Eczema is defines as inflammation of the skin in a localized area or all over the body depending on the cause. The terms Dermatitis and eczema are commonly used interchangeable but do not mean the same thing.
Dermatitis is irritation or inflammation of the skin from any cause while Eczema is specifically irritation from allergy or hypersensitivity to something. As a result eczema is also called Atopic Dermatitis.
The word Atopy means allergy in medical field, it originates from the Greek word Atopia, meaning “abnormal”.
Eczema in most people goes with Asthma and allergic conjunctivitis. This is because all 3 conditions are caused by allergy to a specific allergen. Eczema affects all ages but is more common in infants and children due to their fragile skins, which make it easy for allergens to get in.
There are many Eczema creams and lotions that are working and many more which are not working, some of them will be mentioned here.
Symptoms of Eczema
Eczema has a characteristic rash that distinguishes it from other types of rashes in the following ways:
- Papular, Erythematous (red), scaling (peeling) and itchy rash patches
- Usually located on the flexors of the joints; this means it is on the insides of elbows, neck, back of knees and front side of ankles.
- There is usually very dry skin on the rash with cracking
Atopic Dermatitis (Eczema) usually goes with two other allergy related conditions. Most people have a triad of Eczema, Asthma and allergic Rhinoconjunctivitis.
Children with eczema find it difficult to sleep at night due to the itch and cause stress to the parents as the child will be crying at night. The itch get worse once you start to scratch yourself.
Symptoms appear very early in childhood and become less severe in adulthood. Patients with eczema experience flare ups when in contact with allergic substances. Studies have demonstrated that people that live in urban areas are more likely to develop Atopic dermatitis than those who live in rural areas or developing nations.
Patients with Contact Dermatitis develop rash only on the area that is in contact with the offending material. For example, Allergy to nickel, which is very common will manifest as rash on the wrist where the person wears the wrist band or on the neck if the person has a necklace made of nickel.
Sometimes eczema can Complicate in one or more of the following ways:
- Impetigo: It is crusty lesions and sores that occur due to superimposed bacterial infection of the superficial skin
- Cellulitis: This is infection of large area of the skin and deeper layers involving the subcutaneous tissue
- Erythroderma: Is generalized body rash with inflammation and redness that requires admission in hospital and aggressive treatment. More than 70% of the body is covered by redness
- Lichenification: It is thickening and hyperpigmentation of the skin with exaggerated skin lines on the affected area. It is caused by frequent excessive scratching .
Causes of Eczema
There are many factors that contribute to the development eczema:
1. Genetic factors
Studies have shown that there are genetic mutations that cause increased sensitivity to ordinary substances which then leads to overreaction by the skin upon exposure to that substance. As much as 10% of Europeans have the mutations. Other mutations cause the skin barrier to be less functional. This happens when there is a mutation on the genetic code responsible for production of Filaggrin protein. This protein is responsible for maintaining strong ski physical barrier that stops external pathogens from entering the body.
There is a genetic susceptibility if someone in the family has history of allergy like asthma or Seasonal rhinitis and conjunctivitis.
2. Environmental factors
There are environmental trigger factors that play a role in development of Eczema. One of them is Hygiene hypothesis, which explains why the condition is more common in developed areas. Hygiene hypothesis proposes that lack of exposure to many different substances, especially in the first year of life, due to being “too clean” is the reason there is increase in people with allergies in developed nations. Statistics show that many allergies like Peanut allergy, bee allergy and animal dander allergy is very common in developed countries than in developing nations.
Eczema can be triggered by using very strong detergents to bath or using lotions that contains substances that an individual is sensitive to.
Excessive bathing, sweating and rough fabrics can trigger or exacerbate (make worse) eczema.
Treatment of Eczema
Eczema is a chronic condition that requires long term care.
Treatment of Eczema has many factors to consider. These are:
- Relieving itch
- Treat the rash
- Prevent recurrence and worsening
This can be done with the use of oral antihistamines like Chlorphenamine or cetirizine.
- Chlorphenamine (Allergex®) 1mg to 4mg oral depending on the age of the child. It is taken at night.
- Cetirizine 5mg to 10mg once a day helps as well.
The difference between Cetirizine and Allergex® is that the latter has sedative effects while the former does not cause drowsiness.
Treat the Rash
Rash is treated with topical corticosteroids like Betamethasone and Hydrocortisone creams.
They are anti-inflammatory agents which help with both itch and rash. Hydrocortisone is less potent and used in sensitive areas like face and neck while Betamethasone cream, which is more potent is used on the rest of the body.
These creams should not be applied on the eyes or near them as they can cause irritation.
Use Aqueous cream as soap and apply Emulsifying ointment (UE) after bathing.
Preventing Eczema flare-ups and tips
It is important to know what works and what does not work if you have eczema. The following tips will help prevent worsening and recurrence of eczema:
- Avoid using soap on affected areas when bathing as it breaks the skin barrier
- Avoid woollen clothes and rough clothes on the skin directly
- Cut the nails short to prevent injury when scratching
- Avoid overheating by blankets at night
- Diet modification Plays No Role and is Unnecessary
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