You have an itch. You scratch it. You itch again, scratch again. This provides relief, no doubt, but this cycle can convert a simple molehill of a disease into a mountain!
What is Eczema ?
Eczema is a term for a group of medical conditions that cause the skin to become inflamed and irritated.
The symptoms of eczema may range from a simple rash to extensive lesions. Almost all patients of eczema complain of severe itching. Due to repeated itching and scratching, over time patients develop leathery thickening of the skin on affected areas.
• Dry, flaky sensitive
• Itching often uncontrollable
• Dark, leathery skin
• Oozing or crusting
What are the types of Eczema?
Atopic dermatitis – is a chronic skin condition with a hereditary component and tends to run in families whose members have asthma. Atopic dermatitis usually starts during infancy and continues in childhood. Some children eventually outgrow the condition; others may continue to have symptoms till adulthood. Characteristically the lesions are found on the scalp, face, elbows, wrists, back of the knees and ankles.
Atopic Dermatitis on face
Contact dermatitis – is a reaction that occurs when the skin comes in contact with certain substances that cause skin inflammation. Contact dermatitis is of two types:
Irritant contact – Irritant contact dermatitis develops when the skin comes in contact with an irritant or toxic substance like detergents or paints. People whose hands are frequently exposed to water, such as chefs, bartenders, launderers and healthcare staff often experience irritant contact dermatitis. The triggers are paints, detergents, bleaching agents, hair dyes, kerosene etc.
Irritant Contact Dermatitis due to detergents
Allergic contact – Allergic contact dermatitis occurs when the skin develops an allergic reaction after being exposed to a foreign substance. This causes the body to release inflammatory chemicals that can make the skin feel itchy and irritated. Common triggers are jewelry made of nickel or gold, fragrant soaps, certain deodorants and perfumes, chemicals used in cosmetics, latex gloves, bleaching agents, poison ivy etc.
Allergic contact dermatitis due to jewelry
Seborrheic dermatitis – is a condition that causes red, scaly, waxy patches and dandruff. It tends to develop on oily areas of the body like the scalp, face, nose corners, around mouth, upper chest and the back. In severe cases, the entire facial skin turns dark and leather-like. The patient feels the need to constantly moisturize the skin because it never feels sufficiently moisturized. Simple things like smiling or opening the mouth to eat can become difficult for the patient. Seborrheic dermatitis is caused by overproduction of oil and a super-added yeast infection called Malassezia. The condition may also develop in infants and is called ‘Cradle Cap’. Infants aged 3 months or younger develop crusty yellow or brown scales on the scalp. It is caused due to hormonal changes that occur in mother during pregnancy. The hormones stimulate the infant’s oil glands leading to overproduction of oil and subsequent lesions. It usually disappears within few weeks or months.
Photo dermatitis – is an abnormal reaction of the skin to sunlight or UV light. When exposed to sunlight or UV light the allergen gets activated and releases certain chemicals to trigger the rash. The photo-sensitive response may be caused due to genetic tendency, certain medications or diseases like lupus or polymorphic light eruptions.
Photo Dermatitis on forearms
Stasis dermatitis – is dermatitis that happens in people with poor blood circulation. It most often occurs in the lower legs because that is where the blood typically collects. It is common among adults over the age of 50 years. Poor blood circulation is caused because of venous insufficiency. Venous insufficiency occurs when there is backflow of blood. Normally there are one-way valves in the leg veins that keep the blood flowing in the right direction i.e. towards the heard and prevent backflow. In people with venous insufficiency the valves become weak due to which the blood flows back and pools in the lower legs. This pooling of blood causes stasis dermatitis. The affected area is usually swollen, red, and itchy with open sores. In serious cases, the lesions may progress to form ulcers.
Stasis Dermatitis on leg
Xerotic eczema – is eczema that occurs due to very dry skin. The affected area appears dry, flaky, cracked and red and is accompanied by excessive itching. It is commonly seen in elderly patients. With age there is breakdown of the skin barrier and the skin loses its ability to maintain water. This condition may be genetic or caused due to environmental factors like low humidity. It can also be caused due to frequent and lengthy hot showers using harsh soaps or detergents.
Xerotic eczema on upper arm
Lichen simplex Chronicus – is thickening of the skin that arises secondary to repetitive scratching or rubbing. It is more common in people with anxiety or obsessive compulsive disorder. There may be single or multiple lesions which may appear dry, thickened and leathery with scratch marks. It is commonly seen on the back of scalp and neck, wrists, forearms and legs.
Lichen Simplex Chronicus on lower leg and ankle
What are the causes of Eczema?
Eczema is caused due to an overactive response by the body’s immune system to an irritant. Some of the below factors can make a person more likely to suffer from eczema.
Genetic – Eczema is commonly found in families with a history of other allergies or asthma.
Dry skin – When the skin becomes too dry it can become rough, scaly, sensitive and may crack easily. This can weaken the skin barrier and cause eczema flare-ups.
Exposure to irritants & allergens – These can be everyday products that can irritate and flare up the skin. Perfumes, deodorants, cosmetics, paints, chemicals, hair dyes, soaps, detergents, artificial jewelry, metals, rubber are some of the common irritants. The commonly known allergens are seasonal pollen, animal dander, dust mites, certain foods like eggs, peanuts, fish and sea food.?
Stress – eczema flare ups are common with stress. When a person is stressed, the body tries to protect the skin by boosting inflammation. This may lead to eczema flare-ups. Several studies have shown that those living with anxiety may be prone to constant eczema breakouts.
Hot or Cold temperatures – Eczema can get triggered by change of temperatures. Most people experience flare-ups when they sweat or get heated up. This is commonly seen after exercising or after strenuous physical activity or sun exposure. Traveling can also make your skin quickly move from one extreme temperature to another leading to eczema flare ups.
Infections – skin infections like bacterial, viral or fungal can lead to eczema or make the existing eczema worse.
Hormones – hormonal fluctuations may cause eczema flare-ups. Women often report worsening of symptoms during menstrual periods. Pregnancy, oral contraceptive pills, thyroid disorders are also known to trigger eczema in some people.
How is Eczema treated?
The goal of eczema treatments is to relieve the symptoms, prevent itching and infections and treat the allergy. Treating eczema involves a 4 pronged method.
1) External applications – Most patients with chronic itching develop dark, leather-like skin on affected areas. Further open scratch wounds are also prone to bacterial infections & soon start oozing out pus or bleeding. The external applications include ointments and creams to restore the skin barrier, to treat infections and to reduce itching. To facilitate absorption these applications are usually applied when the skin is damp, such as after bathing.
2) Oral medicines – Oral medicines are prescribed to control inflammation, reduce the immune system reactions and to treat the allergy. Anti-bacterials or anti-fungal medication may be prescribed in cases with super-added infections.
3) Skin Care – This is one of the most important elements in managing all types of eczema. Continuation of skin care even after the skin has healed helps to prevent relapses.
• Bathing – once or twice daily is recommended using a mild soap and lukewarm water.
• Moisturizing – Frequent and generous use of moisturizers and emollients is extremely beneficial to keep the skin soft and supple. The moisturizers help skin to feel more comfortable and less itchy. They keep the skin moist, flexible and help to prevent cracks. Choosing the right moisturizer that suits your skin is essential.
• Clothing – made up of woollen, lycra, silk, polyester should be avoided. Only 100% cotton clothing is advisable.
• Home remedies – like application of pastes and oils of different kinds should be strictly avoided.
• Sudden heating and sudden cooling – can aggravate the skin and situations like this should be avoided.
4) Diet – Certain known food allergens that are found to aggravate eczema – like milk, fish, eggs, nuts, sea food, citrus foods and artificial colors. Preserved foods and canned foods contain food preservatives which may flare up eczema. This does not mean that all these foods should be avoided. But it does mean that these foods should be consumed with caution and observation. Introducing these foods one at a time at 15 day intervals and noting its effect on the skin in a food diary can help eliminate the allergens in a particular case.
5) Environment – House dust mites can aggravate eczema. It can be minimized by getting rid of things like carpets, curtains, open book shelves. The floor of the house should be vacuum cleaned or regularly moped with a wet cloth.
6) Avoiding triggers – Identification of the trigger is half the job done. Once the specific irritant or allergen is identified, treatment can be started in that direction. Generally staying away from the trigger for a certain period of time is advised to develop resistance. In cases where exposure to the triggering factor cannot be avoided, for example if the patient is allergic to certain weather changes or to the sun, a specific protective regimen may be required to minimize the effect of the trigger.
7) Lifestyle changes – Learning to cope with stress is essential. Stress reduction techniques are helpful. Adequate sleep, reducing the consumption of alcohol and smoking is also helpful.