WHAT IS ECZEMA?Eczema is a chronic inflammatory skin condition, characterized by dry skin, with patches that are red and intensely itchy.
These patches of eczema may ooze, become scaly, crusted, or hardened. Symptoms can range from mild to severe and the condition can negatively impact quality of life. Eczema can occur anywhere on the skin and is commonly found on the flexors (bends of the arms and backs of the knees).
There are many types of eczema, with the most common one being atopic dermatitis. Atopy refers to a hereditary tendency toward eczema, asthma, and allergic rhinitis (hay fever). People with eczema may suffer with one of the other atopic diseases.
WHAT ARE THE CAUSES?There are genetic, immunological and environmental factors that play a role in eczema.
Eczema can come and go, and can migrate around the body—just as one patch clears up, another may develop. This is the chronic nature of the disease. When the skin cycles back to inflammation, the patient is experiencing a flare-up. Contrary to popular belief, foods or food allergies do not cause eczema, even though a certain food may contribute to an acute flare of eczema.
TYPESThere are several types of eczema. Here is a more detailed description of each type:
AD is the most common form of eczema and is closely linked with asthma and allergic rhinitis (eczema, asthma, and allergic rhinitis make up the atopid triad). It can affect both children and adults, usually running in families. One of the most common symptoms of AD is itching (pruritus), which can be almost unbearable. Other symptoms include dryness of the skin, redness and inflammation. Constant scratching can also cause the skin to split, leaving it prone to infection. In infected AD the skin may crack and weep and develop pustules. Treatments include emollients to maintain skin hydration and steroids to reduce inflammation.
ACD develops when the body’s immune system reacts against a substance after contact with the skin. The allergic reaction often develops over a period of time through repeated contact with the substance. For example, an allergic reaction may occur to nickel, which is often found in earrings, snaps on baby’s undershirts, belt buckles and jean buttons. Reactions can also occur after contact with other substances such as perfumes and rubber. In order to prevent repeated reactions it is best to prevent contact with anything that you know causes a rash.
This is a type of eczema caused by frequent contact with everyday substances, such as detergents and chemicals, which are irritating to the skin. It most commonly occurs on the hands of adults and can be prevented by avoiding the irritants and keeping the skin moisturized. It commonly occurs in patients who have atopic dermatitis.
A condition that affects babies under one year old, the exact cause of which is unknown. Also referred to as cradle cap, it usually starts on the scalp or the nappy area and quickly spreads. Although this type of eczema looks unpleasant, it is not sore or itchy and does not cause the baby to feel uncomfortable or unwell. Normally this type of eczema will clear in just a few months, though the use of moisturising creams and bath oils can help to speed this along.
Characteristically affects adults between the ages of 20 and 40. It is usually seen on the scalp as mild dandruff, but can spread to the face, ears and chest. The skin becomes red, inflamed and starts to flake. The condition is believed to be caused by a yeast growth. If the condition becomes infected, treatment with an anti-fungal cream may be necessary.
Varicose eczema affects the lower legs of those in their middle to late years, being caused by poor circulation. Commonly the skin around the ankles is affected, becoming speckled, itchy and inflamed. Treatment is with emollients and steroid creams. If left untreated, the skin can break down, resulting in an ulcer.
Is usually found in adults and appears suddenly as a few coin shaped areas of red skin, normally on the trunk or lower legs. They become itchy and can weep fluid. Usually discoid eczema is treated with emollients (and steroid creams if necessary).
IMPAIRED SKIN BARRIER FUNCTIONOur skin is the barrier to the outside world, is somewhat waterproof, and keeps our internal organs and systems safe from the elements and from bacteria invading our bodies.
Atopic dermatitis patients have impaired barrier function. This means that the skin barrier is broken down, loses moisture, and can allow bacteria to grow and enter the body (causing bacterial infections on the skin). The loss of water leaves the skin dry and cracked. The goal of eczema management is to replenish moisture, and create a barrier to protect the skin. This is why moisturizers can help.
FLARE-UPS & TRIGGERSFlare-ups can be prompted by environmental elements or “triggers” such as certain soaps, clothing fabrics, deodorants, carpet fibers, dust, and others.
Sometimes a flare-up will occur, however, with no discernible trigger. Overheating, excessive sweating, low humidity, certain foods and stress can also contribute to flare-ups. When the skin becomes irritated by any one of these irritants, it itches, causing the sufferer to scratch the affected area. Scratching makes the condition worse and the skin becomes inflamed and reddened, aggravating the itch. This is called the “itch-scratch cycle” and can become severe and cause pain.
Look around you and write down all of the possible things in your surroundings that could be contributing to your flare-ups. For example, do you experience a flare-up or worsening of your eczema when you wear a certain sweater? Is your eczema worse in the winter? Do you itch on the days when you clean your house? Does perfume irritate your skin? Use this trigger chart to help to identify your triggers.
Controlling factors in your environment can help minimize flare-ups. By minimizing or eliminating your triggers, you can help to reduce the number of flare-ups experienced. One of the frustrating parts of eczema is that flare-ups can still occur even when you are diligently avoiding triggers and taking care of your skin. Keeping your skin moist is your first line of defense against eczema.
Certain foods can trigger a flare-up, just like other environmental triggers. This can occur by eating the trigger food, or by skin contact with the food during preparation or during eating (on the hands and around the mouth). It is important to note that food allergies do not cause eczema, however foods can trigger a flare-up. It is not recommended to undertake food elimination diets, withhold foods, or entire food groups, for long periods of time without consulting your doctor or your allergist to confirm that there is in fact an allergy to that food. If you suspect an allergy to a certain food, you should consult your allergist.
Allergy skin testing can help to provide clues about environmental and food allergies, however patients with atopic dermatitis have high false positive rates, as the simple act of scratching the skin during testing can cause inflammation which may then be misinterpreted as an allergic reaction. Antihistamine use can also impact the accuracy of allergy testing. Speak with your allergist about your eczema, and your medical treatments prior to testing.
Atopic eczema is a chronic, recurring condition with “flares” (active or new patches of eczema — which look red, scaly, and/or bumpy) and remissions (when eczema is not as active). Some people always seem to have some active areas. There are no definite cures for eczema although patients can achieve excellent control and live quite comfortably.
When one member of the family suffers with eczema, the whole family suffers. Rigorous moisturizing and skin care treatment regimens, constant monitoring of the condition, lifestyle changes in an effort to avoid triggers, and sleepless nights can greatly impact the quality of life for all members of the family.
COMPLICATIONSSome complications of eczema include skin infections, eczema herpticum, neurodermatitis, and eye complications.
Scratching that is associated with eczema can break the skin causing open sores which can then become infected. This can cause mild or more serious infections. See a physician if there is swelling, pain, crusting, or oozing of the eczema.
Skin that becomes inflected with the herpes simplex virus (the virus that causes cold sores) is called eczema herpeticum. The symptoms may include painful pus or fluid filled blisters or sores, which may be accompanied by fever, tiredness, and swollen glands. Prompt treatment is very important, as the inflection can spread to the eyes or internal organs, causing serious problems.
Caution should be taken around anyone with a cold sore; kissing and skin-to-skin contact should be avoided. Take extra caution with infants and children, especially those with eczema and/or open areas on their skin. Sometimes, with infants and small children, contact with the herpes simplex virus can be fatal. See a doctor immediately if there are concerns.
Long term itching and scratching of the skin can lead to an increased sensation of itch, which could possibly lead to neurodermatitis (also known as lichen simplex chronicus). These areas of the skin that are frequently scratched become thick and leathery in appearance, and the patches can be red and darker than the rest of the skin. Persistent scratching can lead to permanent changes in skin colour. See a physician if experiencing intense itch and/or there are noticeable changes in the skin.
In rare cases, severe atopic dermatitis can lead to eye complications, which could potentially cause permanent eye damage. See a physician if experiencing eye watering, inflammation around the eye, and eye discharge.