This post discusses what is eczema and how to treat it. It covers the types, causes, diagnosis, treatment options and preventive measures and advice.
The term Eczema is derived from the Greek word which means to ‘boil over, and it is commonly used to describe a group of diseases known to doctors as dermatitis (inflammation of the skin).
This group of diseases is characterized by itchy rashes, redness (in fair skins), and sometimes blisters and swelling. In severe cases, scarring and thickening of the skin may occur.
This disease includes the following skin conditions:
- Atopic dermatitis.
- Contact dermatitis.
- Seborrhoeic dermatitis.
- Nummular (discoid) dermatitis.
Dermatitis occurs mostly in children, affecting almost one in five children in developed nations, with lower rates in the developing world. It also affects adults, with 1% prevalence (one in a hundred) noted in some areas.
Altogether, more than two hundred million people globally are believed to be affected by the disease.
The overall global prevalence of the disease is noted to have been rising steadily over the years, possibly due to the increase in affluence and urbanization over the decades.
Predisposing Factors To Eczema
There are some factors which can make you more likely to have eczema. They include the following:
- Urban environment: Your environment affects your chances of getting eczema. Eczema appears to be more common among those who live in urban environments as opposed to rural areas. It appears to be associated with a westernized lifestyle.
- Higher social class: If you are highly educated or you belong to the higher income class, you will have an increased risk of the disease. This is because you will then be more likely to be exposed to refined chemical products that can cause the disease. Children in the higher social class also have reduced exposure to the ‘maturing’ effect of the natural environment on the immune system which can make them more susceptible to having eczema and other allergies.
- Increased use of antibiotics: When antibiotics are used too frequently without proper indication, they can make children susceptible to having attacks of eczema.
Causes of Eczema
The commonest form of eczema is atopic dermatitis. This disease is widely believed to be caused by an underlying impairment in the function of the skin. The natural barrier and moisturizing functions of the skin are reduced in many people with atopic dermatitis.
There is a particular skin protein called filaggrin has been implicated in atopic dermatitis. This protein helps strengthen the skin barrier, as well as increase moisture retention in the skin.
Alteration in the structure of this protein due to genetic mutation causes a predisposition to dry skins which are more easily penetrated by different environmental agents.
In such people, environmental agents like pollen, bacteria, animal fur, house dust mite and other irritants, easily cause inflammation due to the weakened condition of their skins.
The inflammation caused by these agents leads to itching, redness and rashes. People who have atopic dermatitis also tend to have a family history of other allergies like asthma, allergic rhinitis etc.
People who have atopic dermatitis may also suffer from a level of immune dysfunction.
This means that their immune system may tend to react excessively to normal environmental agents, resulting in an inflammatory response on even mild exposure to allergens.
Atopic dermatitis may be classified as:
This is often noted in the first 6 months of life. The skin is itchy, red, and dry. It usually improves with increasing age.
This affects children from about 2 years and older. The itchy red rashes are often present at the elbow, behind the knee, and at the ankles. They may also be present on the face.
This also often occurs at the elbow creases, behind the knee and at the wrist and ankles.
Atopic dermatitis often shows flares, which are periods when the disease increases in intensity. Causes of flares include dust, fur, infections, hay, heat, stress, irritants etc.
This form of dermatitis is caused by an inflammatory response when you contact either an allergen or a substance which irritates the superficial layers of the skin.
Common substances that may cause contact dermatitis include some plants like poison ivy, grasses, nettles; chemicals like solvents, plastics, some soaps, perfumes and other industrial chemical materials.
Some common forms of contact dermatitis include diaper dermatitis and housewife hand eczema.
Contact dermatitis is characterized by a rash, itching, and sometimes blisters in the area that came in contact with the irritant.
3. Seborrhoeic dermatitis:
Seborrhoea is a form of dermatitis that affects the scalp, face and chest. It is associated with areas of the body rich in sebaceous glands which produce oily sebum (mostly around hair follicles). The disease is characterized by red itchy rashes and scales usually on the scalp, but also on other parts of the body. It is believed to be partly due to fungal growth. Milder forms of seborrhoeic dermatitis are often referred to as dandruff.
4. Nummular (discoid) dermatitis.
This form of dermatitis is characterized by circular or coin-shaped lesions in affected areas. It is also caused by contact with irritant materials that irritate the skin. Chemical preparations that contain metals such as nickel or cobalt are possible irritants that can cause this form of dermatitis. Nummular dermatitis is commoner in adults than in children
Course Of The Disease
Depending on the duration of symptoms, eczema may be acute, subacute or chronic.
This is characterized by redness, rashes, and mild swelling in affected areas. The inflammatory response caused by the release of chemicals by lymphocytes results in the accumulation of fluid and blood cells in the affected area. This is what causes the redness and the swelling which you see. The chemical agents also sensitize local nerve endings resulting in itching.
This is characterized by redness, rashes, swelling and mild thickening of the skin.
This occurs in long-standing eczema. It is characterized by thickening of the skin in affected areas. If the swelling persists for some time without resolution, it can eventually lead to thickening of the skin.
The associated scratching can also result in the entry of bacteria into the skin, which will result in bacterial superinfection. The injury caused by the scratching can eventually result in scarring of the skin in affected areas.
To diagnose the disease, health workers will usually ask you some questions.
They may want to know when you first noticed the symptoms.
They may also ask for a history of contact with animal fur, hay, dusty environments, chemical products, new cosmetics etc.
Because atopic dermatitis is associated with other allergies, they may ask you for any family history of diseases like asthma, food allergy, recurrent rhinitis, etc.
The health worker will then examine the lesions of the disease. There may need to check other parts of your body such as your lymph nodes, your liver, spleen and kidneys.
Sometimes, the health worker may use a swab to dab the rashes and blisters, to see if there will be any bacterial growth, and to check for viruses.
Treatment Of Eczema
Eczema is usually treated by applying topical medications to the skin. These are ointments that are used to reduce the symptoms of eczema flares, and also to prevent the development of eczema.
In some cases, you may need to take oral medications to treat eczema flares.
The medications which you can use in the treatment of eczema include:
- Emmolients: These are ointments which are also known as moisturizers. When you apply moisturizers regularly to your skin, they will keep your skin moist, and help strengthen its barrier functions. This will make it difficult for allergens and other irritants to penetrate the skin and cause eczema. If you have recurrent eczema, you should apply moisturizers frequently to keep your skin moist. The drier your skin, the more frequently you should apply the moisturizer. You can carry a moisturizer with you to school or to the workplace.
- Topical steroid creams: Steroids are drugs which can be used to treat inflammation. Steroid creams of different strengths are available, and your doctor may recommend a steroid cream for you to use in the treatment of an attack of eczema. Steroid creams will reduce the redness and itching that is associated with eczema. However, steroids have some side effects; therefore they should not be used too often. Your doctor will give you instructions on how to apply a steroid cream; usually once or twice a day.
- Antibiotic ointments: If bacterial superinfection is suspected by your doctor, he may add an antibiotic cream for you. This ointment will clear any bacterial organisms that may be associated with your eczema. You can know if there is a bacterial infection by inspecting the eczema lesions. If they are wet with a discharge, and crusts are present, then bacterial infection is quite likely to have occurred.
- Other immunosuppressant ointments: These are topical preparations of drug s designed to suppress the immune system at the point of application, thereby reducing inflammation and leading to an improvement in symptoms. Your doctor may recommend them if your eczema does not respond to steroid ointments. They should be used sparingly as they may have some side effects, and excess usage may predispose to some forms of cancer. Medications that belong to this category include the following drugs: tacrolimus and pimecrolimus. These are called calcineurin inhibitors.
- Other treatment modalities include the application of dressings and bandages over affected areas. This helps to increase the effectiveness of ointments applied to the skin, and can also reduce scratching of the skin.
Oral drugs such as antihistamines or oral steroid medications or antifungal drugs may sometimes be prescribed by your doctor, to help reduce the symptoms of the disease.
In more severe cases, drugs like methotrexate, azathioprine and ciclosporin may be administered orally to suppress the immune system.
Prevention Of Eczema
If you suffer from frequent attacks of eczema, you should take the following steps to avoid precipitating attacks
- Avoid any allergens that may precipitate attacks of eczema. These include dusty environments, animal furs, hay, plant pollen etc.
- Some people are allergic to some food items such as eggs, groundnuts, etc.this can be suspected if your eczema still persists despite avoidance of the allergens mentioned above.
- Avoid chemical agents that may irritate or sensitize your skin. If an attack of eczema is associated with a particular cosmetic such as a cream, perfume, or a new soap, discontinue its use.
- In some people, rubber products such as latex gloves can precipitate attacks of eczema. Therefore they should be avoided.
- If you suffer from dry skin, then you may need to make frequent use of moisturizers to keep your skin moist. This will help reduce your tendency of having attacks of eczema.
Outcome Of The Disease
Eczema is quite common in children, and it affects one in five children under the age of two years in some countries. About half of the children who suffer from attacks of the disease will eventually outgrow it before they become adults.
A few people continue to suffer from attacks of eczema well into adulthood. About one in a hundred adults will have a problem with recurrent eczema attacks.
Children who have the following associated factors may continue to suffer from eczema even when they become adults:
- Children who also suffer from attacks of asthma, or allergic rhinitis, or recurrent allergic conjunctivitis.
- Children whose eczema attacks begin very early in childhood.
- People whose eczema attacks spread over most of their body.
- Children who have a high level of IgE antibodies.
Eczema is a word used to describe a group of diseases. These diseases have the same clinical presentation. They are characterized by rashes, itching, and reddish discolouration of the skin.
The management of eczema depends on the particular type of disease involved. The commonest type of eczema is atopic dermatitis which occurs more in children than in adults.
- Nicole Yi Zhen Chiang, Julian Verbov. Dermatology, a handbook for medical students and junior doctors. 2nd edition. London, UK: British Association of Dermatologists; 2014.
- Australasian society of clinical immunology and allergy. Eczema ( atopic dermatitis). www.allergy.org.au. Accessed 4th January 2019.
- All you need to know about eczema treatment-WebMD
- National Eczema Association
- Eczema Management and Treatment-Cleveland Clinic
- Atopic Dermatitis-Diagnosis and Treatment-Mayo Clinic