Eczema is a condition that causes the skin to become itchy, red, dry and cracked. It is a long-term/chronic condition. Eczema is the most common of all inflammatory dermatoses.
Eczema comprises a group of skin disorders exhibiting a common pattern of histological & clinical findings which vary depending on the stage of the disease.
A few types of eczema are discussed below–
Atopic Dermatitis
Atopic dermatitis or eczema is a chronic, relapsing pruritic skin disorder of unknown aetiology, associated with personal & family history of atopy.
Pruritis is the main character with a symmetrical distribution of lesions.
It predisposes an individual to a triad of disorders–
- Bronchial asthma,
- Allergic rhinitis &
- Atopic dermatitis
Infantile atopic dermatitis
Usually starts at or after 3 months of age.
Symptoms
- Severe itching
- Erythema
- Oedema
- Papulovesicular
- Exudative lesions
on the face, scalp and extensor aspects of the lower limb. In severe cases, the upper limb, as well as the trunk, are also affected.
Treatment
In over 90% of cases, the disease subsides by the age of 18 months.
Childhood atopic dermatitis
Symptoms
Itchy popular lesions in
- The cubital & popliteal fossae
- Sides of the neck
- Wrists
- Ankles
Treatment
It may remit or continue on to the adult phase at the age of puberty.
Adult atopic dermatitis
The distribution of lesions is the same as in childhood but there is a marked tendency to lichenification and generalization.
Complications
Secondary bacterial and viral infections ( eczema herpeticum, eczema vaccinatum)
Treatment
- Avoiding contact with irritants—Wool & Synthetic Clothes
- Controlling extremes of temperature
- Minimizing the use of soaps & detergents.
- Emollients and mild potency topical steroids.
- Systemic antibiotics in exudative lesions
- Antihistamines
- Topical Immuno-suppressants’
Seborrhoeic Dermatitis
Lesions are commonly distributed in the sebaceous glands-rich areas, i.e. the scalp, eyebrows, nasolabial folds, chest, axillae & groin.
Seborrheic dermatitis has a characteristic morphology with red, well-marginated scaly areas and the scales may be either fine or white or yellow greasy scales. Severe cases present with thick crusting.
Infantile seborrhoeic dermatitis
This arises in newborn babies up to the age of six months. The scalp lesions can present as small dry patches of hyperkeratosis overlying mildly erythematous skin that may become so thickened that it forms a cap, meriting its description as cradle cap
Symptoms
- It usually presents as a cradle cap
- It may also affect skin creases such as armpits and groin (when it presents as a type of napkin dermatitis)
- Non-itchy salmon pink flaky patches may appear on the face, trunk and limbs in severe cases.
Treatment
- Adulthood seborrhoeic dermatitis
- Regular use of anti-fungal agents
- Intermittent applications of topical steroids.
- Infantile seborrhoeic dermatitis
It usually clears up completely before the baby is six months old and rarely persists after one year. If treatment is required,
- Mild emollients
- Hydrocortisone cream
- Topical ketoconazole
General treatment—
- Medicated shampoos( containing ketoconazole, selenium sulfide, zinc pyrithione, coal tar, salicylic acid)
- Steroid scalp applications
- Tar cream can be applied to scaling areas and removed several hours later by shampooing.
- Cleanse the affected skin thoroughly
- Apply ketoconazole or ciclopirox cream once daily
- Hydrocortisone cream can also be used
- Topical calcineurin inhibitors such as pimecrolimus cream or tacrolimus ointment may be used
Severe cases may receive a course of oral antifungal medication or sometimes, ultraviolet radiation
Nummular Eczema
Symptoms
- Itchy, circular or oval lesions with papula-vesicles
- Itchy, circular or oval lesions with papules scales on an erythematous base
- Common in the older age group
- Affects the hands, feet, legs, thighs and trunk, face(rare)
- Chronic, recurrent lesions
Causes/Aggravating factors
- Soaps
- Cold season
- Topical medicaments
- Emotional stress
- Alcohol
Treatment
- Avoidance of contact with irritants
- Liberal use of emollients
- Topical steroids
- Systemic steroids and antihistamines may be required in resistant cases.
Varicose Eczema
Varicose eczema, also known as venous eczema or gravitational eczema, is a type of eczema (a chronic skin condition) that affects the legs. It usually occurs in the skin over and around varicose veins.
Causes
Faulty valves in varicose veins, allow blood to flow in the wrong direction and henceforth, skin with stasis eczema appears weakened
Signs and symptoms
- Skin becomes brownish, bruised, contains red spots, ulcerated, and swollen.
- In more severe cases, the skin develops open sores, blisters, itching, thickening of the skin, and painful patches
- More serious stasis eczema results in oozing skin, crusty areas, and skin ulcers.
Treatment
- Focus on a healthy heart
- Wear an elastic support hose to reduce the swelling and improve circulation.
- Staying off one’s feet or occasionally elevating the feet also reduces swelling.
- Cortisone and moisturizing creams
- Compression stockings or corticosteroid treatments for serious cases.
Contact Dermatitis
Contact Dermatitis may be due to an irritant or an allergen.
Irritant Contact Dermatitis
Irritant contact dermatitis accounts for 80% of all contact dermatitis reactions.
It occurs when the skin comes in contact with a substance that acts as an irritant. Almost any substance under the right circumstances can act as an irritant
Acute Irritant Contact Dermatitis
Causes
Strong toxic chemical such as an acid or alkali.
The rash occurs within minutes to hours after exposure and in most cases, healing occurs soon after exposure.
Symptoms
- Sharp bordered rash
- Redness
- Vesicles
- Bullae
- Skin sloughing.
Chronic Cumulative Irritant Contact Dermatitis
Causes
Repeated exposure to low-level irritants, such as soaps or shampoos. The rash may take weeks, months, or even years to develop.
Symptoms
- Poorly-defined bordered rash
- Itching
- Redness
- Scaling
- Fissuring
- Lichenification
Examples of irritants
- Dribble rash around the mouth or on the chin in a baby, or in older children due to licking; the cause is saliva, which is alkaline.
- Napkin dermatitis due to urine and faeces.
- Chemical burns from strong acids (eg. hydrochloric acid) and particularly alkalis (eg. sodium or calcium hydroxide).
- Hand dermatitis is caused by excessive exposure to water, soaps, detergents, bleaches and polishes.
- Dermatitis on a finger underneath a ring. Soaps, shampoos, detergents and hand creams accumulate under the ring
- Rubber gloves or the powder or sweat or tiny quantities of chemicals inside them
- Rubber may result in latex or rubber antioxidant allergy.
- Fibreglass may cause direct mechanical/frictional damage.
- Dry cold air may cause dry irritable skin (winter itch)
- Cosmetics(mainly gels and solutions) may irritate sensitive facial skin.
Treatment
Avoiding the irritant should allow the rash to clear in two to four weeks. Creams or medication can help reduce itching.
Allergic contact dermatitis
Allergic contact dermatitis is inflammation of the skin manifested by varying degrees of erythema, oedema, and vesiculation.
It is a delayed type of induced sensitivity (allergy) resulting from cutaneous contact with a specific allergen to which the patient has developed a specific sensitivity.
Causes
- Metals( nickel or cobalt) in Jewellery
- Cosmetics(fragrances, hair dye and nail varnish)
- Preservatives
- Rubber, including latex
- Textiles, particularly the dyes and resins that are contained in them
- Strong adhesives ( epoxy resin adhesives)
- Some plants(chrysanthemums, daffodils, tulips and primula)
- Some topical medicines
Treatment
- Avoid the cause
- Emollients
- Topical corticosteroids
- Oral corticosteroids
- Antibiotics
Photodermatitis
Photo-dermatitis is an abnormal skin reaction to sunlight, or more specifically to ultraviolet (UV) rays. It can be acute (sudden) or chronic (ongoing).
Causes
- The reaction of the immune system to UV rays
- Fragrances
- Sunscreens with PABA
- Industrial cleaners that contain salicylanilide
- Chemicals found in medicines
- Antibiotics( tetracycline and sulfonamides)
- Antifungals(griseofulvin)
- Coal tar derivatives and psoralens used topically for psoriasis
- Retinoids( tretinoin )and medications containing retinoic acid, used for acne
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Chemotherapy agents
- Sulfonylureas, oral medications used for diabetes
- Antimalarial drugs(quinine)
- Diuretics
- Antidepressants(tricyclics)
- Anti-psychotics(phenothiazines)
- Anti-anxiety medications( benzodiazepines)
- Chemicals in cosmetics and foods
Symptoms
Itchy, scaly, blistery, reddening of the skin
Prevention
- Limit skin exposure to the sun, especially the intense midday sun.
- Use PABA-free sunscreens that protect against UVA and have a sun protection factor (SPF) of 30 – 50.
- Cover up with a long-sleeved shirt, long pants, and a wide-brimmed hat.
- Beware of using any product that causes sun sensitivity.
Treatment
- Cool, wet dressings.
- Phototherapy
- Medicines
- Multivitamins
Neurodermatitis
Neurodermatitis is also known as lichen simplex chronicus. The scaly patches of skin on the head, lower legs, wrists, or forearms are caused by a localized itch such as from an insect bite that becomes intensely irritated when scratched.
Treatment
Consists of potent topical corticosteroids alone or in combination with tar/ salicylic acid.
Asteatotic Eczema
It is also called eczema craquele due to its skin-cracking characteristic.
Symptoms
- Abnormal dryness of the skin or mucus membranes
- Dry, scaly, itchy, and red skin
- Fine cracks may appear on the skin.
- Dry skin usually gets worse during the winter.
- Common in old age
- The arms and legs are most affected.
Treatment
- Moisturizers, especially those that contain urea and lactic acid
- Topical steroids — for areas that get very inflamed and itchy
Juvenile Plantar Dermatitis
Juvenile plantar eczema, also known as forefoot eczema, is a skin condition that generally presents in boys between 3-15 years of age, but it may also occur in adults and females. When it occurs in children the prognosis is one of gradual improvement.
Causes
- The many synthetic materials and chemicals used in the manufacturing process for shoes and socks.
- Summer season
Symptoms
- Redness
- Irritation
- Cracking
- General soreness
- Itching
Treatment
Topical moisturizers and ointments