Slideshow Pictures: Eczema (Atopic Dermatitis) -- Causes, Symptoms and Treatment
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What Is Eczema?
Eczema is a general term for many types of skin inflammation (dermatitis). For the purposes of this slideshow, eczema is synonymous with atopic dermatitis.
Typically, eczematous skin is itchy, red, and dry -- even cracked and leathery. Eczema most frequently appears on the face and extremities, but it can show up in other areas, too. Eczema is not contagious, but since it is believed to be at least partially inherited, it is not uncommon to find members of the same family affected.
Who Can Get Eczema?
Eczema can affect people of any age, although the condition is most common in infants, and about 85% of those affected have an onset prior to 5 years of age. Eczema will permanently resolve by age 3 in about half of affected infants. In others, the condition tends to recur throughout life. People with eczema often have a family history of the condition or a family history of other allergic conditions, such as asthma or hay fever. Eczema is slightly more common in girls than in boys and occurs in people of all races.
What Are the Causes of Eczema?
Doctors do not know the exact cause of eczema, but a defect of the skin that impairs its function as a barrier, possibly combined with an abnormal function of the immune system, is believed to be an important factor. Asthma, hay fever, and eczema often occur in the same families. Studies have shown that in people with atopic dermatitis there are gene defects that lead to abnormalities in certain proteins (such as filaggrin) that are important in maintaining the barrier of normal skin.
Eczema can be triggered by substances that come in contact with the skin, such as soaps, cosmetics, clothing, detergents, jewelry, or sweat. Environmental allergens (substances that cause allergic reactions) may also cause outbreaks of eczema. Changes in temperature or humidity, or even psychological stress, can lead to outbreaks of eczema in some people.
Eczema most commonly appears as dry, reddened skin that itches or burns. Intense itching is frequently the first symptom in most people with eczema. Sometimes, eczema may lead to blisters and oozing lesions, but eczema can also result in dry, crusted, scaly, and thickened skin induced by repeated scratching.
Signs in Babies, Children & Adults
While any region of the body may be affected by eczema, in children and adults, eczema typically occurs in a typical distribution on the face, neck, and the insides of the elbows, knees, and ankles. In infants, eczema typically occurs on the forehead, cheeks, forearms, legs, scalp, and neck. Eczema can sometimes occur as a brief reaction that only leads to symptoms for a few hours or days, but in other cases, the symptoms persist over a longer time and are referred to as chronic dermatitis.
Types of Eczematous Dermatitis
Atopic dermatitis is the most common of the many types of eczematous eruptions, and often people often inappropriately use the two terms interchangeably. There are many terms used to describe specific forms of dermatitis that may closely resemble atopic dermatitis. We'll take a look at the listed types on the following slides.
Atopic dermatitis is a chronic skin disease characterized by itchy, inflamed skin and is the most common cause of eczema. The condition tends to come and go, depending upon exposures to triggers or causative factors. Factors that may cause atopic dermatitis (allergens) include environmental factors like molds, pollen, or pollutants; contact irritants like soaps, detergents, nickel (in jewelry), or perfumes; food allergies; or other allergies. Around two-thirds of those who develop the condition do so prior to 1 year of age. When the disease starts in infancy, it is sometimes termed infantile eczema. Atopic dermatitis tends to run in families, and people who develop the condition often have a family history of other allergic conditions such as asthma or hay fever.
Contact eczema (contact dermatitis) is a localized reaction that includes redness, itching, and burning in areas where the skin has come into contact with an allergen (an allergy-causing substance to which an individual is sensitized) or with a general irritant such as an acid, a cleaning agent, or other chemical. Other examples of contact eczema include reactions to laundry detergents, soaps, nickel (present in jewelry), cosmetics, fabrics, clothing, and perfume. Due to the vast number of substances with which individuals have contact, it can be difficult to determine the trigger for contact dermatitis. The condition is sometimes referred to as allergic contact eczema (allergic contact dermatitis) if the trigger is an allergen and irritant contact eczema (irritant contact dermatitis) if the trigger is an irritant. Skin reactions to poison ivy and poison sumac are examples of allergic contact eczema. People who have a history of allergies have an increased risk for developing contact eczema.
Seborrheic eczema (seborrheic dermatitis) is a form of skin inflammation of unknown cause. The signs and symptoms of seborrheic eczema include yellowish, oily, scaly patches of skin on the scalp, face, and occasionally other parts of the body. Dandruff and "cradle cap" in infants are examples of seborrheic eczema. It is commonplace for seborrheic dermatitis to inflame the face at the creases of the cheeks and/or the nasal folds. Seborrheic dermatitis is not necessarily associated with itching. This condition tends to run in families. Emotional stress, oily skin, infrequent shampooing, and weather conditions are felt to be factors for developing seborrheic eczema. One type of seborrheic eczema is also common in people with AIDS.
Nummular eczema (nummular dermatitis) is characterized by coin-shaped patches of irritated skin -- most commonly located on the arms, back, buttocks, and lower legs -- that may be crusted, scaling, and extremely itchy. This form of eczema occurs most frequently in elderly men and women. Nummular eczema is usually a chronic condition. A personal or family history of atopic dermatitis, asthma, or allergies increases the risk of developing the condition.
Lichen simplex chronicus is a chronic skin inflammation caused by a scratch-itch cycle that begins with a localized itch (such as an insect bite) that becomes intensely irritated when scratched. Women are commonly affected, and the condition is most frequent in people 20-50 years of age. This form of eczema results in scaly patches of skin on the head, lower legs, wrists, or forearms. Over time, the skin can become thickened and leathery.
Stasis dermatitis is a skin irritation on the lower legs, generally related to the circulatory problem known as venous insufficiency, in which the function of the valves within the veins has been compromised. Stasis dermatitis occurs almost exclusively in middle-aged and elderly people, with approximately 6%-7% of the population over 50 years of age being affected by the condition. The risk of developing stasis dermatitis increases with advancing age. Symptoms include itching and/or reddish-brown discoloration of the skin on one or both legs. Progression of the condition can lead to the blistering, oozing skin lesions seen with other forms of eczema, and ulcers may develop in affected areas. The chronic circulatory problems lead to an increase in fluid buildup (edema) in the legs. Stasis dermatitis has also been referred to as varicose eczema.
Dyshidrotic eczema (dyshidrotic dermatitis) is an irritation of the skin on the palms of hands and soles of the feet characterized by clear, deep blisters that itch and burn. The cause of dyshidrotic eczema is unknown. Dyshidrotic eczema is also known as vesicular palmoplantar dermatitis, dyshidrosis, or pompholyx. This form of eczema occurs in up to 20% of people with hand eczema and is more common during the spring and summer months and in warmer climates. Males and females are equally affected, and the condition can occur in people of any age.
Diagnosis of Eczema
To diagnose eczema, doctors rely on a thorough physical examination of the skin as well as the patient's account of the history of the condition. In particular, the doctor will ask when the condition appeared, if the condition is associated with any changes in environment or contact with certain materials, and whether it is aggravated in any specific situations. Eczema may have a similar appearance to other diseases of the skin, including infections or reactions to certain medications, so the diagnosis is not always simple. In some cases, a biopsy of the skin may be taken in order to rule out other skin diseases that may be producing signs and symptoms similar to eczema.
If a doctor suspects that a patient has allergic contact dermatitis, allergy tests, possibly including a skin "patch test," may be carried out in an attempt to identify the specific trigger of the condition. There are no laboratory or blood tests that can be used to establish the diagnosis of eczema.
Eczema Treatment - Basic Therapies
The goals for the treatment of eczema are to prevent itching, inflammation, and worsening of the condition. Treatment of eczema may involve both lifestyle changes and the use of medications. Most doctors will start patients on basic therapies. Keeping the skin well hydrated through the application of creams or ointments (with a low water and high oil content) as well as avoiding over-bathing is an important step in treatment. It is recommended to apply emollient creams such as petrolatum-based creams to damp skin immediately after a five-minute lukewarm bath, prior to towel drying, in order to seal in moisture while the body is still wet.
Eczema Treatment - Medications
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. If itching is severe, oral antihistamines may be prescribed. To control itching, the sedative type antihistamine drugs (for example, diphenhydramine [Benadryl], hydroxyzine [Atarax, Vistaril], and cyproheptadine) appear to be most effective. In some cases, a short course of oral corticosteroids (such as prednisone) is prescribed to control an acute outbreak of eczema, although their long-term use is discouraged in the treatment of this non-life-threatening condition because of unpleasant and potentially harmful side effects.
Eczema Treatment: Immunomodulators and UV Therapy
Newer drugs called topical immunomodulators are available to help treat eczema. These drugs help control inflammation and reduce immune system reactions when applied to the skin. These drugs are thought to be about as effective as corticosteroids but are considerably more expensive. For extreme cases of eczema, therapy using ultraviolet light may be prescribed. In adults, drugs that suppress the immune system may also be an option in the more severe cases.
Can Eczema Be Prevented?
While there is no cure for eczema, you can take steps to manage your symptoms and lessen the severity of outbreaks. Preventing eczema may be as simple as changing your laundry detergent or as difficult as moving to a new climate or changing jobs. Try the measures listed on this and the following slide to control and help prevent outbreaks of eczema.
Can Eczema Be Prevented (continued)?
Eczema is a chronic, incurable condition that can often resolve spontaneously. Good skin care is a key component in controlling eczema. Proper care of the skin can often be enough in many milder cases of eczema. While eczema is not preventable, the self-care measures provided can help manage symptoms and reduce the severity of outbreaks.
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