Eczema / Dermatitis

The terms ‘Eczema’ and ‘Dermatitis ‘are interchangeable. Eczema is a general term for many types of skin inflammation (dermatitis). Eczema/dermatitis can be either acute or chronic or both.

• When acute, one sees a rapidly evolving red rash which may be blistered and swollen.
• When chronic, one sees a longstanding irritable area that gets darker than the surrounding skin and looks much thickened (lichenified) and scratched.

Commonly found in

Infants and young children. All races can be affected by Eczema.

Signs and Symptoms

Each type of dermatitis has distinct signs and symptoms, but some of the common ones include:

• Itchiness and dryness
• Redness and scaling
• Swelling or bumps
• Skin rash – it is commonly described as an itch that turns into a rash

Types of Dermatitis:

a) Atopic dermatitis

• Atopic dermatitis is a chronic condition, characterized by itchy, inflamed skin and is the most common kind of eczema.
• It is more common in children who have other allergies, like asthma and hay fever.
• It tends to run in families, and may be triggered by allergens in the environment such as house dust, mites, animal dander, grass pollens and moulds.
• As kids get older, atopic dermatitis clears from the face but can later develop in the elbows, behind the knees, and/or on wrists and hands. If the child scratches the affected area, which often happens, the skin may become infected.
• It usually clears up as the child grows older and is usually gone by adulthood.
• It can flare up and then settle down for no apparent reason.

b) Contact dermatitis

• It is a localized reaction that includes redness, itching, and burning in areas where the skin has come into contact with an allergen (substances that an individual has not been sensitized to) or with a general irritant such as an acid, a cleaning agent, or other chemicals.
• Contact eczema includes reactions to laundry detergents, soaps, nickel (a metal present in jewellery), cosmetics, certain fabrics, clothing, and perfumes.
• The condition is sometimes referred to as Allergic contact dermatitis. The inflammation isn’t caused directly by the chemical, but by an allergic reaction in the skin.
• Common triggers are creams, gels, lotions, and shampoos; antiseptics in hand creams; fragrances and deodorants; hair dyes and bleaching agents. Some people are allergic to jewellery metals like nickel and cobalt, and get dermatitis from the area of watches, jean studs or buckles that come in contact with their skin.

c) Irritant contact eczema/dermatitis

• Caused by the direct chemical effect of substances such as detergents, solvents, acids, alkalis, oils and skin cleansers.
• It’s common among caterers, cleaners, nurses, builders, hairdressers and mechanics.
• The hands are often affected.

d) Neurodermatitis

• Also known as ‘lichen simplex chronicus’, this type of dermatitis typically develops when something has created an itchy sensation in a specific area of your skin.
• This irritation may lead you to rub or scratch that area repeatedly.
• Common locations include the ankle, wrist, outer forearm or arm and the back of your neck.
• Underlying factors include dry skin, chronic irritation and eczema.
• The skin becomes thickened with increase of normal skin markings.

e) Seborrheic dermatitis

A condition sometimes classified as a form of eczema that is closely related to dandruff. It causes dry or greasy peeling of the scalp, eyebrows and face, and sometimes of the chest.

f) Xerotic eczema

This is more commonly referred to as the “winter itch” and is seen in extremely dry skin. It worsens in dry winter weather; hands, legs and trunk are mostly affected. The itchy, tender skin resembles a dry, cracked, riverbed. This type is common among the older age group.

g) Stasis dermatitis

Stasis dermatitis can occur when fluid accumulates in the tissues just beneath the skin — typically on your lower legs — due to a sluggish circulation. This condition typically occurs around the ankle area. Possible underlying factors include:

• Varicose veins
• Obesity
• Other conditions that affect circulation in your legs, such as pregnancy or deep vein thrombosis.
• The skin is itchy with a cracked, superficially fissured skin with slight scaling.
• The disorder can make the individual prone to leg ulcers.

Causes of Eczema

The main cause of eczema is thought to be a defect of the skin that impairs its function as a barrier, along with an abnormal function of the immune system of the body. In people with atopic dermatitis, genetic deficiencies lead to abnormalities in certain proteins that are important in maintaining the barrier function of normal skin. Some forms of eczema can be triggered by substances that come in contact with the skin, such as soaps, cosmetics, clothing, detergents, jewellery, or sweat. Changes in temperature or humidity, or even psychological stress, can lead to outbreaks of eczema in some people.

Treatment for eczema at skin and you

An important aspect of treatment is to identify and tackle any contributing or aggravating factors.

Common risk factors include:

• Family history of eczema
• Family history of allergies, including hay fever and asthma
• Contact with irritants in the environment
• Abrupt changes of temperature
• Heavy physical activity that causes sweating
• Emotional stress
• Allergens such as house dust, mites, animal dander, grass pollens and moulds.
• Occasionally, allergic reaction to particular foods

Treatment is always based on:

• An individual’s age
• Overall health status
• The type and severity of the condition

Bathing

Reduce how often you bath or shower, use lukewarm water and avoid hot long water baths. Replace standard soap with a substitute such as a mild soap-free cleanser.

Clothing

Wear soft cotton clothes; wool, nylon is best avoided.

Irritants

Protect your skin from dust, water, solvents and detergents.

Moisturizers (emollients)

Use liberally minimum twice a day on damp skin

• Apply the moisturizer into the skin in the same direction that the hair grows.
• Be gentle in application of the moisturizer.
• For very dry skin, apply the emollient every 2 or 3 hours.
• After a bath or shower, gently dry the skin and then immediately apply the emollient while the skin is still moist.
• Do not share emollients with other people.

Topical corticosteroids

Corticosteroid creams are sometimes prescribed to decrease the inflammatory reaction in the skin. These may be mild, medium or high potency corticosteroid creams depending upon the severity of the symptoms.

Oral corticosteroids

For severe, wide spread and non-responsive cases, a short course of oral steroids may be used. It should be used only under the guidance of a medical practitioner.

Anti-itch medicines

In case of severe itching, oral anti-histamines may be required.

Topical immunosuppressant

Both Tacrolimus and Pimecrolimus are topically applied immunosuppressant creams that reduce itching and inflammation. They are not associated with the skin thinning side effects of steroids.