Eczema

What is Eczema?

Eczema, also called atopic dermatitis, is the most common type of skin inflammation. Its cause is thought to be a combination of genetic and environmental factors. Although it is most commonly seen in children, adults can also be affected. Individuals with eczema often have dry and itchy skin, which is easily prone to infections. This condition is often described as the “itch that rashes,” because the constant itching and resulting scratching can lead to a skin rash.

What Causes Eczema?

Eczema is believed to be caused by a combination of genetic and environmental factors. People with a family history of eczema, asthma, or allergies are more likely to develop eczema due to certain genes that affect the skin’s barrier and immune system. The filaggrin gene, in particular, is associated with eczema and other skin conditions. Other genes involved in creating a protective skin barrier and managing the immune response have also been linked to eczema. Environmental factors, such as exposure to irritants and allergens, can trigger flare-ups in people with eczema. Additionally, the immune system’s abnormal response to environmental triggers can cause inflammation and damage to the skin. Understanding the genetic and environmental factors can help identify those at risk and determine appropriate treatment approaches.

Risk Factors and Frequency for Eczema

Eczema is a common skin condition, affecting around 15% to 30% of children and 2% to 10% of adults over their lifetime. Interestingly, it is more prevalent in rural areas compared to cities, suggesting lifestyle and environment play roles in developing the condition. Eczema tends to develop early in life, with 60% of cases seen in the first year.

A connection has been observed between eczema, asthma, and allergic rhinitis, often known as “the atopic march”. Half of the people with severe eczema are likely to develop asthma, and three-quarters may develop allergic rhinitis.

• Eczema affects about 15% to 30% of children and 2% to 10% of adults in their lifetime.
• It is more common in rural areas.
• The majority of eczema cases (60%) develop in the first year of life.
• Eczema is part of “the atopic march”, a trio of conditions that also includes asthma and allergic rhinitis.
• 50% of severe eczema sufferers may develop asthma, and 75% may develop allergic rhinitis.

Signs and Symptoms of Eczema

Eczema is a skin condition that causes an itchy rash and redness. When it first appears, it can cause very itchy red bumps and scratches on the skin. Over time, if a person continues itching and rubbing the affected area, the skin starts to thicken. This condition can be identified during a physical exam when the skin has visibly exaggerated its usual pattern, a change known as lichenification, caused by scratching or rubbing too much.

The area where the rash appears can change with age. Babies usually have scaly, dry, red patches and small scratches scattered over their bodies, often on their faces, mainly their cheeks. As they grow, the rash becomes more restricted to certain areas such as the wrists, elbows, ankles, and knees. School-aged children and adults usually have rashes in their skin folds, especially in the hollows of the elbows and knees.

Eczema also has other physical signs. For instance, a person with eczema might have Dennie-Morgan lines, which are crease-like wrinkles just below the lower eyelid. About 25% of eczema patients exhibit this feature. Sometimes, they may have lighter patches or fine scaly plaques on their face, a condition known as pityriasis alba. On their hands, they might show an increase in the number and depth of skin lines, often referred to as hyperlinear palms. If a person with eczema also has allergic rhinitis, they may have a horizontal crease across their nose, known colloquially as the “allergic salute”. This condition is caused by the habitual action of rubbing the nose upwards.

• Rash with itchy red bumps and scratches on the skin
• Rash areas depend on age – whole body in infants, certain areas in older children and adults
• Dennie-Morgan lines – wrinkles just below the lower eyelid
• Pityriasis alba – lighter patches or fine scaly plaques on the face
• Hyperlinear palms – increased number and depth of skin lines on the hands
• The “allergic salute” – crease formed across the nose in eczema patients with allergic rhinitis

Testing for Eczema

Typically, doctors identify this condition based on the look of the rash and the patient’s symptoms and personal account. Regular lab work usually isn’t necessary. If it’s not clear whether the patient has this condition, the doctor might perform allergy tests or use a method called patch testing to help make a diagnosis.

Treatment Options for Eczema

The main treatments for eczema involve moisturizing the skin daily and using topical medications during flare-ups. It is important to use fragrance-free ointments with few preservatives to keep the skin hydrated. Ointments are better than creams because they contain more oil, which helps maintain skin moisture.

It is also important to identify and address any triggers that may worsen the condition. These triggers can include environmental allergens, harsh soaps or detergents, scents, and rough fabrics.

Topical anti-inflammatory medications, such as steroids or steroid-free products, can help manage eczema flare-ups. In children, itching often becomes worse at night, so short-term use of oral antihistamines at bedtime can be helpful for sleep disturbance. However, antihistamines are no longer recommended for daytime use to relieve itching caused by eczema.

For patients with severe eczema that does not respond well to treatment, there is a higher risk of skin infections. To reduce this risk, they may be advised to take baths with a small amount of bleach added to the water or use a nasal ointment called mupirocin to decrease skin infections.

What else can Eczema be?

When trying to diagnose eczema, doctors need to consider several skin conditions that may have similar symptoms. Here’s a list of the conditions a doctor might look for:

• Contact dermatitis (skin inflammation due to contact with specific substances)
• Skin fungal infections
• Seborrheic dermatitis (a common skin condition that mainly affects the scalp)
• Drug eruptions (rashes caused by a reaction to certain medications)
• Scabies (a skin infestation caused by a mite)
• Psoriasis (a condition that speeds up the life cycle of skin cells)
• Ectodermal dysplasia (a group of disorders affecting the skin, hair, nails, and teeth)
• Hyper-IgE syndrome (a very rare immune disorder)
• Netherton syndrome (a rare genetic skin disease)
• Wiskott-Aldrich syndrome (a rare genetic immunodeficiency disorder)

These disorders may resemble eczema but have different causes and treatments. It is crucial to get the right diagnosis for appropriate treatment.

What to expect with Eczema

Most kids will eventually grow out of eczema and won’t have symptoms by the time they’re adults. However, if a child’s eczema is severe, started later in life, or has been persistent, it’s more likely that their condition will continue into adulthood.

Possible Complications When Diagnosed with Eczema

People with eczema are at a higher risk of getting bacterial, viral, and fungal infections. The skin’s inability to act as a protective barrier effectively makes it easier for infections to occur. For example, the S. aureus bacteria, which is found in only 10% of healthy people, can be found in over 90% of people with eczema. The severity of the rash often matches the amount of S. aureus bacteria present.

Bacterial infections can lead to conditions such as boils, impetigo, or cellulitis. If someone with eczema keeps getting bacterial infections, they may need to take measures like diluted bleach baths and intranasal mupirocin to reduce the bacteria on their skin.

Eczema also makes a person more susceptible to certain viral infections. One of them is eczema herpeticum, a serious infection caused by the herpes simplex virus-1. This infection causes widespread blisters, fever, and fatigue. It can lead to complications like eye inflammation, meningitis, brain inflammation, or severe infections caused by bacteria entering the bloodstream.

Another viral infection that people with eczema can get is eczema coxsackie, which is a variant of hand, foot, and mouth disease. This condition is primarily linked with the coxsackievirus A16. Unlike the typical symptoms of hand, foot, and mouth disease, eczema patients tend to get widespread blisters and abrasions, usually in areas previously affected by eczema. Symptoms like fevers, decreased appetite, or fatigue are not commonly seen. Instead, parents might notice a brief history of diarrhea or fever a week before the rash appears. In rare cases, it can cause aseptic meningitis.

Preventing Eczema

For people suffering from eczema, figuring out what sparks their symptoms is crucial. Minimizing or totally avoiding these triggers can be a significant part of managing the condition. They could experience better skin condition and fewer flare-ups if they steer clear of allergens, such as dust mites, eggs, peanuts, milk, fish, soy, rice, and wheat, and irritants like chemicals, heat, soaps, high humidity, acrylic, and wool.