What is Eczema? Causes, Symptoms, Treatment

Eczema (dermatitis) is a reaction pattern of the skin due to various causes. It is an inflammatory skin reaction induced by external and internal factors characterized clinically by itching, redness, scaling and papulovesicles.

There are three stages in the evolution. In the acute stage, redness, swelling, vesicles and oozing is seen. In the sub acute stage, diffuse redness, swelling, scabs and scaling is seen.  In the chronic phase, skin thickening (lichenification) is seen.

It can be classified into two groups – endogenous type, wherein the onset of the disease is caused due to the factors within the body, and exogenous, which is provoked by external factors. There can be association of both in some cases.

The predisposing causes are: Age, family history, climatic factors, stress and psychological factors. Personal or family history of atopy should be looked for. Local factors like dryness of skin and vascular pooling are also important.

Primary irritant dermatitis occurs due to repeated exposure with mild irritants like water, soap, heat and friction, or with irritants like alkalis, solvents, acids, detergent, etc.

Allergic contact dermatitis is due to a delayed hypersensitivity reaction following contact with allergens like Metals, rubber, plastics, cosmetics, occupational allergens etc.

Asteatotic eczema occurs due to decrease in surface lipids, especially in aged people in winter.

Atopic dermatitis occurs in individuals with ‘atopy’, often co-existing with asthma or allergic rhinitis, urticaria and food allergies.

Seborrhoeic dermatitis occurs in body areas rich in sebaceous glands (scalp, face, and trunk).

Nummular eczema is coin shaped dry, scaly lesions on extensor surface of extremities.

Lichen simplex chronicus is localized patches created by habitual rubbing and scratching.

Pityriasis alba is usually seen in children with asymptomatic hypopigmendted, scaly patches over face, neck and arms.

Stasis dermatitis is eczematous dermatitis of the legs due to venous insufficiency with oedema and hyper pigmentation.


What are the Symptoms of Eczema:

Symptoms may include dry, rough patches on affected skin; red, itchy spots or patches with swelling and scratch marks; weeping wet lesions with crusts or scabs due to constant discharge.

Long-term eczematous skin may show changes due to constant scratching and sometimes chronic application of topical corticosteroids.

Confirmation regarding the diagnosis and prognosis can be done by regular clinical examination, patient’s allergic history, skin biopsy, few specific blood investigations, skin patch test, etc.

In routine life, the nagging itching, recurrent oozing and bleeding impair the quality of life. The chronicity of the condition also affects the well-being of an individual.

Scratching and rubbing become habitual and may be done subconsciously. The disease becomes self-perpetuating. It is often frustrating and emotionally exhausting for the patients.

During monsoons, certain allergic eczemas, popular urticarial reactions (caused by mosquito bites), insect bite reactions etc. can be commonly seen.

Patients having fungal infections or localized eczema can experience a generalized flare-up of eczematous rashes known as ‘id-reactions’. With the onset of hot and humid environment during and pre-monsoons, the stickiness, irritation and itchiness can increase in predisposed eczematous skin.

To avoid exacerbations during the coming monsoon months, avoid prolonged baths, avoid damp, sweaty skin and try to keep it dry. If you have a history of frequent rashes of eczema, avoid excessive use of sensitizing fragrant-rich starch based talcum powders.

You can ask your dermatologist to recommend a non-sensitizing deodorant like ‘sweat nil’ or powders like ‘Terbest’.

To avoid exacerbations during the coming monsoon months, avoid prolonged baths, avoid damp, sweaty skin and try to keep it dry

Also Read: Home Remedies for Eczema
Also Read: Home Remedies for Acne

What are the Treatment for Dermatitis:

• Modify your skincare regime to avoid aggravating factors. Avoid soaps, use syndet haves instead. Avoid cutaneous exposures to allergens, irritants, UV light etc.

• Moisturizers are an essential part of daily therapy and work best when applied immediately after shower or a few hours after topical steroids. Avoid allergens like propylene glycol or fragrances in moisturizers to avoid risk of sensitization.

• Cool wet dressings, topical medium high potency corticosteroids with/without topical antibiotics and oral antihistamines to relieve itching, are generally the first-line of treatment.

• Protective clothing is a must for patients prone to allergic contact dermatitis (e.g. Vinyl gloves for hand dermatitis).

• Immunomodulatory non-steroidal topical like tacrolimus, pimecrolimus work best for chronic eczema. Barriers creams, calamine lotion help as self-treatments.

• Injections in resistant patches or steroid-impregnated tapes are effective for chronic eczema.

• Oral antibiotics, oral corticosteroids help for reserve cases

With treatment by a qualified dermatologist, this often neglected and bothersome condition can be controlled very well and cured by an intensive maintenance therapy.

However, a word of caution for the patients – avoid self- medication with topical creams once prescribed by your doctor, as they need not work life-long for any relapses.

SOURCE: B-Positive Health Magazine

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