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Eczema

Overview

Eczema is a skin condition that involves inflammation of the outer layer of the skin. It occurs due to multiple factors, but the exact cause of this condition still has not been determined. It is thought to be linked with your genetics and immune system. It can occur at any age, but it is more commonly observed in children. Mild cases of eczema can be managed well, but severe cases can lead to other skin-related complications that may require proper medical attention. Eczema is not contagious and cannot be transmitted by direct skin-to-skin contact. 

Causes

No singular factor has been identified yet as a cause of eczema. It is thought to result from multiple factors that involve genetics, the immune system, and the environment. A considerable percentage of people with eczema have a family history of this disease. Since eczema is a hypersensitive reaction by your immune system, people with a genetic factor for eczema may also have other hypersensitive disorders such as asthma, food allergies, etc. Certain medicines such as flurbiprofen, siltuximab, cidofovir, etc., and food products may also trigger your immune system that can cause eczema. Environmental factors also influence the development or progression of eczema. Low temperature or low humidity may also trigger eczema or cause it to flare up if you already have this skin condition. This is why most cases of eczema are reported during winter because decreased temperature and lower humidity of the environment cause dry and itchy skin. Hormonal changes during stress, menstruation, or pregnancy can also worsen the symptoms of pre-existing eczema. 

Types

Eczema is classified according to incidence, site, severity, and multiple other factors. The most common seven types of eczema include atopic dermatitis, contact dermatitis, neurodermatitis, dyshidrotic eczema, nummular eczema, seborrheic dermatitis, and stasis dermatitis

Atopic dermatitis is the most common type caused by a genetic or immune component. It can be triggered by allergens and occurs mainly on the face, scalp, neck, buttocks, and inside of elbows/knees.

Contact dermatitis results after contact with an allergic substance or chemical irritant such as nickel, poison ivy, etc. It can occur anywhere on the skin that directly contacts the offending agent. 

Neurodermatitis occurs after continuous scratching of a localized spot on the skin. It may result from an insect bite and can be seen on the scalp, forearms, and lower legs. 

Dyshidrotic eczema is frequently observed on palms and soles of feet. It is present in the form of minor vesicles that may burst at any time. 

Nummular eczema occurs in the form of scaly, round patches with a clear outline. They are usually present on the lower legs and cause extreme discomfort. 

Seborrheic dermatitis results in the formation of scales or flakes on the scalp and eyebrows. In its mild form, it occurs as dandruff along with consistent itching. 

Stasis dermatitis occurs in people with reduced blood circulation to a particular area, especially in the lower legs and around ankles. The skin of such regions becomes thick, dark, and crusty.

Risk Factors And Epidemiology

Cold weather is considered a major risk factor for eczema due to lower humidity and temperature. People living in cold countries have a higher tendency to develop this condition. Some cases of eczema have also been reported due to excessive hygiene care during infancy. This is observed mainly in developed countries where parents are over-cautious about their children, leading to a less developed immune system.  Exposure to passive smoking or other chemical irritants is another risk factor. Other factors such as age, weight, occupation, and working environment may also affect the development of eczema. 

Eczema can occur at any age, but the most frequent cases of different eczema are observed in children. There is no gender prevalence, and it occurs both in males and females. 

Signs And Symptoms

The signs and symptoms of eczema may vary depending on its type. Common symptoms that usually occur in all kinds of eczema include itching, redness, scales or crust formation, and purulent lesions such as blisters. They can be noticed on any skin region, but they are often observed on the face, scalp, neck, and insides of elbows or knees. A mild form of eczema is manageable, but severe forms of eczema cause excessive itching, breaking the outer skin barrier. This may lead to other secondary viral, fungal, or bacterial infections. 

Diagnosis

Diagnosis of eczema is usually made on a clinical basis. A detailed history is required, including all previous allergies, medications, occupational hazards, etc. This is followed by a clinical examination of the affected skin regions to notice the spread and severity of this condition. No specific tests have been identified for the diagnosis of eczema.

Differential Diagnosis

Different types of eczema need to be differentiated from other skin diseases that may cause itchiness or dryness. These include herpetiform ulcers, bullous pemphigoid, measles, hand-foot, mouth infections, candidiasis, etc.

Lifestyle Modifications

There are no specific treatment options available to treat eczema. Medications that are given in the form of creams, lotions, or ointments can only provide symptomatic care. However, certain lifestyle modifications can reduce the symptoms of eczema. These include maintaining skin hygiene, regularly moisturizing it, wearing allergen-free fabrics, avoiding food substances or other agents if you have pre-existing allergies, taking baths with lukewarm water, avoiding using harsh soaps or detergents, and maintaining proper diet plus hydration.

Medication

Moisturizing lotions, creams, or ointments containing emollients such as balneum, eucerin, etc., should be used to reduce dryness and scaly patches. Antibiotics, antihistamines, or corticosteroids may also be prescribed if deemed suitable by your dermatologist. 

Prognosis

Eczema can occur as a life-long disease because it has no specific cure available. Most of the cases can be managed well with medications and lifestyle modifications. 

Prevention

Prevention of eczema is difficult, especially if it has a genetic component. The occurrence of eczema can be somewhat limited by extra skincare during dry, cold weather, frequent moisturization, intake of diet which includes necessary vitamins, and drinking plenty of water to avoid dehydration.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 17, 2023.

References

Eczema - StatPearls - NCBI Bookshelf (nih.gov)

https://www.ncbi.nlm.nih.gov/books/NBK538209/

Eczema: Symptoms, treatment, causes, and types

https://www.medicalnewstoday.com/articles/14417

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