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Eczema

Hand Eczema, Nummular Eczema, Stasis Dermatitis, Asteatotic Eczema, Lichen Simplex Chronicus

What is Eczema?

Eczema is an inflammation of the skin. It is not life-threatening or contagious. However, it typically causes itchiness, discomfort and a dry, scaly rash. The terms “eczema” and “dermatitis” are usually used interchangeably. There are several types of eczema, but most people use the term to refer to the most common variety known as atopic dermatitis.

Eczema is a common condition that affects people of all ages and races. It usually begins early in life, typically before the age of 5, and often appears periodically throughout a person's lifetime. In some cases, the condition will improve over time. In other cases, it will remain chronic (ongoing). Although some children outgrow the condition, they usually are plagued with dry skin that is easily irritated for the rest of their lives.

Because the disease is intensely itchy, patients often have the urge to rub or scratch the affected area. However, this only makes the condition worse.

Several different triggers for eczema have been identified. They include:

  • Bacteria
  • Abrasive clothing (e.g., wool)
  • Consuming and handling certain foods
  • Illness
  • Jewelry
  • Physical or mental stress
  • Rubbing the skin
  • Soaps, detergents, lotions
  • Perfume
  • Sweating
  • Weather (hot, cold, humid or dry)
  • Exposure to skin irritants (e.g., solvents such as gasoline) or allergens (e.g., dust mites, pollen, mold, pet dander)
Eczema is often hereditary and may be found in other family members. People who suffer from severe eczema often also have hay fever or asthma, or have family members who do.

Almost 50% of occupational diseases are due to work-related skin injury. Examples of other skin disorders are contact dermatitis and atopic dermatitis, a common condition associated with allergies. Eczema may be associated with varicose veins and venous insufficiency in lower extremities.

Types and differences of eczema

There are several different types of eczema. They include:

Atopic dermatitis

The most common form of eczema. It may occur in association with allergies and frequently runs in families with a history of asthma or hay fever. It typically begins in infancy (where it is often related to food allergies) and varies in severity during childhood and adolescence before becoming less troublesome in adulthood. However, exposure to certain allergens or irritants can trigger an outbreak later in life. Stress can exacerbate atopic dermatitis. Some people use the term “atopic dermatitis” interchangeably with “eczema.”

Contact dermatitis

Results from direct skin contact with various irritants (irritant contact dermatitis) or allergens (allergic contact dermatitis). Irritants include laundry soap, skin soaps and cleaning products. Allergens include rubber, metals such as nickel, jewelry, perfume, cosmetics, hair dye, weeds such as poison ivy, and neomycin, an ingredient often found in topical antibiotic creams. A brief exposure to a small amount of allergen can cause contact dermatitis. However, it takes a more significant amount of an irritant – and a longer period of exposure – to trigger irritant contact dermatitis.

Neurodermatitis

Occurs when a tight garment or insect bite irritates the skin, leading to chronic scratching or rubbing and a subsequent rash that is dull red to brown, thickened and slightly scaly. Common locations include ankles, wrists, outer forearms or arms, and the back of the neck.

Seborrheic dermatitis

Common in people with oily skin or hair, it involves an overproduction of skin cells and the skin's natural oil (sebum). It may reoccur depending on the season of the year or whether the patient is under stress. People who have neurologic conditions such as Parkinson's disease or who are immunocompromised such as in HIV patients also are at risk for this form of eczema. Seborrheic dermatitis is often an inherited condition.

Stasis dermatitis

Occurs on the lower legs when fluid builds up in tissues just beneath the skin, thinning out the skin and interfering with the blood's ability to nourish the skin. Stasis dermatitis is associated with varicose veins and other chronic conditions in the legs.

Perioral dermatitis

Often associated with conditions such as rosacea, adult acne or seborrheic dermatitis of the skin around the mouth or nose. The precise cause is unknown, but exposure to makeup, moisturizers and dental products may be involved.

Latex dermatitis

Occurs when the skin comes into contact with latex, a fluid produced by rubber trees and found in gloves, balloons, condoms and other products.

Dyshidrotic dermatitis

An intensely itchy, chronic form of eczema that typically appears on the palms, fingers and soles of the feet. The cause of dyshidrotic dermatitis is unknown but may include allergies, exposure to irritants and stress. It often progresses to small, fluid-filled bumps, which peel off after one or two weeks. This leaves cracks in the skin that resolve slowly over time.

How is it diagnosed?

Eczema signs and symptoms

Skin affected by eczema has the following characteristics:

  • Itching (sometimes severe).
  • Small blisters with oozing.
  • Thickening and scaling from chronic inflammation.

The most common complaint of eczema is the itchiness (pruritus), with a scaly, wet or dry rash. The rash may be a new problem of short duration or a chronic condition.

Hand eczema is seen in persons with frequent exposure to hand washing, such as food handlers and health care workers, or any occupation that exposes the hands to moisture and soaps.

Nummular eczema occurs most frequently in middle-aged men. The cause is unknown but seems to be related to dry skin and exposure to irritants.

People with poor circulation and varicose veins can develop a condition called stasis eczema or dermatitis. Individuals will report dark red discoloration of the skin on the lower leg, ankle, and top of the foot.

Asteatotic eczema, also known as "winter itch," commonly occurs on the lower legs of elderly people during dry times of the year.

To diagnose eczema, a physician will perform a complete physical examination and compile a thorough medical history. Other tests may also be performed. For example, a physician may conduct patch testing that exposes a patient's skin to various substances to determine if any of the substances inflame the skin, which would be characteristic of contact dermatitis. Allergy testing may occasionally be necessary to identify allergens that may trigger atopic dermatitis.

A physician may also take a scraping of the rash and examine it under a microscope to make sure it is not caused by a fungus. Eczema is usually diagnosed if three conditions are present:

  • Characteristic scaly rash
  • Intense itching
  • Personal or family history of asthma, hay fever or other allergies

How is Eczema treated?

Treatment options for eczema may depend on the type of eczema being treated, and whether it manifests as dry and scaly lesions, dry and thickened lesions or weeping lesions. In general, the goal is to reduce skin inflammation, dryness and itchiness. Medications such as over-the-counter or prescription antihistamines, corticosteroids, antibiotics and antifungal topical creams or ointments may be used. The kinds of treatment are often similar for the different types of eczema. Therefore, in some cases distinguishing between the types is not necessary. Some patients with severe or chronic (ongoing) eczema may wish to consult a dermatologist for treatment.

Other treatments, according to type of eczema, include:

Atopic dermatitis

Corticosteroid creams and lotions are used to ease symptoms. Recently, topical medications called immunomodulators have been used to treat atopic dermatitis. They affect the immune system and help maintain normal skin texture while reducing flare-ups. Patients whose skin cracks open may use wet dressings with a mild astringent to help contract the skin, reduce secretions and prevent infection.

Contact dermatitis

Avoidance of the source of irritation or allergy is the best treatment. Corticosteroid creams or wet dressings provide moisture to the skin that may relieve redness and itching. It may take up to four weeks for this type of dermatitis to clear.

Neurodermatitis

Treatment is focused on getting the patient to avoid scratching or further aggravating the skin. Dressings, corticosteroid lotions and creams, and wet compresses may help soothe skin by reducing inflammation and relieving itch. Sedatives and tranquilizers are also sometimes used to prevent patients from scratching.

Seborrheic dermatitis

Patients are instructed to frequently shampoo while also carefully rinsing the scalp. A specific shampoo may be suggested that contains ingredients such as tar, zinc pyrithione and salicylic acid. Corticosteroid creams and lotions may soothe the skin and relieve itching.

Stasis dermatitis

Treatment focuses on preventing fluid from accumulating in the ankles and lower legs for extended periods. Patients may have to wear elastic support hose or require varicose vein surgery. Wet dressings can also soften the thickened skin and control infection.

Perioral dermatitis

Several months of treatment with oral antibiotics is typically recommended. A mild corticosteroid cream may also be prescribed.

Latex dermatitis

Avoidance is the best treatment for latex dermatitis. This entails ensuring that the patient does not use or come into contact with latex-based products.

Dyshidrotic dermatitis

Topical corticosteroids are usually used to control mild breakouts. More substantial breakouts can be controlled with oral steroids or treatments of PUVA phototherapy (ultraviolet light).

Patients with eczema may also need antibiotics or other treatments if they are diagnosed with an associated secondary infection.

Medications

  • Ointments containing coal tar or cortisone drugs to decrease inflammation. These may help more if used at night under occlusive plastic wrap.
  • Antihistamines to decrease itching.
  • Antibiotics for complicating infections, if they occur.
  • Sedatives or tranquilizers (rarely).
Deltasone (Prednisone), Prograf (Tacrolimus), Ilosone (Erythromycin), Sinequan (Doxepin), Atarax (Hydroxyzine), Periactin (Cyproheptadine), Decadron (Dexamethasone), Medrol (Methylprednisolone)

What might complicate it?

Secondary infection is very common from the Staphylococcal and Streptococcal bacteria.

Predicted outcome

As a chronic condition, episodes of eczema may be relieved by appropriate treatment but are prone to relapse and recurrence.

Alternatives

Contact dermatitis, fungal infections like tinea corporis, and scabies (lice) are other possibilities.

Appropriate specialists

Dermatologist, allergist, and immunologist.

Last updated 3 July 2021