Eczema occurs in different forms like general eczema, dyshidrotic eczema and nummular eczema. Your skin becomes dry and itchy and requires emollient use.

Eczema

Medilink Consultant clinic

Online Consultation

ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

Overview

<p dir="ltr">Eczema is a medical condition where the skin is inflamed or irritated. The most common type of eczema is atopic dermatitis or atopic eczema. When a person is atopic, they are more prone to getting allergic reactions and conditions. For example, asthma and hay fever.</p>

<p dir="ltr">Eczema affects 3% of adults, and 10% to 20% of infants in the United States<sup><a href="#accordion">[1]</a></sup>. Most children grow out of it by their 10th birthday, but some of them continue to have symptoms for the rest of their lives.</p>

<p dir="ltr">There is no cure for eczema, but people manage the symptoms and are advised to avoid the irritants. In addition, eczema is not contagious, so it does spread from one person to another.</p>

<p dir="ltr">The prevalence of eczema is highest in two-year-old (16.5%) children, and lowest in adults between thirty and thirty-nine (2.8%). The incidence of eczema was higher in male infants and male adults above the age of seventy. It was also noted that eczema was common in black and Asian ethnic groups and not in people of the white ethnicity<sup><a href="#accordion">[2]</a></sup>.</p>

<p dir="ltr">Atopic dermatitis makes the skin itchy and red. It is very common in kids, but can happen at any age. It is a chronic condition and flares up periodically. In addition, those affected may also have <a href="https://www.merisehat.pk/disease/asthma" target="_blank">asthma </a>or hay fever.&nbsp;</p>

<p dir="ltr">Although there is no cure for atopic dermatitis, treatment and self-care can prevent the symptoms and new outbreaks. For example, patients with eczema should not use harsh soaps, moisturise regularly, and apply eczema creams or ointments.</p>

<p dir="ltr" style="text-align:justify">&nbsp;</p>

<p dir="ltr">Eczema isn&rsquo;t contagious. However, the cause is not fully known, and researchers are still understanding its triggers.&nbsp;</p>

<p dir="ltr">However, it is well known that allergens and irritants switch on the immune system, producing inflammation. This inflammation gives rise to the symptoms of most types of eczema.&nbsp;</p>

<p dir="ltr">There are seven types of eczema:</p>

<p dir="ltr">&nbsp;</p>

<h5 dir="ltr"><strong>1. Atopic Dermatitis</strong></h5>

<p dir="ltr">This is the most common form of eczema and is linked with other allergic disorders, for example, <a href="https://www.merisehat.pk/disease/asthma" target="_blank">asthma </a>and hay fever. Moreover, it usually starts during childhood.<br />
&nbsp;</p>

<h5 dir="ltr"><strong>2. Contact Dermatitis</strong></h5>

<p dir="ltr">Almost every person gets contact dermatitis once in their lives when their skin encounters the triggers. The triggers are unique and vary in the two types:</p>

<ul dir="ltr">
	<li><strong>Irritant Dermatitis</strong></li>
</ul>

<p dir="ltr">It is the most common and occurs in people with atopic dermatitis. The triggers are soap, skincare, jewelry with nickel, and detergents.</p>

<ul dir="ltr">
	<li><strong>Allergic Dermatitis</strong></li>
</ul>

<p dir="ltr">When your skin encounters things that you are allergic to, allergic dermatitis flares up. The common allergens are nickel, poison ivy, fragrances, rubber, latex, thimerosal, and beauty products. Moreover, in some people, even sunlight can trigger it.</p>

<p dir="ltr">&nbsp;</p>

<h5 dir="ltr"><strong>3. Dyshidrotic Eczema</strong></h5>

<p dir="ltr">Although dyshidrotic eczema is less common, it is very challenging. It causes outbreaks of tiny blisters on the hands, palms, sides of fingers, and soles of the feet. Sweating and metallic irritants can trigger it.</p>

<p dir="ltr">&nbsp;</p>

<h5 dir="ltr"><strong>4. Neurodermatitis</strong></h5>

<p dir="ltr">Neurodermatitis only causes one or two patches of eczema around the nape, arm, or leg. The risk factors are other forms of eczema. For example, atopic dermatitis and contact dermatitis. Furthermore, very dry skin can also cause it. It is also linked with anxiety and <a href="https://www.merisehat.pk/disease/ocd-obsessive-compulsive-disorder" target="_blank">OCD (obsessive-compulsive disorder)</a>. Women between the age of thirty and fifty have a higher chance of getting it.</p>

<p dir="ltr">&nbsp;</p>

<h5 dir="ltr"><strong>5. Nummular Eczema</strong></h5>

<p dir="ltr">It is a coined shaped eczema that occurs after an injury or insect bite. People who have a family history of atopic dermatitis, <a href="https://www.merisehat.pk/disease/asthma" target="_blank">asthma</a>, or allergies have a higher chance of getting nummular eczema.</p>

<p dir="ltr">&nbsp;</p>

<h5 dir="ltr"><strong>6. Seborrheic Dermatitis</strong></h5>

<p dir="ltr">Seborrheic dermatitis occurs in areas of oil glands. For example, it&rsquo;s called dandruff on the scalp. It can happen after a severe reaction to high Malassezia yeast content, which is a common skin organism. The other conditions that it is linked to are psoriasis, rosacea, and other diseases.</p>

<p dir="ltr">&nbsp;</p>

<h5 dir="ltr"><strong>7. Stasis Dermatitis</strong></h5>

<p dir="ltr">Poor blood flow can lead to stasis dermatitis in the lower legs. While other forms of eczema are linked to genes, this type is not.&nbsp;</p>

<p dir="ltr">Lifestyle habits, for example being overweight, can increase the chances of stasis dermatitis.<br />
&nbsp;</p>

<p dir="ltr">Having more than one type of eczema at the same time is possible. Each type has its treatment and triggers. Therefore, consulting a healthcare provider who specializes in the treatment of eczema is important.</p>

<p dir="ltr">Dermatologists can identify the type, and treat or prevent flare-ups.</p>

<div>&nbsp;</div>

Signs and Symptoms

<p dir="ltr">The symptoms vary based on the person&rsquo;s age and the severity of the condition. People with atopic dermatitis have fluctuating symptoms. At some point, their symptoms can worsen and at another, they improve or clear up.</p>

<p dir="ltr">Following are the differences between the symptoms and their types:</p>

<p dir="ltr">&nbsp;</p>

<h5 dir="ltr"><strong>General Eczema</strong></h5>

<p dir="ltr">The symptoms of general eczema are usually mild, and the most common symptoms include:</p>

<ul>
	<li>Dry skin</li>
	<li>Scaly skin</li>
	<li>Itching</li>
	<li>Open or crusted sores</li>
</ul>

<p dir="ltr">People with severe eczema require an intensive treatment regime to relieve their symptoms. Moreover, rigorous, or continuous scratching can make it worse and cause skin infections.<br />
&nbsp;</p>

<h5 dir="ltr"><strong>Eczema In Black Ethnicities</strong></h5>

<p dir="ltr">Eczema is commonly categorized as bright red and bumpy patches on the skin.&nbsp;</p>

<p dir="ltr">While eczema impacts all skin colors and ethnicities, in black ethnicities, eczema appears differently. It is difficult to identify because the redness is obscured on dark skin. Therefore, it appears dark brown, ash grey, and purple, which can also lead to misdiagnosis or delay in diagnosis.</p>

<p dir="ltr">Eczema and atopic dermatitis, are more common in African Americans, especially children<sup><a href="#accordion">[3]</a></sup>. The inflammation and itching also require higher doses of medications for relief. Furthermore, they tend to develop more severe cases in comparison with white children and tend to miss school more often compared to white children.&nbsp;</p>

<p dir="ltr">Familiarity with healthcare providers with how eczema looks for every skin color is essential for the treatment and diagnosis of eczema.&nbsp;</p>

<p dir="ltr">Eczema has an impact on the quality of life in African Americans, and when it is persistent or uncontrolled, darkening or lightening of the skin (discoloration) is seen. If not treated properly, it can lead to scarring and pigmentary changes. It can also be a stressful situation and cause anxiety.</p>

<p dir="ltr">The treatment for eczema is the same for every skin tone, but early diagnosis is always better. Hence, proper diagnosis is very important in black individuals.</p>

<p>&nbsp;</p>

<h5 dir="ltr"><strong>Infant Eczema</strong></h5>

<p dir="ltr">The following symptoms are common in babies under two years:</p>

<ul dir="ltr">
	<li>Scalp and cheek rashes</li>
	<li>Rashes that look like boils before leaching fluid</li>
	<li>The rashes can cause extreme itching, and interfere with sleep</li>
</ul>

<p dir="ltr">&nbsp;</p>

<h5 dir="ltr"><strong>Childhood Eczema</strong></h5>

<p dir="ltr">The following symptoms are common in children two and over:</p>

<ul>
	<li>Kids can get rashes behind the creases of the elbows and knees</li>
	<li>Rashes on the neck, wrists, crease between the buttocks, and legs</li>
	<li>Bumpy rashes</li>
	<li>Darker or lighter rashes</li>
	<li>Thick skin, also called lichenification. It can also develop into a permanent itch</li>
</ul>

<p dir="ltr">Kids who develop eczema at this age usually get it before the age of five. Around 60% of children do not show any symptoms when they reach adolescence<sup><a href="#accordion">[4]</a></sup>.</p>

<p dir="ltr">Hispanic and black children have more severe symptoms of eczema, compared to children who are white<sup><a href="#accordion">[5]</a></sup>.</p>

<p>&nbsp;</p>

<h5 dir="ltr"><strong>Eczema In Adults</strong></h5>

<p dir="ltr">Adults with atopic dermatitis have the following symptoms:</p>

<ul>
	<li>The rashes are scalier compared to ones in children</li>
	<li>They appear in the creases of the elbows, creases of the knees, and nape more commonly</li>
	<li>Most of the body is covered by rashes</li>
	<li>The affected areas become very dry</li>
	<li>The rashes are very itchy, which is permanent</li>
	<li>Infections of the skin</li>
</ul>

<p dir="ltr">Adults with a history of atopic dermatitis during childhood may no longer have the condition but can get dry or irritated skin very easily. They may also get eczema on the hands, and the eyelids.</p>

<p dir="ltr">The appearance of the skin in people with atopic dermatitis is dependent on their scratching habits and whether the skin has an infection. Moreover, rubbing and scratching can worsen the itching, irritate the skin, and increase inflammation.</p>

<p dir="ltr" style="text-align:justify">&nbsp;</p>

Causes

<p>A combination of immune system activation, stress, environmental triggers, and activation of the immune system can cause eczema (atopic dermatitis).</p>

<h5><br />
<strong>Immune System&nbsp;</strong></h5>

<p>The immune system overreacts to small allergens or irritants in eczema. Moreover, this overreaction can also inflame the skin.</p>

<h5><br />
<strong>Genetics</strong></h5>

<p>If you have a family history of eczema, you are more likely to get it. People who have a family history of hay fever, <a href="https://www.merisehat.pk/disease/asthma" target="_blank">asthma</a>, or allergens are at a higher risk. The allergens include pollen, pet dander, or foods that can trigger allergic reactions. Moreover, a change in the genes that control the proteins that maintain the skin can affect it. If the protein levels are not optimum, your skin may not be healthy completely.</p>

<h5><br />
<strong>Environment</strong></h5>

<p>Environmental factors can also irritate the skin. For example, tobacco smoke, air pollution, soaps, and fabrics. When the weather is not humid and drier, that can also cause dryness and itchiness of the skin. Humidity and heat can make itching worse because of sweating.<br />
When someone has severe eczema, their total IgE level is elevated, due to which food-specific or any other allergen-specific IgE levels are also elevated and positive.</p>

<h5><br />
<strong>Stress</strong></h5>

<p>Stress levels can worsen eczema, which includes physical, emotional, and mental stress.</p>

<p>&nbsp;</p>

<h5><strong>Other Common Triggers</strong></h5>

<p dir="ltr">When the skin is exposed to external irritants, the skin flares up, which also causes an overreaction of the immune system.&nbsp;</p>

<p dir="ltr">The common triggers are:</p>

<ul>
	<li>Detergents and cleaners with chemicals or preservatives</li>
	<li>Scented products</li>
	<li>Cigarette smoke</li>
	<li>External allergens, for example, mold, dust, pollen, and dust mites</li>
	<li>Scratchy and rough materials like wool</li>
	<li>Synthetic fabrics</li>
	<li>Changes in temperature</li>
	<li>Sweating</li>
	<li>Food</li>
	<li>Pet dander</li>
	<li>Stress allergens</li>
	<li>Upper respiratory tract infections</li>
</ul>

<p dir="ltr">&nbsp;</p>

<p dir="ltr">Atopic dermatitis does not have any screening tests or guidelines for screening. Healthcare providers usually diagnose it by examining the skin and medical history. Testing is also done to rule out other diseases of the skin and to identify conditions that can be accompanied by eczema.</p>

<p dir="ltr">&nbsp;</p>

<h5><strong>Skin Prick Test</strong></h5>

<p dir="ltr">A skin prick test can help in the identification of allergic reactions. For example, hives and sneezing because of dust or pollen exposure. But these tests are not useful for the diagnosis of eczema or dermatitis, they are to determine the causative irritants.&nbsp;</p>

<p>&nbsp;</p>

<h5><strong>Serum IgE Levels Test</strong></h5>

<p dir="ltr">An IgE-specific test measures the level of different IgE antibodies in the blood of the person. It is used to diagnose and manage food allergies better, which is the case in patients with eczema. The levels are elevated in people with eczema. Moreover, it can also be helpful in the diagnosis of environmental allergies in some cases.<br />
&nbsp;</p>

Diagnosis

<p>Eczema and dermatitis types look very alike on the skin. The rashes are scaly, red, and dry. They can also crack and ooze. The rashes are mostly very itchy and preventing scratching is difficult in most cases.<br />
Some healthcare providers differentiate between atopic, contact, or nummular dermatitis by the distribution of the skin rashes. They also ask about the medical and family history of the patients.<br />
Allergy tests are conducted to know the cause of contact dermatitis without the requirement of needles. A patch test is one of the most reliable methods to determine the cause of the allergic reaction.</p>

<p>&nbsp;</p>

<h5><strong>Physical Exam And Medical History</strong></h5>

<p dir="ltr">Healthcare providers examine the skin carefully, examining the appearance of the rashes. They may ask when the symptoms started, and which part of the body has been affected. Noticeable patterns of the appearance of the rash, aggravating factors, and environmental variations are also of key concern. Moreover, the family history of eczema or dermatitis of a patient is also of vast importance.&nbsp;<br />
&nbsp;</p>

<h5 dir="ltr"><strong>Patch Test</strong></h5>

<p>Healthcare providers do a patch test to detect allergic contact dermatitis. It enables them to find out if the person has encountered anything during his daily routine that caused the reaction. Patches are applied to the person&rsquo;s back with test substances in small discs. Hypo-allergic&nbsp;tapes secure the patches, and needle pricking is not involved. However, this test does not detect food allergies or hives.<br />
&nbsp;</p>

<h5><strong>Skin Biopsy</strong></h5>

<p dir="ltr">In some cases, dermatologists need to remove a small skin piece for lab testing, which is done if lab tests and physical examination do not lead to a definitive diagnosis.</p>

<p dir="ltr">It is an outpatient procedure where the healthcare provider injects local anesthesia and removes a small part of the skin with a scalpel. The biopsied area heals within one week. The biopsy specimen is examined under a microscope to see whether the patient has eczema or dermatitis, which accounted for the rashes. It takes three to seven days to get the results of the biopsy.</p>

<p dir="ltr" style="text-align:justify">&nbsp;</p>

Treatment

<p dir="ltr">Your healthcare provider or dermatologist can help in the identification of the type of eczema and the correct treatment. The treatment depends on the type and severity of eczema. Moreover, a combination of more than one treatment can be helpful.</p>

<p dir="ltr">&nbsp;</p>

<h5><strong>Medications</strong></h5>

<p dir="ltr">Antihistamines are available over the counter and can relieve itching. They block the allergic reactions that are triggered by histamine. Although they can cause drowsiness, it is best to take them before bedtime.</p>

<p dir="ltr">Diphenhydramine, hydroxyzine, and cyproheptadine are the commonly prescribed antihistamines. It is recommended to take them at night because they can make patients sleepy.&nbsp;</p>

<p dir="ltr">Itching because of eczema keeps children awake at night and antihistamines can deal with that. It does not treat it or stop eczema but helps them sleep. Treatment for eczema will still be required.</p>

<p dir="ltr">The possible side effects of antihistamines are:</p>

<ul>
	<li>Drowsiness&nbsp;</li>
	<li>Xerostomia (dry mouth)</li>
	<li>Blurred vision</li>
	<li>Mood swings and restlessness in children</li>
	<li><a href="https://www.merisehat.pk/disease/constipation" target="_blank">Constipation&nbsp;</a></li>
	<li>Rapid heart rate</li>
</ul>

<p dir="ltr">&nbsp;</p>

<h5 dir="ltr"><strong>Cortisone</strong></h5>

<p dir="ltr">Steroid creams, for example, cortisone ointments can also relieve itching and scaling of the skin. However, they may have side effects like irritation, thinning of the skin, and discoloration of the skin.</p>

<p>&nbsp;</p>

<h5 dir="ltr"><strong>Hydrocortisone</strong></h5>

<p dir="ltr">Over-the-counter hydrocortisone, a low-potency steroid, can also be used to treat mild eczema. But high potency steroids that are used in the treatment of moderate to severe eczema can only be prescribed by a healthcare provider.</p>

<p>&nbsp;</p>

<h5 dir="ltr"><strong>Oral Corticosteroids</strong></h5>

<p dir="ltr">Oral corticosteroids may also be prescribed if topical hydrocortisone does not help. The side effect of oral corticosteroids is bone loss.</p>

<p>&nbsp;</p>

<h5 dir="ltr"><strong>Oral Antibiotics</strong></h5>

<p dir="ltr">Healthcare providers treat infections associated with eczema with oral or topical antibiotics.</p>

<p>&nbsp;</p>

<h5 dir="ltr"><strong>Immunosuppressants</strong></h5>

<p dir="ltr">Immunosuppressants are prescription-only and they prevent your immune system from overreacting. The flare-ups of eczema are prevented, but they have side effects, for example, increased risk of cancer development, high blood pressure, infection, and kidney disease.</p>

<p>&nbsp;</p>

<h5 dir="ltr"><strong>Lifestyle Changes</strong></h5>

<p dir="ltr">Stress can trigger eczema, but you can reduce it by:</p>

<ul>
	<li>Breathing exercises</li>
	<li>Yoga</li>
	<li>Meditation</li>
	<li>Listening to music</li>
	<li>Sleeping enough</li>
</ul>

<p dir="ltr">Cold compresses or a lukewarm bath for fifteen to twenty minutes can help alleviate itching.<br />
&nbsp;</p>

<p dir="ltr">Eczema can cause the following complications:</p>

<ul>
	<li>Trouble sleeping or disruption of sleep hygiene</li>
	<li>Scratching repeatedly can open the skin to bacteria or viruses, causing skin infections&nbsp;</li>
	<li>Atopic eczema can lead to hay fever or <a href="https://www.merisehat.pk/disease/asthma" target="_blank">asthma </a>in children younger than twelve years</li>
	<li>Scratching can make the skin thick and scaly</li>
	<li>Having one type of eczema can increase the risk of developing another type</li>
</ul>

<p dir="ltr">&nbsp;</p>

<p dir="ltr">The risk factors of atopic dermatitis include the following:<br />
&nbsp;</p>

<h5 dir="ltr"><strong>Genetics</strong></h5>

<p dir="ltr">Atopic dermatitis can be common in people with strong genetic components. For example, children are more likely to get eczema if one of their parents has had it. Although this is not clearly understood, parents who have atopic dermatitis, hay fever, and asthma have a higher risk of having children with the same conditions.<br />
&nbsp;</p>

<h5 dir="ltr"><strong>Environmental Factors</strong></h5>

<p dir="ltr">Environmental factors that worsen atopic dermatitis are:</p>

<ul>
	<li>Clothing, soaps, and detergents</li>
	<li>Extreme temperatures, for example, perfumes chlorine, and chemicals</li>
	<li>Not moisturizing the skin after taking a bath</li>
</ul>

<p dir="ltr">&nbsp;</p>

<p dir="ltr">People who are at risk of developing allergies are prone to atopic dermatitis compared to those who do not have allergies. The allergens are:</p>

<ul>
	<li>Plant pollen</li>
	<li>Pet dander</li>
	<li>Dust mites</li>
	<li>Moulds</li>
	<li>Some foods</li>
</ul>

<p dir="ltr">Atopic dermatitis can develop at any age. However, children are at a greater risk. Although, these symptoms get better in adulthood.</p>

<p dir="ltr">&nbsp;</p>

<h5><strong>Occupational Exposure</strong></h5>

<p dir="ltr">Occupational dermatitis is due to chemical products that people encounter at their workplaces. It is termed contact dermatitis, and it can have long-term consequences on the health of the workers. However, with proper precautions, it can be prevented.<br />
&nbsp;</p>

<p dir="ltr">Eczema flare-ups can be prevented with certain steps and changes that might work best for you:</p>

<ul>
	<li>Stress reduction</li>
	<li>Avoiding the triggers</li>
	<li>Skin hygiene</li>
	<li>Shower time less than ten minutes</li>
	<li>Avoiding hot baths</li>
	<li>Regular use of moisturizers&nbsp;</li>
	<li>Using non-comedogenic skincare (skincare that does not block the pores), laundry products, and bath products</li>
	<li>Avoiding scratching the skin</li>
</ul>

<p dir="ltr">&nbsp;</p>

<p dir="ltr">It is believed by researchers that some genes that are inherited from parents increase the risk of eczema. Moreover, environmental factors trigger it. One of the important genes is FLG. It keeps the skin moist and prevents any harmful substances or bacteria from attacking the skin. If FLG mutates the risk of eczema increases.</p>

<p dir="ltr">Scientists have discovered that 118 genes are linked to eczema, psoriasis, and other familial skin conditions. In addition, they discovered that the KIF3A gene weakens the natural barrier of the skin, which causes it to dry out and lose water<sup><a href="#accordion">[6]</a></sup>.</p>

<p dir="ltr">Furthermore, researchers are continuing to look for genes that are linked with eczema. It can help them learn more about the skin condition, enabling them to find better treatment options or ways to screen eczema for prevention.</p>

<p dir="ltr">&nbsp;</p>

Key Points

<ul>
	<li>Eczema is an inflammatory condition and atopic dermatitis is the most common type.</li>
	<li>It is common in kids, but most of them grow out of it by adolescence.</li>
	<li>The severity varies from case to case, but it can cause discomfort in most cases.</li>
	<li>Medications and lifestyle changes can treat and prevent eczema. Although, it has no cure.</li>
</ul>

<p>&nbsp;</p>

[1] Silverberg, J.I. and Simpson, E.L., 2014. Associations of childhood eczema severity: A US population based study. Dermatitis: contact, atopic, occupational, drug, 25(3), p.107.

[2] de Lusignan, S., Alexander, H., Broderick, C., Dennis, J., McGovern, A., Feeney, C. and Flohr, C., 2021. The epidemiology of eczema in children and adults in England: A population‐based study using primary care data. Clinical & Experimental Allergy, 51(3), pp.471-482.

[3] Croce, E.A., Levy, M.L., Adamson, A.S. and Matsui, E.C., 2021. Reframing racial and ethnic disparities in atopic dermatitis in Black and Latinx populations. Journal of Allergy and Clinical Immunology, 148(5), pp.1104-1111.

[4] ÇETİNKAYA, P.G. and Şahiner, Ü.M., 2019. Childhood atopic dermatitis: current developments, treatment approaches, and future expectations. Turkish journal of medical sciences, 49(4), pp.963-984.

[5] Fischer, A.H., Shin, D.B., Margolis, D.J. and Takeshita, J., 2017. Racial and ethnic differences in health care utilization for childhood eczema: An analysis of the 2001-2013 Medical Expenditure Panel Surveys. Journal of the American Academy of Dermatology, 77(6), pp.1060-1067.

[6] Stevens, M.L., Zhang, Z., Johansson, E., Ray, S., Jagpal, A., Ruff, B.P., Kothari, A., He, H., Martin, L.J., Ji, H. and Wikenheiser-Brokamp, K., 2020. Disease-associated KIF3A variants alter gene methylation and expression impacting skin barrier and atopic dermatitis risk. Nature communications, 11(1), pp.1-10.