WHAT IS ECZEMA?
APPEARANCE AND SYMPTOMS
GRADES OF ECZEMA
What is 'ECZEMA'?
The word eczema comes from Greek words that mean to boil over. Dermatitis comes from the Greek word for skin and both terms refer to exactly the same skin condition.
Categorized as an overactive immune system disorder, eczema affects up to 20% of the worlds population (about 1 billion people). An increase of between two- and five-fold has been seen over the past 30 years. It affects more than 15 million Americans. Ten percent of all children have eczema, with most cases being diagnosed before the age of 5. Although eczema may clear up by adolescence, many people continue to suffer from it throughout their lives. Eczema is more common in urban areas and affects both males and females in all racial groups.
Eczema is a chronic, itchy inflammation of the skin associated to a varying degree with other features such as:
redness of affected areas of skin
generally dry skin, which is often thickened in the areas that have been scratched
lumps or blisters in affected areas
signs of superficial infection such as weeping or crusty deposits.
Although eczema can develop at any place on the body, it typically appears on the hands, wrists, arms, neck, upper chest, face and backs of knees. The worst symptom for many is the intense itch which leads to the itch/scratch cycle: you itch and you scratch further damaging the skin and thus causing more itching. Emotional stress can provoke it as well as internal and external chemical sensitivities and allergies.
Eczema is harder to manage in children because scratching and rubbing is difficult to control, especially at night while they try to sleep.
In children, the most commonly affected areas are the cheeks, chin, back, stomach, and arms. Areas such as the hands, feet, and creases of the elbows and knees are also commonly affected. In adults, eczema is commonly found on the eyelids, neck, hands and wrists, and behind the elbows and knees.
Food allergies and certain foods such as wheat, gluten, dairy and nuts can trigger eczema outbreaks. Hydrochloric acid deficiencies may also be associated as well as overproduction of candida (yeast) and consequently leaky gut syndrome. Further, underproduction of the delta-6 desaturase enzyme and overproduction of delta-5 desaturase enzyme which are involved in inflammation may be a key factor.
Eczema is divided into a small number of subgroups based largely on the factors that may be most important in causing eczema in any one individual, but it is important to recognize that the symptoms and appearance of the skin in all these types can be exactly the same. Also, the classification system is far from perfect as it is often difficult or impossible to accurately say what causes eczema to occur in any one person.
Atopic: the allergic type often seen in people who also have hay fever or asthma.
Allergic contact: due to skin contact to a substance to which the individual is sensitive. The same substance does not cause eczema in a person who is not sensitive to it.
Irritant contact: due to skin contact with irritating chemicals, powders, cleaning agents, etc. Contact with such a substance is likely to cause eczema in any person, although a degree of individual variation still exists.
Discoid: This type of eczema shows as discrete coin-shaped patches (like islands) of eczema on the limbs. The affected areas have a well-defined edge and are red. On top there are often small blisters, scales or crusts. This often reflects the fact that they are infected with bacteria.
Usually the pattern of skin lesions (affected areas) on the limbs is symmetrical. The lesions are very itchy, so thickening of the skin (lichenification) is common. Because of their well-defined margins, lesions of discoid eczema can be confused for fungal infections of the skin (ringworm) or for contact eczema.
Discoid eczema can affect all age groups, but is usually associated with middle-aged or older men.
The causes are unknown, but in younger people discoid eczema tends to be seen together with atopic eczema. In adults it is said to be possibly associated with stress, local irritation of the skin and drinking too much alcohol
Seborrhoeic: a well recognized pattern of eczema affecting all age groups from young adults to the elderly. Seborrhoeic eczema is also seen in babies during the first year of life and it appears in the nappy area and the scalp. In adults, it appears on the scalp and in the skin creases between the nose and sides of the mouth. It can be caused by yeast infection.
1. Scalp and face: skin is greasy, red and scaly. Affects the central face and forehead, the sides of the nose down to the outer ends of the mouth, the edges of the scalp, eyebrows and behind the ears. The scalp is very scaly (dandruff).
2. Front of chest: a red scaly patch over the breast bone.
3. Back of trunk: multiple red raised dots across and between the backs of the shoulder blades.
4. Skin folds: a moist red skin reaction in the groins, under the breasts and in the armpits. In childhood seborrhoeic eczema the skin folds are most affected, but there can be a yellowish scaly crust on the scalp, too (known as cradle cap).
The condition varies in severity. A mild case would be a little bit of dandruff and flaky skin over the face. In severe cases, the skin is widely affected and very itchy; the scalp is itchy, oily and, if very inflamed, there is much scaling of the scalp skin.
Skin infection by yeast called Pityrosporum is thought to play a part in seborrhoeic eczema.
Others: a miscellaneous group including eczema of the legs caused by varicose veins and pompholyx an intensely itchy form located on the hands and composed of small or (sometimes) large blisters.
This is the main symptom, and without it a rash is not due to eczema (unless the itch has been improved by treatment). Itch is also a common feature of many other skin conditions as well as being a symptom of a range of diverse medical conditions not primarily to do with the skin, so although it is an essential symptom when diagnosing eczema it is not specific for it. We still do not fully understand what causes itch, but nerve fibers specialized in transmitting the itch sensation appears to exist within the skin. Like other nerves, these are ultimately connected to the spinal cord and so to the brain. It used to be thought that the sensation of pain traveled along the same nerve fibers as for itch but this seems now to be unlikely. Interestingly, the two sensations can act against each other. Thus relief from severe itching may sometimes be had from inflicting pain instead, as might be seen in someone who prefers the discomfort of a very hot bath to that of constant itching. The act of scratching may itself cause nerve signals to travel down the pain fibers, blocking the sensation of itch from being experienced.
Increased redness of the skin usually means increased blood flow. An extensive network of tiny blood vessels (capillaries) is present in the deeper layers of the skin that project loops of smaller vessels into the more superficial layers. The very top layer of skin is composed of dead skin cells and has no blood supply, so a superficial cut to this level will not bleed. When skin is inflamed the local network of blood vessels widens, increasing the flow of blood and making it red. The process of inflammation in eczema is complex and can be triggered by a range of factors but an important additional one to take into account when eczema flares up is the presence of bacterial infection. When bacterial infection gets into the deeper layers of the skin there is usually a marked increase in redness and heat from the tissues. Recognizing that this may be due to infection is important in bringing the eczema under control.
Eczema covered skin that has been inflamed for a while is usually much thicker than unaffected skin. Mainly this occurs as a protective response of the skin to the repeated trauma of scratching. Eczema often affects the skin in areas around joints such as the elbow, behind the knees and in front of the ankles (the flexures) where the skin also needs to be particularly flexible. Commonly one will see splits in the skin here (fissures), as the thickened skin is unable to bend as it would normally.
The microscopic study of skin structure in eczema shows there is less adhesion between the skin cells, particularly in the upper layers of the skin. This contributes to scaling and makes it easier for skin bacteria to get into the deeper layers, between the gaps. It also makes it possible for tissue fluids to ooze between the cells and, if sufficient, to gather into collections or blisters. Small blisters may be seen in active eczema but occasionally large ones may occur, either due to the particular nature of the eczema or because of skin infection coming along as well when the blisters may be filled not only with clear fluid but also pus.
The fluid that oozes from inflamed skin is rich in protein. When this dries out in contact with air the protein is left behind as a crusty deposit. Often this occurs in conjunction with infection, when the infected crusts typically have a golden color. A similar crusting is seen in the infectious skin condition called impetigo, which is commonly seen in children of primary school age as it is easily passed on by touching. In impetigo treating the infection eliminates the problem, but it is of course only part of whats required in eczema.
Grades of eczema
A useful way to classify eczema is based on the degree of activity and the duration the eczema has been active.
Acute in medical language means of rapid onset. Often conditions that come on over a short period of time are also quite vigorous in their activity, although strictly speaking acute should not be taken to be another word for severe. Acute eczema therefore would be an area that recently flared up and would be red, probably also have blisters and possibly some oozing or crusts.
Chronic properly means long-standing. Once the initial phase of activity has died down a bit of skin that has been eczematous for a while is dry, scaly, thickened and cracked.
At any stage of eczema it can become infected. This wont always be obviously different from acute eczema unless there are pus-filled blisters. With experience one can usually discern the golden crust of infection and pick up the other clues that suggest infection.
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Care for Your Skin
Bathe only with a mild soap, such as Dove, Basis or Oil of Olay. Use a small amount of soap when bathing. Keep the water temperature cool or warm, not hot.
Moisturizers help keep your skin soft and flexible. They prevent skin cracks. A plain moisturizer is best.
Try not to scratch the irritated area on your skin even if it itches.
Too much heat and sweat can make your skin more irritated and itchy.
Eczema can flare up when you are under stress. Learn how to recognize and cope with stress.
Dietary restrictions that may help avoid flare ups include eggs, seafood, peanuts, milk, citrus foods and soy. This is very individual and should be discussed with your health care provider. Control of stress, nervousness, anxiety, and depression may help prevent flares of eczema.