ECZEMA
 Atopic dermatitis or eczema is a common recurring skin disease that is also called atopic eczema. One person in ten gets afflicted with eczema at some time in their life, typically in childhood.
Eczema is a type of dermatitis or inflammation of the skin’s upper layers. The term eczema is largely applied to a variety of persistent skin rashes. It is characterized by redness, dryness, itching, and skin edema. Crusting, blistering, flaking, oozing, cracking and bleeding also occur.
In some cases, allergens in the diet (cow’s milk proteins and preservatives like nitrites, sodium benzoate) may contribute to the worsening of eczema. Identifying these allergens can help to treat eczema.
During an eczema flare-up, antihistamine medication is given to reduce the itching. Corticosteroids are also prescribed. Dermatitis is treated with glucocorticoid (a corticosteroid steroid) ointment or cream. Mild to moderate eczema is dealt with a weak steroid (e.g. hydrocortisone or desonide). While more acute cases require a higher strength steroid (e.g. Clobetasol propionate).
CAUSES
There are no specific causes of eczema, but the predisposition to acquire it is largely hereditary or handed down through the family. Some irritants like chemicals or solvents, tobacco smoke, and the weather can provoke eczema. Allergens such as moulds, dust mites, pets and plant pollens can also trigger an outbreak. Other factors that can trigger eczema are stress, certain foods like wheat and dairy products, nuts, citrus fruits, chemical food additives, eggs and preservatives.
DIAGNOSIS & SYMPTOMS
A diagnosis is based on the appearance of inflamed and itchy skin in sensitive areas such as chest, face and other skin creases.Given the many possible causes for eczema flare-ups, a doctor is likely to establish a number of other factors first before making a conclusion:
- Dietary preferences
- Family history
- Allergic tendencies
- Lifestyle habits
- Any chemical or material contact in the home and workplace
- Any prescribed medicine intake
Eczema symptoms vary from person to person:
- Dry and itchy skin
- Rashes on the arms, cheeks and legs
- Cracks behind the ears or in other skin folds
- Thick and leathery skin
- Small bumps on the skin
- Red and scaly skin
- Crusting, cracking, oozing or scaling of the skin
TEST AND TREATMENT
Test
Radioallergosorbent Test (RAST) or a Paper Radioimmunosorbent Test (PRIST)—Blood is combined separately with many diverse allergens and the antibody levels are measured. A high level indicates allergy to the substance.
Skin Patch Testing—The alleged irritant is applied to the skin and held in place with an adhesive patch. Another patch with no substance is also used as a control. The patch is removed after 24 to 48 hours. A red and swollen skin under the patch indicates an allergy to the substance.
Treatments
Topical Steroids—The strength used will depend on the eczema’s stage and location. In chronic cases, ointment and cream bases are both appropriate. Strong corticosteroids can be used as a temporary measure to get initial control. It is then changed to a weaker steroid suitable for the condition.
Ichthammol and Tar Preparations (0.5-1%)—Bandages soaked in Ichthammol is an old remedy still used in the U.K. for treating childhood eczema. Tar/ steroid-soaked bandages are useful for recurring lichenified eczema as tar reduces itchiness.
Control of Infections—Antibiotics like cloxacillin or erythromycin can control infection that frequently causes eczema.
Systemic Corticosteroid—A short course of this is effective in controlling severe eczema. This should not be administered to those in their puberty years.
Systemic Antihistamines—Optional doses can be given during episodes of excessive scratching.
Hospitalization—A regular and thorough treatment in a hospital can be very helpful in severe cases for the patient to be removed from his environment and its potential trigger causes.
Alternative Treatments—Patients who failed to respond to conventional treatments try the application of evening primrose oil (which contains linoleic acid, effective in reducing erythema); Chinese herbs; and sodium cromoglycate.
COMPLICATIONS
Infection—Staph, aureus, fungal, and viral infections are common in eczema. Eczema herpeticum (herpes simplex) infection in eczematous skin is distinguished by multiple, sore, vesiculopustular lesions; and often become hemorrhagic, wrinkled and crusted.
Exfoliative Dermatitis—A severe problem that requires hospitalization.
Eye—Extensive use of systemic steroid and topical steroid around the eyes results in increased prevalence of anterior subcapsular cataract.
PREVENTION
- The patches used for treatment are typically dry and itchy so it is best to apply moisturizers right after bathing.
- List down what substances irritate your skin and limit contact with them
- Avoid heat and sweating as these are the most common triggers if the scratch-itch cycle
- Reduce stress
STATISTICS
From the Center for Disease Control, 2005:
- There are 29.8 million office appointments to dermatologists annually
- There were approximately 13 million office appointments to physicians for skin rash
From the National Institutes of Health, 03-4272, 2003:
- More than 15 million people in the U.S. have symptoms of eczema.
- 65% of patients acquire symptoms in the first year of life.
- 90% of patients develop symptoms before the age of 5.
- 10%-20% of all infants have eczema and nearly half of these children will get
- better by the time they are between five and fifteen years of age.
75% of children with atopic dermatitis go on to develop hay fever or asthma. |
