonstrated breastfeeding for at least four months can reduce the risk of the development of eczema in children. The European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma, and Immunology recommends exclusive breastfeeding for a minimum of 4 months and up to 6 months as a primary prevention measure against allergic diseases such as eczema.

Diagnosis

Usually, doctors perform a physical examination to diagnose eczema. They will enquire about the symptoms and look for dryness and redness in the skin. In certain cases, one or more of the following tests may be performed to confirm the diagnosis or to rule out other possible skin conditions or diseases:

Patch test or allergy skin test: In this test, a small patch containing a small amount of allergen (substances that trigger an immune reaction) is placed on the skin to examine for reactions.

Skin biopsy: This test is primarily performed to check for other possible skin conditions with similar rashes.

Blood tests: It is performed to verify for other causes of rashes.

Treatment

Because currently there is no cure present to cure eczema, the treatment primarily focuses on controlling the symptoms and:




  • Provide relief from pain and itching

  • Reduce flare-ups

  • Moisten the skin and prevent drying

  • Prevent the worsening of eczema

  • Reduce the risk of skin infection

  • Prevent the thickening of the skin


The doctor may recommend one or more of the following treatment options to manage eczema:


Moisturisers (emollients): Emollient creams can help keep the skin moist. It should be applied to clean, dry skin every day. They should be used especially by people who live or work in heated/air-conditioned environments. Some people may require to try different emollient creams to identify the one best suited for their skin.


Coal tar: It should be used only under the doctor’s supervision. Coal tar helps to provide relief from itching; however, it has a characteristic strong smell and tends to stain clothes.


Anti-inflammatory ointments: The doctor may prescribe steroidal preparations (creams and lotions) of various strengths to identify the one with the lowest strength that provides adequate relief from the symptoms. Steroids meant to be taken by mouth are prescribed only in severe cases. Non-steroidal creams are effective when applied in the initial days of the appearance of symptoms.


Phototherapy: This treatment involves exposure of the skin to ultraviolet radiation. People with a severe case of eczema may require up to 30 sessions of treatment. However, the treatment is associated with serious side effects such as faster skin ageing and increased chances of skin cancer.


Other medicines: Antihistamine (oral use), antibiotics (oral use), immunomodulators (for application on the skin), and barrier restoration creams.

Lifestyle/management

People can incorporate the following changes in their lifestyle to ease the symptoms and get relief from discomfort:




  • Bathe using lukewarm water for 5-10 min daily as it helps to hydrate the skin.

  • Apply moisturiser on the skin after every bath or whenever the skin feels dry. Moisturisers work best when applied within 5 min of shower.

  • Avoid the use of creams and lotion that irritate the skin.


Certain fragrances and ingredients in creams and lotions can cause flare-ups on application. Hence, people prone to flare-ups should test different products before using them on a regular basis. One can test the product by




  • Applying a small amount of the product on the skin

  • Allowing the product to remain on the skin for about 24 h

  • Checking the skin after 24 h


Clear skin indicates that the product is less likely to trigger a flare-up.




  • Use fragrance-free skincare products.

  • Avoid wearing tight-fitting clothes or those made of wool to prevent flare-ups. People with eczema are advised to wear loose-fitting cotton clothes.

  • Use dye-free and fragrance-free detergents to wash clothes.

  • Newly bought clothes should be washed first with dye-free, detergent-free detergents. One should remove the tags and cover the seams because they can irritate the skin and trigger flare-ups.

  • Identify and avoid substances that trigger flare-ups or immune reaction.

  • Avoid exposure to extreme temperatures. High temperatures can cause sweating, while the cold temperature can dry the skin. Both these conditions can trigger a flare-up.

Prognosis And Complications

Prognosis


While the condition in many children subsides as they approach puberty, others continue to live with the condition. Adults are able to control and effectively manage the symptoms with the right combination of different treatment options and lifestyle changes. However, they are likely to experience flare-ups of symptoms throughout their life.


Complications


The following complications are associated with eczema:




  • Eye problems such as cataracts or eyelid dermatitis

  • Skin infections such as warts, herpes simplex virus or Staphylococcus aureus

  • Difficulty in maintaining relationships

References

1. American Academy of Dermatology Association. Eczema types: Atopic dermatitis overview [Internet]. Available at: https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis. Accessed on Feb 24, 2021.

2. NHS. Atopic eczema [Internet] [Updated Dec 5, 2019]. Available at: https://www.nhs.uk/conditions/atopic-eczema/. Accessed on Feb 24, 2021.

3. Johns Hopkins Medicine. Eczema [Internet]. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/eczema. Accessed on Feb 24, 2021.

4. Kanwar AJ. Skin barrier function. Indian J Med Res. 2018;147(1):117-118.

5. Cleveland Clinic. Eczema [Internet] [Updated Oct 28, 2020]. Available at: https://my.clevelandclinic.org/health/diseases/9998-eczema. Accessed on Feb 24, 2021.

6. American Academy of Dermatology Association. Eczema types: Atopic dermatitis symptoms [Internet]. Available at: https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis/symptoms. Accessed on Feb 24, 2021.

7. American Academy of Dermatology Association. Eczema types: Atopic dermatitis causes [Internet]. Available at: https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis/causes. Accessed on Feb 24, 2021.

8. Kim JH. Role of Breast-feeding in the Development of Atopic Dermatitis in Early Childhood. Allergy Asthma Immunol Res. 2017;9(4):285-287.

9. American Academy of Dermatology Association. Eczema types: Atopic dermatitis diagnosis and treatment [Internet]. Available at: https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis/atopic-dermatitis-treatment. Accessed on Feb 24, 2021.

10. BetterHealth Channel. Eczema (atopic dermatitis) [Internet] [Updated Jul, 2020]. Available at: https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/eczema-atopic-dermatitis#:~:text=Atopic%20dermatitis%20(eczema)%20is%20a,impetigo%2C%20cold%20sores%20and%20warts. Accessed on Feb 24, 2021.

11. American Academy of Dermatology Association. Eczema types: Atopic dermatitis diagnosis: Tips for coping [Internet]. Available at: https://www.aad.org/public/diseases/eczema/atopic-dermatitis-coping. Accessed on Feb 24, 2021.

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