Eczema - Causes, Symptoms And Treatment


Background












Eczema is a chronic inflammatory skin condition commonly referred to as ‘atopic eczema’ or ‘atopic dermatitis’, & characterised by an itchy red rash. Although Eczema affects any part of the body and it usually settles in the skin creases such as the folds of elbows or behind the knees and sometimes also crusting, scaling, cracking and swelling of the skin can occur.


Eczema lesions vary in appearance from collections of fluid in the skin (vesicles) to gross thickening of the skin (lichenification) on a background of poorly demarcated redness.

Dry skin that results in impaired barrier function is also a key feature of eczema. Besides, Eczema is associated with other atopic diseases such as seasonal allergic rhinitis (hay fever) and asthma. Around 30% of people with eczema develop asthma and 35% develop allergic rhinitis.

The specific cause of eczema remains unknown, but many health professionals believe that it develops due to a combination of -

  • Genetics

  • Abnormal function of the immune system due to irregular food habits by including more of dairy products, eggs, nuts and seeds, soy products, and wheat etc.

  • Environment i.e hot & cold temperatures

  • Activities that may cause skin to be more sensitive

  • Defects in the skin barrier that allow moisture out and germs in i.e irritants like soaps, detergents, shampoos, disinfectants, juices from fresh fruits, meats and vegetables.

  • Endocrine disorders such as thyroid disease or any hormonal imbalance during pregnancy and at certain points in the menstrual cycle.




Most Commonly Known Types Of Eczema



1. Atopic Dermatitis









Introduction


In people with AD the immune system becomes disordered and overactive. This triggers inflammation that damages the skin which eventually leaves it dry and also suffers itching and rashes on the skin which appears purple, brown or grayish hue on darker skin tones and red in lighter skin tones. Itching is the hallmark of AD, with some data showing that more than 85% of people with the condition experience this distressing symptom every day. Sore or painful skin and poor sleep caused by itching are also common.


Atopic dermatitis exists with two other allergic conditions: asthma and hay fever (allergic rhinitis). People who have asthma and/or hay fever or who have family members who do, are more likely to develop AD.



Symptoms


In Infants under the age of 2 -

  • rashes on the scalp and cheeks

  • rashes that bubble up before leaking fluid

  • rashes that can cause extreme itchiness, which may interfere with sleeping

In children under the age of 2 and above -

  • rashes that appear behind the creases of elbows or knees

  • rashes that appear on the neck, wrists, ankles, and the crease between the buttocks and legs

  • bumpy rashes

  • rashes that can become lighter or darker

  • skin thickening, also known as lichenification, which can then develop into a permanent itch

In adults the common symptoms are -

  • rashes that commonly appear in the creases of the elbows or knees or the nape of the neck

  • rashes that cover much of the body

  • very dry skin on the affected areas

  • rashes that are permanently itchy and can make skin dry and discolored, and repeated scratching can cause thickening and hardening.

Treatment


Treatments for eczema typically fall into two categories:

  • moisturizers to relieve dryness and itching

  • anti-inflammatories to reduce swelling, itching, and redness


When AD is mild, doctor as part of treatment recommends

  • Maintaining a regular bathing and moisturizing routine to protect and strengthen the skin barrier by using a mild soap or soap substitute that won't dry skin and a good moisturizer cream, lotion, or ointment. Smooth it on right after a shower or bath, as well as one other time each day.

  • Getting high-quality sleep

  • Eating a healthy diet

  • Managing stress by regular exercise, and also set aside time to relax with meditation and hanging out with friends.


If these methods are not enough, doctor may prescribe medicated creams or oral medication to hydrate the skin, reduce itching, and relieve inflammation. Medications include:

  • corticosteroid creams to relieve itching and inflammation

  • corticosteroid tablets, which are for short-term use only, to relieve itching and inflammation

  • topical calcineurin inhibitors, which suppress inflammation to reduce symptoms

  • antihistamines, which some scientists believe can reduce the severe itching caused by atopic dermatitis.



Please note above mentioned medications to be taken only after doctor's recommendations. 


The treatment for eczema in infants and babies is similar to that which adults use, with the focus being on the application of moisturizing creams or ointments and anti-inflammatories that reduce the urge to scratch. Besides, ensure that a baby’s room is not too warm at night as sweat can make the symptoms of eczema worse.



Two tips to reduce atopic dermatitis on skin -


a. Use natural products which can help lock in moisture and relieve itchiness like -

  • Coconut oil - Apply virgin or cold-pressed coconut oil directly to eczema to moisturize the area and reduce bacteria. Use it once or twice per day on damp skin.

  • Sunflower oil - Sunflower oil may help improve the skin’s protective barrier and reduce inflammation. Apply it twice a day.


b. Always use moisturizer on affected areas of skin within 3 minutes of getting out of the bath to stop the skin from drying out.



2. Contact dermatitis











Introduction - .Contact dermatitis happens when the skin becomes irritated or inflamed after coming in contact with a substance that triggers an allergic reaction like poison ivy, jewelry made of certain metals (especially nickel or gold) and sunscreen.


It is a skin condition that results from exposure to something to which you’re either sensitive or allergic. It’s red, itchy, and uncomfortable, but it’s not life-threatening. Moreover, you won't get a rash the first time your skin touches something you're allergic to but the touch sensitizes your skin, and you could have a reaction the next time.


Usually contact dermatitis, appears 48–72 hours after exposure to an allergen, the symptoms of irritant contact dermatitis can result within a few hours if the exposure is a strong irritant.



There are two main types of contact dermatitis -


Irritant contact dermatitis -


It happens when skin cells are damaged by exposure to poisonous or irritating substances. It is not an allergic reaction.


In children, the most common form of irritant contact dermatitis is "diaper rash." This is a skin reaction in the diaper area. It is caused by prolonged contact with the natural chemicals found in urine and stool. Childhood irritant contact dermatitis also can develop around the mouth because of skin contact with dribbles of baby food or drools of saliva.


In adults, this condition is often an occupational illness. It is triggered by exposure to strong soaps, solvents or cutting agents. It is especially common among: hairdressers, health care workers, homemakers, mechanics



Allergic contact dermatitis - It is a delayed allergic reaction that appears as a rash a day or two after skin is exposed to an allergen. It occurs only in people who are naturally oversensitive to certain chemicals. A common example is poison ivy. After exposure, the body generates a robust inflammatory reaction to the oils in the plant leading to an itchy rash within one to two days.


With allergic contact dermatitis, the inflammation may not develop until 24 to 36 hours after contact with the allergen. This is because allergic contact dermatitis involves the body's immune defenses.


Skin allergies vary from person to person. The most common types of allergens responsible are:

  • A chemical found in poison ivy, oak and sumac

  • Nickel and cobalt in metal jewelry, clothing snaps, zippers and metal-plated objects

  • Latex in gloves and rubberized clothing

  • Certain preservatives, such as formaldehyde



General symptoms -

  • Red, irritated skin

  • Itching

  • Swelling

  • Bumps or blisters, sometimes filled with clear fluid

  • Hot or tender skin

  • Dry, cracked, scaly skin

These symptoms can range from mild to severe, and they can appear anywhere from a few hours to 10 days after coming into contact with the irritant or allergen but the contact dermatitis rashes will not spread to anyone else.



Prevention and Treatment


Treatment -


To treat contact dermatitis successfully, you need to identify and avoid the cause of your reaction. Then treat the irritated skin and next determine what caused the reaction so you can avoid that allergen or irritant in the future.

However, your allergist can prescribe creams and in some cases oral medication to relieve the itching and help the damaged skin to heal.


Prevention -


Avoiding known allergens and irritants is the best way to prevent contact dermatitis by taking precautions like -

  • Choose fragrance-free moisturizers.

  • Use mild, fragrance and dye-free soaps and cleansers.

  • Wash immediately after coming into contact with a known allergen or irritant

  • Avoiding exposure to irritating chemicals, plants, jewelry and other substances that trigger irritant or allergic contact dermatitis.

  • Prevent diaper dermatitis - By Changing baby diapers frequently and cleaning the soiled area with warm water and a soft cloth. Avoid using store-bought wipes and cleansers on your child's skin. These products can trigger skin reactions.




3. Dyshidrotic Eczema












Introduction -


Dyshidrotic eczema causes small, intensely itchy blisters on the palms of hands, soles of feet and edges of the fingers and toes. This skin condition can also make blisters pop up on the soles of your feet or on your toes. And this common form of eczema, also called pompholyx (which means “bubble” in ancient Greek), foot-and-hand eczema, palmoplantar eczema and vesicular eczema, is found more frequently in women than in men. It is most common in younger adults, typically between the ages of 20 and 40.


Symptoms -

  • Itching or a burning pain before blisters appear

  • Blisters on the edges of your fingers, toes, palms, and soles of your feet

  • Red, cracked skin

  • Sweaty skin around the blisters

  • Nails that thicken and change color


Treatment & Prevention -



Treatment -


Your doctor can prescribe an ointment or cream with a steroid in it to bring down swelling and help get rid of the blisters.


Your skin will take in the medicine better if you put a wet compress on it after you use the cream. If you have a severe flare-up, you might need to take a steroid drug.


If these treatments don't work well for you, you might try one of these:

  • Light therapy by using ultraviolet (UV) light to clear up skin.

  • Botulinum toxin to make your hands and feet from sweating, which can trigger the blisters.

  • Draining the blisters to drain fluid from the blisters.


Prevention -

  • Wash your hands and feet every day. Use lukewarm water and a mild, scent-free soap. Afterward, gently pat your skin dry.

  • Take your rings off before you wash your hands. Moisture can get trapped under your rings and cause more blisters.

  • Wear gloves with cotton liners whenever your hands are in water, like when you wash dishes.

  • Put a thick moisturizer on your hands and feet every time you shower or wash. Rub it on while your skin is still wet to seal in water. You also might use a cream that has dimethicone to protect your skin.

  • Turn on a humidifier in dry weather to keep your skin from cracking.

  • If allergies set off your eczema, try to stay away from things that trigger them.

  • Don't scratch the blisters. You'll make them worse



4. Hand eczema











Eczema that only affects your hands is called hand eczema or hand dermatitis. Both genetics and contact allergens and irritating substances play a role in “triggering” this form of eczema. It often affects people who work in cleaning, catering, hairdressing, healthcare and mechanical jobs where they may come into contact with chemicals and other irritants. However hand eczema isn’t contagious. You cannot “catch” it from another person, or give it to someone else.

Symptoms -

Hands get red, itchy, and dry

Dryness, to the point of peeling and flaking

Bleeding or weeping skin


Diagnosis & Treatment -


Diagnosing hand dermatitis is done by carefully examining the skin with other body areas. And then analysing the pattern of hand dermatitis, highlighting potential triggers and also initiate patch test to find out allergy involved for occurrence of hand eczema. The tests are done over several days and on the final day it is read and explained by an expert.



The best treatment for hand eczema is avoiding what caused it to help guard your skin against further irritation. The most important thing to remember is to be consistent in your skin care routine.



Home remedies to help control your hand eczema -

  • If you need to clean your hands, wash them with lukewarm (not hot) water and fragrance-free cleanser(avoid water less, antibacterial cleansers which often contain ingredients like alcohol and solvents

  • Gently blot hands dry, and apply a moisturizer with higher oil content immediately after you wash your hands.

  • Use cotton gloves to protect your hands while you do chores, like folding the laundry,cleaning etc.

  • Use disposable gloves if you’re doing work with foods like potatoes, onions, peppers, meat, or acidic fruits (like tomatoes, or citrus).

  • Ask someone else to shampoo your hair, or shampoo it yourself while wearing protective gloves (waterproof vinyl with cotton liners).

  • Remove rings from your fingers while doing housework and before washing and drying your hands, as irritants can get trapped beneath.

  • Once your eczema clears, your doctor may want you to use petroleum jelly on your hands, overnight, with gloves. Use the same gloves over and over, so that they continue to absorb the product and lock moisture in while you wear them.

  • Take care of any breaks or cuts on the skin before chemicals have a chance to come into contact with them and cause irritation




5. Neurodermatitis









Neurodermatitis is also known as lichen simplex chronicus and is similar to atopic dermatitis. It is a skin condition that starts with an itchy patch of skin. Scratching makes it even itchier. This itch-scratch cycle causes the affected skin to become thick and leathery typically on the neck, wrists, forearms, legs or anal region but not life-threatening or contagious.


The itching can be so intense or recurrent that it disrupts your sleep, sexual function and quality of life. Moreover, over-the-counter or prescription medications may help ease the itching.


Women are more likely than men to suffer from neurodermatitis at a ratio of 2:1 especially those with anxiety disorders, obsessive-compulsive disorders and family members with histories of other skin diseases, including eczema and contact dermatitis, are more likely to develop neurodermatitis.


Symptoms


Thick, scaly patches form on your arms, legs, back of your neck, scalp, bottoms of your feet, backs of your hands, or genitals. These patches can be very itchy, especially when you’re relaxed or asleep & if you scratch the patches, they can bleed and get infected.


The patches are differently colored, such as reddish, brownish, yellowish, gray or purple. Older patches can appear white or pale in the center, surrounded by darker colors.



Diagnosis and Treatment


The neurodermatitis is diagnosed by examining the affected skin and determining whether you've been itching and scratching. To rule out other causes, he or she may conduct skin biopsy for testing.


Doctor's treatment is aimed at controlling the itching, preventing scratching and addressing underlying causes of neurodermatitis


  • Anti-itch medicated creams

  • Corticosteroid injections are directly injected into the affected skin to help it heal.

  • Medicine to ease itching and some of these drugs may cause drowsiness and help with alleviating scratching while you sleep.

  • Prescribe anti-anxiety drugs as anxiety and stress can trigger neurodermatitis

  • Light therapy is also recommended as part of treatment for exposing the affected skin to particular type of light.


Lifestyle and home remedies


  • Stop rubbing and scratching to control skin condition and prevent recurrence.

  • Apply cool, wet compresses on the affected skin for few minutes before applying medicated cream will soothe & soak cream in the skin and relieve the itch. Putting a cool, wet compress on the affected skin for a few minutes before you apply a medicated cream helps the cream soak into the skin.

  • Try over-the-counter medications i.e apply an anti-itch cream or lotion to the affected area.

  • Cover the affected area with bandages or dressings can help protect the skin and prevent scratching.

  • Keep your nails trimmed as it will not damage the skin, especially if you tend to scratch while you're asleep.

  • Take short, warm baths and moisturize your skin and use mild soaps without dyes or perfumes.



Eczema throughout life


Eczema is a chronic health problem that affects many people of all ages, but is most common in infants.


a. Infant eczema - It occurs in around 20% of children under two years of age, and usually starts in the first six months of life. Infantile eczema usually improves significantly between the ages of two to five years and usually starts on the scalp and face. Red, dry rashes may show up on the cheeks, forehead, and around the mouth only and usually does not develop in the diaper area.


Eczema rashes can be different for each child. They can be all over the body or in just a few spots. The eczema rash often worsens at times (called “exacerbations" or “flares") and then gets better (called “remissions")where the rashes develop may change over time.



b. Childhood eczema - In young school-aged children, the eczema rash is often in the elbow creases, on the backs of the knees, on the neck, and around the eyes.may follow infantile eczema, or start from two to four years of age. This form of eczema usually improves with age.


Many children with eczema do not have enough of a special protein called “filaggrin" in the outer layer of skin. Filaggrin helps skin form a strong barrier between the body and the environment. Skin with too little of this protein has a harder time holding in water and keeping out bacteria and environmental irritants.


Both a person's genes and their environment play a role in eczema. It often runs in families and tends to occur with other allergic conditions such as asthma and allergic rhinitis (hay fever and seasonal allergies). Many children with eczema also have food allergies, but foods themselves do not cause eczema. From 33 to 63 percent of young children with moderate to severe eczema also have food allergies. It is recommended that children under the age of 5 who have moderate to severe eczema be evaluated for milk, egg, peanut, wheat, and soy allergies, if the child continues to have eczema even after treatment.



c. Adult eczema - It is similar to that of older children with areas of very dry, itchy, reddened skin at the elbow creases, wrists, neck, ankles and behind the knees. It can cause rough, hard and thickened skin, which may also have weeping areas. Different areas of the body can be affected for adults, including face, hands and even eyelids. The itching for adults can feel unbearable as a flare-up can affect skin all over the body.





Conclusion


In a nutshell we can conclude that many people with eczema report feeling embarrassed and self-conscious about their skin. So receiving proper treatment and getting stress under control can help calm symptoms and usually manageable, regardless of your age. There are many treatments currently available and future therapies are on the way. With careful evaluation and follow up with your allergist / immunologist, you can have a very high quality of life and enjoy all your activities.


However, a combination of self-care and the above natural remedies may be all you need to manage mild-to-moderate cases of eczema.





Sources


https://acaai.org/allergies/types-allergies/skin-allergy/eczema-atopic-dermatitis


https://www.aaaai.org/conditions-and-treatments/library/allergy-library/eczema-atopic-dermatitis


https://www.allergy.org.au/patients/skin-allergy/eczema


https://my.clevelandclinic.org/health/diseases/17989-neurodermatitis


https://www.health.harvard.edu/a_to_z/contact-dermatitis-a-to-z


https://nationaleczema.org/eczema/types-of-eczema/hand-eczema/#:~:text=Hand%20eczema%2C%20also%20known%20as,triggering%E2%80%9D%20this%20form%20of%20eczema.


https://www.webmd.com/skin-problems-and-treatments/eczema/dyshidrotic-eczema#1


https://acaai.org/allergies/types/skin-allergies/contact-dermatitis


https://www.webmd.com/skin-problems-and-treatments/contact-dermatitis#1


https://www.webmd.com/skin-problems-and-treatments/eczema/eczema-causes#1


https://www.webmd.com/skin-problems-and-treatments/eczema/understanding-eczema-treatment#2


https://nationaleczema.org/eczema/types-of-eczema/atopic-dermatitis/


https://www.healthline.com/health/types-of-eczema


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