Eczema

Overview:

Eczema is an itchy skin disorder caused by an inflammation of the skin that affects people of all ages, but commonly appears in early childhood. Most children will grow out of eczema by their teenage years.  It is more often seen in families with a history of allergies, asthma & hay fever.

Types of eczema:

There are many types of eczema, some of which include;

• Asteatotic Eczema (Eczema Craquele) - This condition is commonly seen in elderly people who are more prone to dry skin. The shins are typically affected although other areas such as the hands & arms.  The condition is characterised by dry, scaly, itchy redness,  & the outbreak of lesions. Asteatotic eczema can have the appearance of cracked porcelain (hence the name).

• Atopic eczema (Atopic Dermatitis, AD) - This is the most common form of eczema. Both adults & children can suffer from atopic eczema although it is most frequently seen in children. It is a familial disease (ie; seen in families) and often occurs in conjunction with other allergic disorders such as asthma or hayfever. Common areas affected include parts that crease (ie; behind the knees, in front of the elbows) & also the face, neck & chest. It is believed to be caused by a variety of allergens such as dust mites, pet dander etc.

• Contact dermatitis - Contact dermatitis most commonly affects adults & is caused by contact with an irritant such as plants, metals (such as earrings) & chemicals.

• Dyshidrotic eczema (pompholyx eczema, housewife's eczema, vesicular eczema)- Dyshidrotic eczema is a recurrent form of eczema usually affects the hands and feet where small, serum filled blisters appear beneath the skin, these blisters may begin to ooze. These become worse in hot & humid weather.  The cause of dyshidrotic eczema is not known, previously it was thought excessive sweating & or stress were triggers, it is now believed to be an environmental allergy such as nickel, smoking, fungal infections & certain foods. Secondary bacterial infections are not uncommon.  

• Nummular dermatitis (Discoid eczema) - Nummular dermatitis is characterised by disk shaped, itchy, red lesions usually found on the arms & legs, worsening in the winter months are typical of nummular dermatitis. It can occur in adults of any age, although is seen more commonly in older people, especially those with very dry skin. Secondary bacterial infection can occur in some patients. The cause isn't known.

• Seborrheic dermatitis - A common form of eczema, seborrheic dermatitis tends to affect the scalp. The infant form of seborrehic dermatitis is known as cradle cap. In adults, it produces flaky, white to yellow, oily patches of skin. Other parts of the body such as the chest, folds of the nose & eyebrows may also be affected with seborrheic dermatitis. 

• Stasis dermatitis - Also known as varicose eczema or gravitational eczema, stasis dermatitis is most common in older people. It affects the lower legs & sometimes feet. It is caused by sluggish circulation (usually due to a blood clot or varicose veins) which causes fluid to build up & leads to swelling. This causes itching, dry, red & scaly patches on the affected areas. In some cases, the rash breaks down into a sore. This is known as stasis ulcer.

Signs of eczema:

Symptoms vary depending on the type of eczema, but common symptoms include;

• Itching

• Redness

• Dry, flaking skin

• Itching may lead to secondary infections.

• In rare cases a condition known as eczema herpeticum may occur, this is caused when the herpes simplex virus enters the skin lesions. Signs of eczema herpeticum include high fever, multiple, itchy, fluid filled blisters. This is a serious complication & requires medical attention urgently as it can be life threatening.

Diagnosis of eczema:

Your doctor may be able to diagnose eczema based on clinical symptoms. They may wish to test for allergies to determine the possible cause of eczema.

Treatment of eczema:

Treatment depends on the type of eczema although in almost all types, keeping the skin well moisturised is the mainstay treatment. You will notice that the treatment is the same for most types of eczema. Replacing soap with emollients, avoiding harsh/perfumed products on the skin, application of topical steroids & antihistamines.

You should always seek medical advice before treating yourself for eczema. Some medications are not suitable to use on young children or in pregnant or lactating women.

Asteatotic Eczema:

• Bathing in lukewarm water & replacing soap with emollients (moisturising creams, ointments). Avoid the use of perfumed moisturisers as these may aggravate the situation.

• Whey drying after a bath, pat dry, don't rub the skin.

• During an outbreak, topical steroid ointments. It is generally recommended to use the lowest strength possible & apply only on affected areas.

• Oral antihistamines may be necessary during an outbreak to reduce the itch.

• Use a humidifier around the home.

Atopic eczema:

• Avoiding known triggers where possible.

• Bathing in lukewarm water & replacing soap with emollients (moisturising creams, ointments). Avoid the use of perfumed moisturisers as these may aggravate the situation.

• Whey drying after a bath, pat dry, don't rub the skin.

• Oatmeal baths can often help relieve the itching.

• During an outbreak, topical steroid ointments. It is generally recommended to use the lowest strength possible & apply only on affected areas. Long term side effects of topical steroid ointments include thinning of the skin.

• Oral antihistamines may be necessary during an outbreak to reduce the itch.

• If the skin becomes infected, your doctor may prescribe antibiotics.

• Ultraviolet therapy. This is known as phototherapy & uses an ultraviolet light. Either ultraviolet A (UVA) or ultraviolet B (UVB). In severe cases, a substance called psoralen is applied prior to phototherapy. Psoralens make the skin more sensitive to UV light. This is known as PUVA (psoralens plus ultraviolet A). Ultraviolet exposure does increase the risk of skin cancer.

• In severe cases, hospitalisation may be necessary where bandages & wet wraps will be applied. This also gives the patient a break from the home where the possible trigger (ie; an allergen) could be causing the problem.

• Topical immunomodulators (TIMS). These are relatively new drugs on the market. They suppress the immune system in the affected area. It may be recommended in cases that have failed to respond to other types of therapy, or in areas of the body where skin is thin, such as the face or groin.

Contact dermatitis:

• Avoiding the use of irritants where possible.

• During an outbreak, topical steroid ointments. It is generally recommended to use the lowest strength possible & apply only on affected areas. Long term side effects of topical steroid ointments include thinning of the skin.

• Oral antihistamines to reduce the itch.

• If the skin becomes infected, your doctor may prescribe antibiotics.

Dyshidrotic eczema:

• Avoiding the use of irritants where possible.

• During an outbreak, topical steroid ointments. It is generally recommended to use the lowest strength possible & apply only on affected areas. Long term side effects of topical steroid ointments include thinning of the skin.

• Oral antihistamines to reduce the itch.

• If the skin becomes infected, your doctor may prescribe antibiotics.

• Ultraviolet therapy. This is known as phototherapy & uses an ultraviolet light. Either ultraviolet A (UVA) or ultraviolet B (UVB). In severe cases, a substance called psoralen is applied prior to phototherapy. Psoralens make the skin more sensitive to UV light. This is known as PUVA (psoralens plus ultraviolet A). Ultraviolet exposure does increase the risk of skin cancer.

• Avoid products containing nickel.

• Reduce stress, where possible.

Nummular dermatitis:

• Emollients: Bathing in lukewarm water & replacing soap with emollients (moisturising creams, ointments). Avoid the use of perfumed moisturisers as these may aggravate the situation.
• When drying after a bath, pat dry, don't rub the skin.
• Topical steroids: During an outbreak, topical steroid ointments. It is generally recommended to use the lowest strength possible & apply only on affected areas. Long term side effects of topical steroid ointments include thinning of the skin. These should be applied immediately after your bath.
• Systemic steroids: Either in tablet form or injections. These may be prescribed for severe cases or cases that fail to respond to topical steroid creams.
• Oral antihistamines may be necessary during an outbreak to reduce the itch.
• If the skin becomes infected, your doctor may prescribe antibiotics.
• Ultraviolet therapy: This is known as phototherapy & uses an ultraviolet light. Either ultraviolet A (UVA) or ultraviolet B (UVB). In severe cases, a substance called psoralen is applied prior to phototherapy. Psoralens make the skin more sensitive to UV light. This is known as PUVA (psoralens plus ultraviolet A). Ultraviolet exposure does increase the risk of skin cancer.
• Topical immunomodulators (TIMS). These are relatively new drugs on the market. They suppress the immune system in the affected area. It may be recommended in cases that have failed to respond to other types of therapy, or in areas of the body where skin is thin, such as the face or groin.
• Use a humidifier in dry environments such as homes with central heating.

Seborrheic dermatitis;

• Anti-seborrheic shampoos - These contain an ingredient to remove excess sebum & reduce irritation. The active ingredients in these shampoos may vary from brand to brand but most will contain one of the following; salicylic acid, tar, sulfur and propylene glycol. After the shampoo has been applied & lathered up, leave on the hair for approximately 10 minutes before rinsing off.

• Anti-fungal shampoos containing the anti-fungal agent containing ketoconazole.

• During an outbreak, topical steroid ointments. It is generally recommended to use the lowest strength possible & apply only on affected areas. Long term side effects of topical steroid ointments include thinning of the skin.

Stasis dermatitis:

• Treating the underlying cause if possible.

• Pressure bandages may be of help.

• During an outbreak, topical steroid ointments. It is generally recommended to use the lowest strength possible & apply only on affected areas. Long term side effects of topical steroid ointments include thinning of the skin.

Please note:

The medical articles on this site have not been written by a doctor & should not be considered a replacement for a doctor visit. The articles are provided for informative purposes only.

Always seek immediate medical advice for any problems.

While great care has been made in the creation of these articles, we cannot guarantee the accuracy or omissions on these pages. If in any doubt whatsoever, seek professional medical advice.