Eczema is an inflammatory skin condition that causes the skin barrier to weaken, impairing its ability to protect the body from outside elements and retain moisture. The skin becomes dry, red/hyperpigmented, itchy, thickened, and bumpy. The urge to scratch the skin is often irresistible. Excessive scratching can lead to the formation of blisters and skin infections. It can affect people at any age, from newborns to the elderly.
According to National Eczema Association, more than 31 millions
of Americans are suffering from some form of eczema. Eczema is a collective term describing seven types of dermatitis. The terms dermatitis and eczema are often used interchangeably, which is not incorrect. However, not all dermatitis is eczema. All eczema is dermatitis.
Eczema can come in mild, moderate, or severe forms. Most people suffering from it experience periods when symptoms are less noticeable, followed by periods when the condition becomes more acute. These periods are called ‘flare-ups’. Flare-ups are usually caused by triggers which will be discussed later in the text.
Symptoms of dermatitis occurring in specific areas of your body may be indicative of the trigger. Typically dry, scaly, itchy skin is found on:
Less commonly, it can also appear on:
Although itchy, red, or hyperpigmented and dry skin are common symptoms for all types of eczema, there are several other symptoms that can determine which one of seven different types of eczema you are suffering from. It is important to be diagnosed correctly by a healthcare professional, as different types of eczema have specific triggers. One person can have more than one type of eczema. The main types of eczema are:
The most common type of eczema. Also known as ‘ atopic eczema’. It usually starts in childhood and becomes less severe with age. ‘Atopic’ is the term used to describe being prone to develop conditions related to allergies like eczema, asthma or hay fever. These are all conditions affecting the body’s immune system and are responsible for excessive allergic reactions. Not all people with atopic dermatitis have asthma or hay fever. Patients with atopic dermatitis typically have skin barrier alterations caused by the overreactive immune system. This makes the skin much more susceptible to infection and allows irritating substances/particles to enter the skin, causing itching and inflammation. A mixture of genetic and environmental factors causes atopic dermatitis. This condition often is hereditary and runs in families. . This term is used to describe eczema occurring in response to contact with irritants or allergens in environment therefore, contact dermatitis is usually divided into two types: irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD). . Symptoms can occur as a reaction to household cleaning products, cosmetics, raw food, or cold wind. Symptoms usually involve painful, fluid-filled blisters, ulceration, mild to severe dryness, and rash. It is considered the most common work-related skin condition. Occupations at higher risk are chefs, hairdressers, metal workers, nurses, cleaners, and construction workers. Irritant contact dermatitis will occur in anyone exposed to sufficient concentration of an irritant for long enough. It happens when the irritant damages the skin’s protective barrier faster than it can repair it. occurs in people who develop an allergic reaction to a product or specific substance. Repeated exposure to the chemical is required to develop an allergy. Over a period of time, usually months or years, the body learns to recognize the substance, and we become sensitized to it. This substance is harmless to people who are not allergic to it. Symptoms appear 28-72 hours after exposure to the allergen and settle down after a while when the allergen is removed. It usually presents as localized skin eczema in contact with the allergen, but the reaction can sometimes spread or become generalized. Common allergens are found in jewelry, nail varnish, fragrances, plants, and topical medication. This type of eczema appears as small blisters on the hands, feet, and edges of the fingers and toes. The skin can crack and flake, causing bleeding. Due to the areas of the body it usually affects it sometimes is referred to as ‘hand and foot eczema’. It can be caused by immune system activation due to inflammation, allergy or frequently damp or sweaty hands. Stress has been linked to this type of illness. It is believed to affect more women than men. It is usually seen in adults under the age of 40.Patch of dry and itchy skin that can occur anywhere on the body but is most commonly found on arms, shoulders, elbows, wrists, back, neck, scalp, and ankles. It is very similar to atopic dermatitis but rarely disappears without treatment and usually isn’t widespread. It is unclear what causes it, but it is known to be triggered by stress. The itching can be continuous, causing constant scratching, which irritates the nerve endings in the skin resulting in more itching and scratching. . This type of eczema has an appearance of round patches. These can be very dry, scaly, and oozing. It develops in people with dry skin. Older people, whose skin is dry and thin, can be more prone to it. Colder weather when our skin is exposed to heating and low humidity is a factor causing the skin to become dry. This form of eczema can also develop from scratch, bite, burn, or localized area of infection. It can sometimes be triggered by medications that have a side effect of skin dryness. Discoid dermatitis appears suddenly as 2 or 3 coin-shaped, irritated patches of skin. These patches are slightly bumpy at first and become raised, creating lumps or blisters which can ooze and get infected. It usually occurs on the legs, trunk, or forearms. This form, like other types of dermatitis, is not contagious. This type of dermatitis affects the parts of the body where glands called sebaceous glands occur. These glands are responsible for producing the oily substance – sebum. The sebaceous glands are located in hair follicles. Therefore, large numbers of them will be found on hairy parts of our body, like the scalp, face, and upper back. It presents as flaking of the skin – dandruff. About 11% of the population suffers from seborrheic dermatitis. It disappears with treatment but has a tendency to recur. It is believed to be caused by a reaction to the overgrowth of the yeast naturally inhabiting our bodies – Malassezia yeasts. Psoriasis often coexists with seborrheic dermatitis. Other diseases like: AIDS, rosacea, acne, Parkinson’s disease, epilepsy, depression, eating disorders, alcoholism, and recovery from a stroke or heart attack have also been linked with dermatitis. Stasis dermatitis develops in people with poor circulation or venous insufficiency. These cause the fluid from veins to leak and flood the lower legs effecting in swelling. Venous insufficiency can come with aging, but it can also be a sign of a serious underlying medical condition, such as kidney or heart disease. Other risk factors include: varicose veins, obesity, high blood pressure, or lack of activity in lifestyle. Stasis dermatitis presents as dark spots on the lower legs, itching, swelling, scaling, dryness, and even venous ulcers. Untreated, the skin on the lower legs becomes shiny. It can occur in both or just one leg. 
There are a lot of factors contributing to the appearance, extent, and intensity of the symptoms of dermatitis. It can vary from person to person depending on their skincare routine, severity, or coexistence of several types of eczema. On lighter skin, the rash is usually red, while on darker skin tones, it can present as hyperpigmentation or gray and purple areas of skin. People with eczema usually experience flare-ups interluded by periods when symptoms are less severe. Symptoms may vary depending on the type of eczema, but generally speaking, the symptoms are:
Determining the triggers of your flare-ups is a colossal step to managing the symptoms of eczema. If you are able to diagnose the trigger, you might be able to begin avoiding it. This could stop the flare-ups and improve the quality of your life.
Detailed past medical history and the history of flare-ups are powerful tools in determining the triggers. Your dermatologist will collect all the available facts and, like a detective, try to trace the source of your problems. The triggers are very often not obvious to the patients themselves. If it is unclear what triggers your flare-ups, you might be referred for allergy testing. These can include patch testing, skin prick testing, or blood tests. It is important to know what type of eczema you have. A skin biopsy or skin scraping test can be useful in diagnosis. Different types of dermatitis will have different triggers.
Treatment of dermatitis is bespoke to the patient and depends on the type and severity of the condition as well as a response to the previous treatments. First-line treatments usually include avoiding the triggers and using emollients and topical steroids.
Emollients can come in the form of creams, lotions, ointments, gels, and sprays. Emollients prevent your skin from drying, reducing the likelihood of a flare-up. A good skin care routine is very important in managing dermatitis. Emollients should be used as often as possible, at least twice a day. You can use your emollient as a wash instead of soap. For each application, you should apply at least 50g (7 dessert spoons) to the whole body. You should always smooth the emollient down with the direction of the hair growth rather than rubbing it into your skin, which can cause folliculitis.
Topical steroids are used alongside emollients to treat eczema flare-ups in short treatment bursts to control inflammation. Topical steroids are not recommended for long-term use due to possible side effects. The right strength will be prescribed by a dermatologist based on the severity of the condition and the age of the patient. Topical steroids are only effective when used with emollients. The best practice is to apply steroids around 20 minutes after applying emollients to allow absorption. A fingertip unit might be a useful indication of the correct amount of topical steroids application.
For severe eczema that doesn’t respond to topical steroids, treatments like phototherapy, oral steroids, or immunosuppressant drugs can be used. Phototherapy is a treatment utilizing UV radiation to treat skin conditions. Sometimes symptoms of eczema can ease with sun exposure. Phototherapy, however, is performed in controlled settings where the healthcare professional can make sure you receive the right dose of UV radiation without putting you in danger of sun exposure carries. Phototherapy treatment is usually performed over 12 to 16 weeks in treatment sessions 2 or 3 times a week.
Oral steroids can be used in managing eczema that does not respond to topical steroids or as an urgent treatment for acute reactions to allergens. These are prescribed by dermatologists and are not suitable as a long-term solution due to the side effects.
Since dermatitis is an inflammatory reaction due to excessive immune response, immunosuppressants are being used as a treatment for it. It comes in the form of tablets or injections. These are very strong medications and must be used under a supervision of a specialist doctor. Blood tests will be run before commencing the immunosuppressant treatment to ensure you are suitable for the drug. These will be repeated frequently throughout the course to monitor your blood count as well as liver and kidney function. Additional tests might be recommended by your health care professional.
Identifying triggers, implementing a good skincare routine, and getting the right treatment are vital for managing eczema, as it can impact daily living and sleep quality. Untreated eczema can lead to inflammation and even a systemic reaction. People with chronically itchy skin can be more susceptible to depression. Using low-pH skin cleansers, cold compresses, wearing soft, breathable fabrics made from natural fabrics, and moisturizing frequently can help with the itchiness.
The best way to prevent dermatitis is to keep your skin hydrated.
Eczema is a non-contagious skin condition that leads to skin inflammation through the deterioration of the skin’s protective barrier. There are various types of eczema, all of which have one common symptom – itchy skin. Stress is a very important risk factor, as well as a family history of eczema and allergies. Symptoms can be managed by avoiding triggers, keeping your skin moisturized, and undergoing treatments for dermatitis. Eczema can be easily mistaken for other skin conditions, e.g., psoriasis, so talk to your healthcare professional to get the correct diagnosis and the best possible outcome of treatment.
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