What Is Eczema

What Is Eczema?
Eczema is a descriptive term for a chronic skin condition that usually

begins in early childhood. It is seen most commonly in individuals who
have family members who have asthma and hay fever. This is not to
say that eczema is a classical allergic disease. There seems to be
general agreement that this condition is inherited because of the
complete loss or relative lack of a skin protein.
Who Can Get Eczema?

There are criteria that must be met before the diagnosis of eczema is
considered. In most patients, the condition began in childhood. Patients
develop plaques of weeping, oozing skin that are very itchy. A
personal or family history of eczema, asthma,
and/or inhalantallergies is helpful. In older children or adults, the
lesions of eczema tend to occur in the folds of the skin in front of the
elbows and in the folds of skin behind the knees. Eczema tends to
improve in most patients as they get older.
What Are the Causes of Eczema?

The belief that the cause of eczema seems to be a defect in the
production of a particular skin protein (filaggrin) is currently quite
popular. All of the other problems that seem to be present in those
afflicted include dry skin, hyper-reactivity to wool, itching
during sweating, colonization by pathogenic staph bacteria,
predisposition to disseminated herpes simplex infections, and a variety
of immunologic abnormalities.
Eczema Symptoms
There is a debate about which comes first in atopic eczema, the itching
or the rash. This is analogous to the chicken and egg controversy. It
really does not matter. When the rash is in an acute stage, it is weepy
and oozy. Later after the patient has been rubbing and scratching for
some weeks, it becomes a plaque of thickened skin. This is called
lichenification.
Signs in Babies, Children & Adults

Atopic eczema has a typical distribution on the surface of the skin; this
can be quite helpful in making the correct diagnosis. In crawling
children in diapers, the rash is frequently seen on the elbows and knees
but spares the diaper area. In older children and adults, the rash is often
present in the folds of skin opposite to the elbow and kneecap but
spares the armpits. Other areas commonly involved include the cheeks,
neck, wrists, and ankles.
Types of Eczematous Dermatitis

Atopic eczema (atopic dermatitis) is one of a number of eczematous
eruptions that need to be distinguished. This is important because
treatment depends on the correct diagnosis. We'll take a look at the
listed types on the following slides.
Atopic Dermatitis
Atopic eczema is an inherited skin condition more common in
individuals with a personal or family history of eczema, inhalant
allergies like asthma or hay fever. Patients develop weeping, oozing,
itchy lesions in a characteristic distribution. The severity depends to a
great extent on the amount of moisture in the skin.
Atopic eczema is less common in very humid environments and is

harder to control in arid areas in the wintertime. It often begins in
infancy and improves in most people as they reach adulthood.
Contact Eczema
Contact dermatitis is a dermatitis that occurs in response to exposure to
an irritant or allergenic substance. Irritants cause skin damage by
producing direct toxic damage to the skin cells. Contact allergens are
not necessarily irritating or toxic but are recognized by the immune
system. Once the immune response is stimulated, a dermatitis occurs at
the site of exposure.
Seborrheic Eczema
Seborrheic dermatitis is a chronic recurrent dermatitis, and it is
probably the most common of all rashes in adults. The rash
characteristically appears on the scalp, forehead, brows, ears, the folds
that extend from the nose to the lips (nasolabial folds), middle of the
chest, and middle of the back. It occurs in infants as cradle cap. Its
course is distinguished by periods of improvement followed by flares.
Nummular Eczema
With nummular eczema, round plaques of eczematous skin often
appear on the lower legs. It often is seen in the elderly and seems to be
associated with dry skin.
Neurodermatitis
Lichen simplex chronicus is a localized, thickened area of skin caused
by itching and rubbing. Although there is usually some inciting cause,
the origin of the problem is entirely obscured by the eruption. Any of
the eczematous eruptions can evolve into lichen simplex chronicus if
rubbed long enough.
Stasis Dermatitis
Stasis dermatitis usually occurs on the lower legs of patients who have
sustained damage to the valves present in the large veins responsible
for returning blood to the heart. These valves, along with muscular
contractions of the leg muscles, help propel venous blood from the
periphery to the lungs and heart. Damage to these valves causes a long
column of blood to produce enough hydrostatic pressure on the wall of
the vein so small leaks occur. The lower legs swell and brownish blood
pigment is deposited in the skin from degradation of hemoglobin. A
dermatitis often occurs, and skin ulcers are common.
Dyshidrotic Eczema
Dyshidrotic eczema (pompholyx) is a common but poorly understood
condition in which very itchy small blisters occur on the lateral surface
of the fingers, toes, hands, and feet. Many patients note exacerbations
during periods of high stress (for example, finals week).
Diagnosis of Eczema
In order to make an accurate diagnosis of eczema, it is important for
your physician to take a complete history and examine all of the areas
of skin that are affected. Occasionally, certain laboratory tests can be
helpful in distinguishing various types of eczema. A pathologist may
need to examine skin scrapings and even a small piece of biopsied
skin.
Eczema Treatment: Basic Therapies

Once the diagnosis of atopic eczema is established, there are certain
well-established approaches to treating this condition. One of the most
important is to keep the skin well moisturized. There are many
inexpensive approaches to maintaining the moisture content of the
skin. Once the skin is wet, a thin layer of a cream or ointment is
applied to prevent the moisture from evaporating. Judicious use of
such substances (emollients) can be very effective in limiting flares of
atopic eczema.
Eczema Treatment: Medications

Corticosteroid creams are very effective at controlling the
inflammatory component of atopic eczema. The thickened, itchy,
weepy lesions respond well to the applications of such creams. In
addition, oral antihistamines are effective in suppressing the itching
sensation as well as acting as a sleep aid during flares.
Eczema Treatment: Immunomodulators

and UV Therapy
Newer drugs have become available for the treatment of atopic
eczema; they claim to be devoid of the side effects of topical steroids.
These newer medications inhibit the immune response by inhibiting
calcineurin, an enzyme necessary for a normal inflammatory response.
Though they are quite effective, they are also quite expensive and seem
to lack potency when compared to the strongest topical steroids.
Ultraviolet light exposure can effectively control eczema in certain
patients because of its effect on inflammatory cells in the skin.
Can Eczema Be Prevented?

Applying a good moisturizer to damp skin is the most effective method
for limiting flares of atopic eczema. Try the measures listed on this and
the following slide to control and help prevent outbreaks of eczema.
Can Eczema Be Prevented (continued)?

Since the condition is inherited, it would be very difficult to prevent its
development entirely. Living in a warm, humid environment seems to
limit flares of atopic dermatitis. Sleeping with a humidifier in the
bedroom can be of some help. In some patients, adding chlorine bleach
to bathwater can be quite helpful (1/2 cup of bleach to a bathtub of
warm water). It is important to rinse off before applying an emollient.

What Is Eczema

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What Is Eczema

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What Is Eczema?

Eczema is a descriptive term for a chronic skin condition that usually

Who Can Get Eczema?

What Are the Causes of Eczema?

Signs in Babies, Children & Adults

Types of Eczematous Dermatitis

Atopic eczema is less common in very humid environments and is

Eczema Treatment: Basic Therapies

Eczema Treatment: Medications

Eczema Treatment: Immunomodulators

Can Eczema Be Prevented?

Can Eczema Be Prevented (continued)?

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