ECZEMA

Overview

The term “eczema” is derived from the Greek language. It means “to boil out.” The most common form of eczema is Atopic dermatitis. In this condition, the skin becomes inflamed (red), itchy, dry and cracked. It is more common in newborns and young children and often develops in children below one year of age. It affects the males and females equally. You cannot catch eczema by coming in contact with someone who has it as it is “not contagious.”
In infantile eczema, certain self-care measures can improve the rash in infants such as moisturizing your baby’s skin with ointments and creams, avoiding exposure of the baby to extreme temperatures and also avoiding the skin irritants responsible for the rash.
Eczema is a chronic (long-standing) condition, and as the children grow older, it may get cleared completely. It can also appear behind the knees and inside the elbows of adults, teenagers and children. Rarely, it can first appear during puberty in teenagers. Asthmatic patients and patients with seasonal allergies such as hay fever are more prone to eczema.
Allergic contact dermatitis and irritant dermatitis are a part of eczematous dermatoses. Allergic contact dermatitis is cell-mediated allergy caused by a common substance such as nickel or poison oak and irritant dermatitis is caused by excessive exposure to harsh chemicals, scabies infestations, ringworm (fungal infections), asteatosis (very dry skin), dyshidrosis, seborrheic dermatitis and nummular dermatitis. In acute cases, many fluid-filled lesions develop called vesicles, when they break, the watery or yellowish fluid leaks out and forms crusts on the skin. These vesicles can be observed under the microscope in the case of older lesions.
Eczema is not an allergic condition. But in few children taking certain dairy foods such as eggs, milk and nuts may trigger eczema and the reason is unknown. Complications like neurodermatitis, asthma and hay fever, sleep problems and skin infections may occur if eczema is not treated appropriately.
Eczema can affect your quality of life especially when you have a visible rash and itching sensation. Self-care measures and few treatments can relieve eczema to some extent and prevent the new outbreaks but it has no permanent cure. A few self-care measures include moisturizing the skin regularly, application of medicated creams or ointments and also avoiding harsh chemical soaps.
The diagnosis of eczema is done by examination of your skin and reviewing your medical history by your family physician. The cause of eczema has to be identified. If a certain food is suspected to cause the eczema rash, then that food product must be avoided. It can be treated with steroid creams, light therapy, oral medications and lifestyle modifications.

Causes

It is a hereditary condition and runs in families. Many factors may be responsible for eczemas like defects in the skin barrier, an overactive immune system and, few people have extra sensitive skin (when genes for eczema run in the family).
Many patients with atopic dermatitis have elevated IgE antibody (immunoglobulin E). Defective cell-mediated immunity and a variety of abnormal immunologic findings are often observed in these patients. This causes difficulty in fighting certain bacteria, fungi, and virus.

Eczema can be caused by a number of factors that include

• Abnormal function of the immune system
• Genetics
• Environment (Exposure to dry and harsh climates)
• Defects in the skin barrier (Prolonged exposure to water can also trigger eczema )
• Sensitive skin

Eczema may be triggered by many factors which may flare-up certain conditions like bacterial infections, flu and allergic reaction to pollen, mold. They result in a weakened immune system.

Factors that may trigger eczema are:

• Stress
• Dry and cold climates
• Exposure to high air pollutants
• Sweat and heat
• Contact with irritating substances such as synthetic and woolen fabrics
• Dry and dehydrated (scaly) skin
• Others include perfume, makeup, soap, dust, sand and cigarette smoke
• Certain solvents and detergents, chlorine

Symptoms

1) Mostly itching occurs even before the skin rash appears. Dry patches of skin and open sores with crusts may develop along with itching sensation. When scratched, these sores may get infected.
2) Patches of itchy, red, thickened or cracked dry skin appear almost on the hands, face, neck, and legs. The inner creases of the knees and elbows are often involved in young children. In babies, the face can also be affected.
3) Different types of eczema tend to cause different symptoms but the most common symptoms are

• Scaling: The surface of the skin has rough, scaly appearance as the skin flakes.
• Itching: During eczema, the damage to the skin is often due to scratching and it can be intense.
• Fluid-filled and pus-filled blisters on the skin which can ooze and form crusts.
• Redness can be observed in the affected skin. It may bleed and appear blotchy.
• Cracking: Occasionally severely affected skin may develop painful, deep cracks, also called fissures.
• In nummular eczema, coin-shaped (round) rash is seen in one or more areas on the skin surface and is usually confused with fungal infections.
• In dyshidrotic eczema, red or clear fluid-filled bumps develop on the skin that appears “bubbly.” When scratched, the fluid leaks and gives a wet appearance on the skin.
• In steatotic eczema, patients have thin, dried, crack-appearing skin. It usually appears on the lower legs.
• Involvement of the palms and soles of the feet is not usual and may suggest allergic contact dermatitis and fungal infections like scabies. Eyelids are often puffy, red, and itchy.

4) The physician can be consulted if any of the following is experienced

• Eczema inflammation does not respond to the hydrocortisone creams that are occasionally used for relief.
• Development of rash and have a family history of asthma or eczema.
• Sometimes you may develop pus-filled blisters or light brown crusts over the patches of eczema. Antibiotic treatment may be required as it indicates a bacterial infection.
• You may have eczema-herpeticum when numerous, multiple, small fluid-filled blisters are developed over the patches of eczema. It is quite rare but a potentially serious complication.
• Eczema increases the risk of contracting herpes simplex virus. During the flare-up of eczema, genital sores or cold sores may develop when exposed to viral skin diseases.

Types Of Eczema

Atopic dermatitis is most commonly referred to as eczema. It is the most common and chronic type of eczema.

1) Atopic Dermatitis

It is the most common form of eczema. It can affect people of all the age groups.
It is caused by a combination of factors that include:

• Abnormal function of the immune system
• Genetics
• Environment (Exposure to dry and harsh climates)
• Defects in the skin barrier (Prolonged exposure to water can also trigger eczema )
• Sensitive skin (Usage of harsh soap, shampoos)
• Rough clothing (exposure to woolen and synthetic clothes)
• Household chemicals (solvents, detergents)
• Foods, dust mites and allergy

Treatments for atopic dermatitis include

1. Steroid ointments and creams can be used
2. Moisturizing products to lubricate and moisturize the skin
3. Antibiotics to treat infections
4. Drugs that control the immune system:

• Dupilumab (Dupixent) – It is an injection for every two weeks, and
• A non-steroidal ointment named crisaborole (Eucrisa), that is used twice a day topically.

5. UV (ultraviolet light) alone or in combination can be used with a drug called psoralen.

2) Contact Dermatitis

Burning, itching, and redness are commonly seen in this type. Hands are especially vulnerable to developing contact dermatitis. The types of contact dermatitis are :

1. Irritant contact dermatitis: This eczema develops when the skin gets damaged by frequent hand washing and chemicals coming into contact with an irritant on a daily basis or repeatedly).Steroid medications and using moisturizers on the skin is often the treatment for this type of dermatitis.
2. Allergic contact dermatitis: It develops after touching allergy-triggering substances such as nickel, poison ivy, and cosmetics. Steroid medications for local application can be prescribed.

Avoiding direct contact with the allergen or irritant is very important in either form of dermatitis. Protection of the hands can be done by wearing gloves. Antibiotics may be required for either type of dermatitis.

3) Dyshidrotic Dermatitis

This condition is more common in women. It usually affects the fingers, palms of the hand and soles of the feet. It causes itchy, scaly patches of skin that become red. The skin gets cracked and it is painful.

4) Nummular Dermatitis

Men are mostly affected. During winter, it causes dry, round patches of skin.

5) Seborrheic Dermatitis

It usually occurs behind the ears, on the sides of the nose, on the eyebrows, and particularly the scalp. It causes red, scaly rashes and is itchy.

6)  Stasis Dermatitis

Mostly in older populations, it occurs when the veins in the legs swell and leak fluid (due to poor circulation to the legs) causing swelling, itching and skin redness.

Complications

1) Neurodermatitis: An itchy scaly skin may develop as a patch. It is also known as lichen simplex chronicus. The surface of the skin that is affected may be thick, discolored and leathery. Itching in this condition is chronic.
2) Asthma and hay fever: In younger children, eczema may cause asthma and fever. The children develop these conditions usually by the age of 13 years.
3) Sleep problems: The quality of sleep may be affected due to the itch-scratch cycle.
4) Skin infections: Repeated scratching may result in open sores and cracks as a result of breaking of the skin. It may increase the risk of infection from viruses and bacteria, including the herpes virus.

Diagnosis

• It can be diagnosed typically with symptoms and signs of itching, dry, scaly skin or skin rash. You may consult your doctor if you develop any of these symptoms
• The diagnosis is made by your physician by examination of your skin and reviewing your medical history. The cause of eczema has to be identified. The samples of scale from the rash is required to be examined under a microscope to differentiate if it is a fungal infection (ringworm) or eczema. Biopsy (a portion of skin) of the skin is occasionally done but it is not helpful to distinguish between allergic contact dermatitis and atopic dermatitis.
• In a baby with eczema of soles and palms, skin scraping must be done to confirm eczema to differentiate it from scabies.
• If the physician suspects a certain food is causing the eczema rash, he may ask you to avoid the food product and ask you about the history of your food allergies.
• The physician may rule out other skin diseases and identify the conditions causing eczema by using other skin tests and also patch testing.
• Eczema commonly shows weeping which is not seen in psoriasis. Itching is also not present in psoriasis. Psoriasis involves the scalp often but eczema seldom involves the scalp.
• In individuals with dark skin, changes can take place in the skin during or after a flare and eczema rash may be a mixture of dark and light color. In individuals with lighter skin, active eczema may appear red and as it improves, it may be discolored. Total depigmentation of skin is seen in conditions such as vitiligo or discoid lupus.

Treatment

Eczema is a chronic skin condition and may take several months or years to control it. The treatment must be started early. The recognition of eczema is very important in the early stages. The recurrence of the disease is quite common and the symptoms may flare even after taking prolonged treatment.
Certain self-care measures like regular moisturizing of your skin do not help; then your physician may initiate your treatment with medications and therapy. Immunotherapy such as allergy shots usually does not work in eczema.

A) Medications

1) Creams: Corticosteroid cream or ointment may be prescribed by your doctor. The cream has to be applied in the affected area after moisturizing the skin. Thinning of skin and breakage of the skin may develop if this drug is overused. Corticosteroid creams help in control the itching and repair the skin.
Drugs such as tacrolimus (Protopic) and pimecrolimus (Elidel) can also be used in the treatment of eczema. They are calcineurin inhibitors that affect the immune system. Only children above 2 years of age and adults are advised to use this medication. The cream has to be applied directly after moisturizing your skin. After using these creams, avoid exposure to strong sunlight. These drugs have a potential risk of cancer.
For soothing of the itch, calamine lotion can be used on the skin. For management of an acute flare-up of the condition, it is more useful rather than as a long-term therapy.
2) Oral drugs: Prednisone (oral corticosteroid) is prescribed in severe cases of eczema. Oral drugs are effective but cannot be used for a long period. These drugs have potential side effects on prolonged use.
3) Antibiotics: In cases of open sores and cracks, your skin may have a bacterial infection. Your physician may prescribe you an antibiotic cream or tablet depending on the severity of the infection. Oral antibiotics take a short duration of time to treat an infection.
4) Injectables: Dupilumab (dupixent) is an injectable biologic (monoclonal antibody). It has been approved recently by The Food and Drug Administration (FDA). This medication is prescribed to patients suffering from a severe form of eczema. These drugs are expensive and no studies have proof of how well it helps patients with eczema.

B) Therapies

1) LIGHT THERAPY: It involves exposing the skin to controlled amounts of natural sunlight (PHOTOTHERAPY- simplest form of light therapy).
Other forms of light therapy include UVA (ultraviolet A) and UVB (ultraviolet B) that is used alone or in combination with oral drugs. It is used in patients in whom recurrence of eczema is commonly seen (In patients when topical treatment and oral drug usage is of no use).
Light therapy or phototherapy is not advised for children below 2 years of age and it is not done in infants.  Premature aging of the skin and cancers of the skin are the possible side effects of long-term light therapy.
2) DRESSINGS: Usage of wet dressings including wet bandages that are wrapped around the affected area, is an intensive and effective treatment for severe atopic dermatitis. Topical corticosteroids are also used in these dressings. Your doctor may advise you on the techniques of dressing at home or you need to visit the hospital regularly as it requires nursing expertise.
3) COUNSELING: In patients suffering from chronic eczema, talking to a counselor or a therapist may help them improve their quality of life. It can disrupt their sleep and even lead to depression in adolescents and young adults. They may get relief from frustration or embarrassment related to their skin condition.
4) In patients who have severe itching and scratches themselves, approaches like behavior modification and relaxation have better outcomes.
5) INFANT ECZEMA
Eczema in babies is known as Infantile eczema. Certain self-care measures can improve the rash in infants like moisturizing your baby’s skin with ointments, using bath oils and creams, avoiding baby’s exposure to extreme temperatures (exposure to sunlight for a long duration) and identifying & avoiding the skin irritants responsible for the rash.
Antibiotics may be prescribed by your physician when the skin rash looks infected with open sores and cracks. Oral antihistamines are also prescribed in children for itching and during nights to reduce sleep discomfort (helpful for nighttime itching).

C) Lifestyle And Home Remedies: Self-care measures can be taken to soothe inflamed skin and reduce itching

1) Anti-Itch cream: A non-prescription of 1% hydrocortisone cream can be used to relieve the itch temporarily. After moisturizing, it must be used only twice a day to the affected area. Once the symptoms improve, the cream must be used occasionally.
2) Moisturize your skin: You should moisturize your skin at least twice a day. In a child, ointments can be used twice in a day before going to school and before going to bed.
3) Anti-allergic (anti-itch) medications: Antihistamines like cetirizine or fexofenadine (Allegra) can be used once a day (preferably night time). If itching is severe, diphenhydramine (Benadryl) may be helpful.
4) Warm bath: Sprinkle baking soda and uncooked oatmeal in the bathtub. Soak yourself in the tub for 10 to 15 minutes and then pat dry. Moisturizer must be applied while the skin is still damp. Bleach baths may also help. The goal is to suppress colonization by Staphylococcus aureus bacteria during the flare. A ½ cup of bleach for a full bathtub of water is a good balance between generating an irritant dermatitis and getting the desired effect.
5) Apply bandages and do not scratch: If itching is present, covering the itchy area may be helpful. Trimming the nails and wearing gloves at night may be helpful in children to prevent scratching of the skin.
6) Wear cool, smooth-textured clothing: Wear appropriate clothing in hot and cold weather and also during exercises to prevent excessive sweating that may trigger the symptoms. Avoid clothes that are rough and scratchy.
7) Choose mild soaps: Non-alkaline soaps (without dyes or perfumes) with less chemical content must be used to reduce the exaggeration of symptoms.
8) Treat stress and anxiety: Improving your emotional health can help in the better quality of life. Anxiety and stress can worsen atopic dermatitis
9) Humidifier: A portable home humidifier can be used to add moisture to the air inside your home.

Prevention

• To prevent eczema, moisturizing creams or ointments can be used judiciously.
• Improved sleep and stress reduction (lifestyle changes).
• Cold weather can also dry out the skin and trigger flare-ups.
• Avoid irritants like harsh soaps, rough fabrics, and detergents
• Avoid scratching to prevent breaking of the skin (it can help to rub rather than scratch the itchy skin).

FAQs

1) Is eczema a common disease?

Eczema affects the population worldwide and is more common in low socio-economic countries because of poor living conditions. The most common type of eczema is atopic dermatitis. It is predisposed to genetic factors and allergic conditions like asthma and hay fever.

2) What are the common symptoms of eczema?

Intense itching is usually the first symptom of eczema. The rash appears later, itches and may burn, especially in the thin skin like the eyelids and is red and it has bumps of different sizes. When scratched it may ooze and become crusty.

3) What is the best treatment for eczema?

Hydrocortisone steroid creams can quickly reduce inflammation and relieve itching. Doctors recommend hydrocortisone cream to treat mild eczema. In sleep disturbance cases, oral medication is prescribed to provide relief from the scratch-itch cycle.
Apollo Hospitals has the best Eczema treatment doctors in India. To find the best Eczema doctors in your nearby city, visit the links below:

• Eczema treatment in Bangalore
• Eczema treatment in Chennai
• Eczema treatment in Hyderabad
• Eczema treatment in Delhi
• Eczema treatment in Mumbai
• Eczema treatment in Kolkata