Eczema refers to any inflammatory process on the skin marked by redness, itching, weeping, oozing and crusting etc. The word eczema is derived from the word ekzein (Greek) which means to boil out. The Greek word ek means out and Zema means boiling. The disease is not contagious so it does not spread from an infected person to another person.
You’re probably wondering about the answer to, “What is Eczema?” We will learn what the eczema symptoms are and will also discuss exactly what causes eczema. You’ll also learn about baby eczema.
What is Eczema?
Eczema is a chronic disease which is long lasting and causes inflammation of the skin. Atopic dermatitis is generally referred to as eczema as it is the most common type of dermatitis. Dermatitis is defined as inflammation of skin and atopic means an allergy that is usually hereditary.
What Eczema Looks Like
Eczema may be mild when there are patches of skin that are dry and itchy. Along with these, the rashes appear on the skin. Scratching leads to redness, swelling, cracking and oozing of clear fluid in severe cases. Finally, this may lead to bleeding, crusting and scaling. Constant scratching may cause the skin to bleed, split and leave it open to infection. The disease has intermittent courses of flare ups called exacerbations followed by remission when the skin clears up completely.
How it Affects Your Life
Dermatitis may be a stressful and frustrating condition in which daily life is made challenging and uncomfortable. The frequent and intense itching may cause loss of sleep and days off from work. Kids may need to miss school and tend to be irritated.
The Number of People who have Eczema
As per the estimates, the disease affects almost 35 million Americans. 1 to 3% of the adult population (male as well as female) and 20% of kids are affected by it. Seventy per cent of Baby eczema cases start in kids who are younger than 5 years of age and 60% of the infants who have the disease continue to have the symptoms in adulthood. The disease often begins in childhood and infancy. People living in cities and dry climates are more prone to this disease.
Types of Dermatitis
1) Atopic Dermatitis
The chronic disease is characterized by itchy and inflamed skin and is the most common form of skin disease. It usually begins during infancy/childhood, however can strike at any age. It often affects the people who have family history of asthma or hay fever. It affects the skin on the face, hands, feet, inner elbows and back of the knees.
Soap, rough clothing and household chemicals may act as irritants and make the symptoms worse. Dust mites, foods and other allergy triggers may also make the flares increase.
2) Contact Dermatitis
This is a localized reaction which includes redness, itching and burning in skin when it comes in contact with an allergen or irritant such as acid, cleaning agent or any other chemical. It can also occur when a person touches allergens such as Nickel, cosmetics and poison Ivy.
The contact dermatitis is of 2 types:
Irritant contact dermatitis
Allergic contact dermatitis
The hands are more vulnerable to developing contact dermatitis. In order to treat them, moisturizers and steroid medications are recommended which may be rubbed on the skin or taken as a tablet or capsule. Antibiotics are also recommended in case of infections. It is advisable to wear gloves to protect the skin on the hands in order to avoid contact with the allergen or irritant.
3) Dyshidrotic Dermatitis
In this, the skin on the palms of the hands and soles of feet are irritated. Deep, clear blisters develop that itch and burn. It is chronic and very painful. The treatment for this type of dermatitis involves using cool and wet compresses, corticosteroids used as topical ointments or pills and Psoralen combined with the UVA therapy.
In this, scaly patches develop on the skin of the head, lower legs, wrists and forearms caused by localized itching such as insect bites. If scratched, it becomes intensely irritated and the skin grows thick and deeply wrinkled. The main treatment for this disease is to stop scratching and topical steroids are usually recommended.
If Neurodermatitis affects the scalp, it is hard to treat. In such a case, Prednisone is used to cure it.
5) Nummular Dermatitis
These are coin shaped patches of irritated skin and most common on arms, back, lower legs and hips. These are crusted, scaling and itchy. This type of dermatitis is more common in men. Men usually get their first outbreak in their fifties while in women, it occurs in their teen years. The cause of this disease is unknown and the symptoms may increase when exposed to cold and/or dry air, chemicals such as formaldehyde, nickel etc.
You may need to protect your body from scratches and injuries if this disease occurs to prevent infection. A lukewarm bath or shower followed by moisturizing the skin is recommended. A steroid ointment may be applied on the rash and the steroid medications can either be taken by mouth or an injection can be used. Antibiotics are used if the infection develops.
6) Seborrheic Dermatitis
There are yellowish, oily, scaly patches on the scalp, face and sometimes on the other parts of the body. Seborrheic dermatitis is also known as dandruff and it affects the scalp in infants as well as adults. It causes the skin to fall off in the form of flakes. This condition is caused due to an overgrowth of a type of yeast that normally lives in these areas. The overgrowth and rapid shedding of cells on the scalp may also cause dandruff.
It is very difficult to treat this in people with poor immune systems such as people with AIDS. Antifungal treatments or steroid lotions are used to treat it along with shampoos containing salicylic acid, selenium sulfide, zinc pyrithione or coal tar.
7) Stasis Dermatitis
Stasis dermatitis is skin irritation on the lower legs and is generally related to problems in the circulatory system. When the veins in the lower legs do not return the blood properly to the heart, the disease can occur. It develops quickly causing the skin to flake and crust and over the time, brown stains develop. The treatments commonly employed for this disease are steroid creams and ointments, moist compresses, creams and lotions to lubricate the skin, elevating the legs and antibiotics to treat the infections.
What Causes Eczema?
The cause of dermatitis is unknown however the disease seems to be a result of a combination of genetic, immune system malfunctions, and/or environmental and skin barrier issues. The body’s immune system may react to an irritant and this response causes the symptoms of the disease. The people with atopic diseases such as asthma or hay fever are more likely to develop this disease. Children whose parents have atopic diseases are more likely to develop dermatitis.
The disease is also associated with the malfunctioning of the immune system. The immune system recognizes and helps fight harmful bacteria and viruses that invade the body. Atopic dermatitis may cause inflammation in the skin even when a major infection is absent and the body reacts against its own tissues so it can be considered to be a form of autoimmune disease.
Doctors previously considered atopic dermatitis to be an emotional disorder however, now it is known that emotional factors like stress can not cause the disease however, it can make the condition worse and may result in flare ups.
Environmental factors can also bring out the symptoms in the affected individuals any time.
Environmental factors can also bring out the symptoms in the affected individuals any time.
Environmental Factors that may Cause Eczema
Irritants such as soaps, detergents, shampoos, meats, certain vegetables and juices from fresh fruits may cause this disease.
Allergens like dust mites, pets, pollens, molds and dandruff are also known to cause the disease.
Microbes such as bacteria (Staphylococcus aureus), viruses and some fungi are also some of the causes of atopic dermatitis.
Hot and cold temperatures, high and low humidity, changes in temperature and perspiration from exercise may also result in the symptoms of the disease.
Certain Foods are also known to cause the disease such as dairy products, eggs, soy products, wheat and nuts so you must avoid eating these food products.
Stress can make the symptoms worse and it is not a cause of the disease.
Hormonal changes in women during pregnancy or at certain points in their menstrual cycle may cause the symptoms of the disease to get worse.
Eczematous Skin Barrier Functions
The defects in skin barrier are also responsible for the outbreak of dermatitis as the people who are prone to eczema have a weak outer skin barrier that allows moisture to go out and germs to enter on the skin.
The skin of people with dermatitis cannot produce as much fat and oil like people with normal skin can. The gaps open up between the skin cells as there is not sufficient water in the cells to make them plump.
So the skin loses moisture and irritants as well as bacteria can enter into the skin and cause dryness and itchiness. It will urge you to scratch and once you will scratch, the flare ups can be aggravated.
The symptoms of atopic dermatitis vary from person to person. Itching is the most common symptom of dermatitis. Scratching and rubbing the skin when there is itching irritates the skin and increases inflammation as well as itchiness. Itchiness may be a major concern while sleeping as you may unconsciously scratch the affected area.
The skin may be dry and itchy and rashes may appear on face, the hands, feet, inside the elbows and behind the knees.
The affected area in fair-skinned people may initially appear as reddish and then may turn brown. In dark-skinned people, the disease can affect the skin’s pigmentation and make the affected areas lighter or darker than the normal skin color.
The appearance of the skin depends on the amount of scratching and the presence of infections. The skin may be thick and leathery or red and scaly, may contain raised bumps or the fluid may ooze out of it. The skin may also become crusty or infected in some of the worst cases.
The skin around eyes is also affected by the disease including the eyelids, eyebrows and lashes. If you rub and/or scratch the eyes, it can result in swelling and reddening of the skin. The scratching may result in a patchy loss of eyebrows and eyelashes. In some people, an extra fold of skin develops under the eyes.
The Skin Features Associated with Atopic Dermatitis
The various skin features associated with the atopic dermatitis are:
1) Atopic Pleat/Dennie Morgan Fold
This is an extra fold of skin which develops below the eyes.
This refers to the inflammation of the skin on the lips and around them.
3) Hyperlinear Palms
It is a condition in which the number of skin creases increases on the palms.
4) Hyperpigmented Eyelids
The eyelids become darker in color due to inflammation or hay fever.
This is when you develop dryness and rectangular scales on the skin.
6) Keratosis Pilaris
Small and rough bumps develop on the face, upper arms and thighs.
The skin becomes thick and leathery as a result of constant scratching and rubbing.
These are small raised bumps, and if scratched, they can open up and become crusty or infected.
These are red, raised, bumps known as hives that occur due to exposure to an allergen and occur at the beginning of flare ups, after exercise or after a hot bath.
When You May Need to Contact the Doctor
If you develop an itchy rash and have a family history of eczema, asthma or hay fever
If the inflammation does not respond to over the counter hydrocortisone cream application within a week of treatment
Yellowish or light brown crust or pus-filled blisters develop over existing patches of atopic dermatitis. The blisters are caused by a bacterial infection and need to be treated using prescription antibiotics.
If you are exposed to anyone with viral skin diseases such as cold sores or genital herpes, you are at an increased risk of contracting these diseases if you have a flare up of eczema.
The Various Stages of Eczema
When the disease occurs during infancy or childhood, the onset and severity of symptoms is different from one child to another.
Eczema in Infants
It begins to develop in infants when they are around 6 to 12 weeks old. It may appear as a patchy facial rash around the cheeks and chin first and then can progress to red, scaling and oozing skin. In some cases, the skin may become infected by bacteria and fungus. Once the infant grows up and starts crawling, the exposed areas of the inner and outer parts of the arms and legs may also be affected by it. The child may be restless and irritable due to itching and discomfort.
In Children above 2 years to Adolescence
In childhood, the rashes occur behind the knees and on the inside of the elbows, on the sides of the neck, around the mouth, on the wrists, ankles and hands. The rashes begin as papules and then become hard or scaly due to scratching. There may be inflammation of the skin around the lips and constant licking may result in the development of painful cracks in the skin around the mouth. In some kids, the disease goes into remission for a long time and the symptoms may reappear at the onset of puberty. The reason for this may be hormonal changes, stress, and use of certain skin care products and cosmetics that may result in the flare ups.
The disease may show up in adulthood in some people. The pattern of disease in adults is similar to that in children. The sleep patterns may be disturbed and work performance may also be affected. The long term use of medications may also cause some side effects. The people may also have the tendency for developing irritant contact dermatitis that may lead to inflammation and redness of the skin when coming in contact with irritants. Some people may also develop a rash around their nipples that are difficult to treat. Some adults may develop cataracts as a result of atopic dermatitis so doctors recommend getting regular eye examinations.
Eczema in babies, also called infant eczema, can look scary as the symptoms appear during the first few months after your baby’s birth. It is common in babies and can be treated effectively and most babies outgrow before they become school-aged. A small number of children have the disease into adulthood and remissions can happen and last for a few years. The tendency to develop dry skin in babies often lingers.
Symptoms of Baby Eczema
Patches of red or dry skin which are itchy and rough appear on the cheeks and scalp. They may also occur on their arm and leg joints.
Rashes may bubble off before they release fluid.
Extreme itchiness may be caused by rashes which may lead to deprived sleep in a child. If the baby continuously rubs and scratches the skin, it becomes prone to infection.
Causes of Eczema in Babies
Baby eczema is caused when the body doesn’t make enough ceramides. These are the fatty cells that provide a barrier of protection to the skin and help in retaining moisture. Heredity also plays a major role in deciding if the infant will develop eczema. If mom or dad have this problem, the baby is more likely to develop it. The defects in the skin barrier which allow the germs to enter the epidermis may be also a factor that causes the disease.
Eczema Triggers in Babies
The flare ups can be increased by the triggers and the condition may become worse, so it is advised to avoid the following:
Dry skin – This is caused due to low humidity in winter when the air is dry and homes are well-heated. It can make the affected area very itchy. The moisturizers can be applied to the skin to avoid dry skin soon after giving a bath to your baby and patting the skin dry.
Irritants – The scratchy wool clothes, polyester fabrics, perfumes, body soaps and laundry detergents are known to trigger the flare ups so they must be avoided. Instead, cotton fabrics must be used for the kids.
Heat and Sweat – The itching may increase as a result of excessive heat and sweat. Avoid overdressing your kids with more clothes than necessary as it can result in sweating and heat.
Food allergens – Some experts believe that cow’s milk, peanuts, eggs and certain fruits should be removed from the child’s diet to control the symptoms. A breastfed baby may be exposed to those foods through mother’s milk along with ingesting the foods directly.
Tests and Diagnosis of Eczema
There is a unique combination of symptoms in people with dermatitis and the severity varies over time. The doctors usually meet the patient several times to make an accurate diagnosis in order to rule out any other disease that may cause the skin irritation. In some cases, the patient is also referred to a skin specialist (Dermatologist) or allergist for further evaluation.
The doctors carefully study the medical history of the patient and ask questions about the family history of allergic reactions. They also confirm if the patients have any diseases such as hay fever or asthma and are exposed to irritants that may cause the disease. The doctors also check with the patients if there are any sleep disturbances or if they are using any steroids or other medications.
There is no single test that can be used to diagnose the disease presently and very few tests can be performed to indicate allergic sensitivity.
The following tests can be performed to diagnose eczema:
1) Patch Testing
In this, the substances are placed on the skin surface to test for skin allergies.
2) Skin Prick Testing
A small amount of suspected allergen is applied on a needle and pricked on the skin to test for allergies. Pollen and food allergies are tested by this method.
3) Supervised food challenges
Some foods are eliminated and then reintroduced in the diet to identify if a food allergy is present.
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