Eczema is defined as group of conditions that causes inflamed, irritated, and often itchy skin. Eczema is derived from the Greek word for “to boil or bubble over”, which pathologically manifests as oedema within the epidermis (called spongiosis). The terms dermatitis and eczema are often used interchangeably. All eczema is a dermatitis, but not all dermatitis is eczema. Any condition including atopic dermatitis, contact dermatitis, or stasis dermatitis falls under category of eczema. Eczema weakens your skin’s barrier function, which is responsible for helping your skin retain moisture and protecting your body from outside elements.
Eczema can look different on each person diagnosed with the condition. If you have a dark skin tone, an eczema rash can be purple, brown or gray. If you have a light skin tone, an eczema rash can look pink, red or purple. Symptoms of eczema can show on hands, Neck, Elbows, Ankles, knees, Face, in and around ears, Nipples, breasts, penis. Eczema doesn’t usually cause pain. Eczema isn’t contagious. Eczema can’t be spread through person-to-person contact. Irritants, Allergens and Infections are possible exacerbating factors.
Purple eczema
Pink eczema
When a child has eczema, many factors can play a role in what causes it. A poor skin barrier causes the skin to lose water easily, and also lets in irritants, potential allergens, bacteria, and viruses more easily. There is also a problem with the immune system, which tends to be shifted.The immune system is shifted in such a way that it leads to the redness and itching that we see when a child has eczema.
To not confuse psoriasis with eczema, there are certain differences:
Psoriasis causes well-defined, thick, red, scaly patches, commonly in areas like the elbows and knees. It is common to see psoriasis on the face, buttocks, and scalp of a child. You’ll also commonly see thick patches of skin with overlying redness. Eczema tends to appear in the crooks of the knees and the elbows. Psoriasis tends to have mild itching. In eczema, the itching can be intense.
Classifying on The Basis of Chronicity
Acute eczema: Acute spongiosis is typified by massive intercellular oedema of the epidermis with a widening of the intercellular spaces, disruption of desmosomes and formation of microvesicles. Although vesicles are usually intraepidermal, with sufficient vesiculation, they can become subepidermal. Vesicles are filled with proteinaceous fluid containing lymphocytes and histiocytes.
Subacute eczema: This is the most frequently encountered type of spongiotic dermatitis. The degree of spongiosis and exocytosis of inflammatory cells is mild to moderate. Irregular acanthosis and parakeratosis are additional features compared with acute spongiotic dermatitis. A superficial dermal perivascular lymphohistiocytic inflammatory infiltrate, swelling of endothelial cells, and papillary dermal oedema are present.
Subacute eczema: In chronic spongiotic dermatitis, the degree of spongiosis is often mild and difficult to appreciate. Vesiculation is uncommon. There is significant epidermal acanthosis, which may show a psoriasiform pattern with hyperkeratosis, hypergranulosis and minimal parakeratosis. Fibrosis of the papillary dermis may be present.
Factors responsible for Eczema:
Over reactive immune system: Having eczema may cause immune system overreacts to small irritants or allergens (triggers) in your environment. When you contact a trigger, your immune system assumes that these small irritants are foreign invaders, like bacteria or viruses, that can harm your body. As a result, the triggers activate body’s natural defense system. Immune system’s defense is to create inflammation. Inflammation causes symptoms of eczema on your skin.
Genes: Person having a history of eczema or dermatitis in family is more likely to have eczema. People are also at a higher risk if there’s a history of asthma, hay fever and/or allergies. Common allergies include pollen, pet hair or foods that trigger an allergic reaction.
Environment: There’s a lot in environment that can irritate your skin. Some examples include exposure to smoke, air pollutants, harsh soaps, fabrics such as wool, and some skin care products. Low humidity (dry air) can cause your skin to become dry and itchy. Heat and high humidity can cause sweating and that can make your itchiness even worse.
Emotional triggers: Your mental health could affect the health of your skin, which can cause a flare-up of eczema symptoms. If you have high levels of stress, anxiety or depression, you may have more frequent flare-ups of eczema symptoms.
Types of Eczema:
Atopic dermatitis
Atopic dermatitis, or eczema, is often called the “itch that rashes.” Atopic dermatitis is the most common type. Scratching the itchy skin often causes a rash. This condition usually begins during childhood, with most children developing it by 5 years of age. Atopic dermatitis can also develop during puberty. Less often, people get it as an adult. It’s a chronic disease, which means it can last a long time. For many children, the condition goes away by their teenage years. However, some people have the condition for life.
Symptoms include:
Itchy skin, Dry & scaly areas, Red rash (especially on lighter skin tones), Small, rough bumps (more common in darker skin tones), Dark brown, purple, or grayish areas of skin (darker skin tones), Skin feels warm and maybe swollen (inflammation), Scratch marks, Blisters that ooze and crust over.
At this time, atopic dermatitis cannot be cured. However, treatment can ease symptoms and lead to clearer — if not completely clear — skin.
Contact dermatitis
When something that touches your skin either irritates it or causes an allergic skin reaction, you develop Contact dermatitis. The first sign is often itchy skin, followed by a rash. The face, neck, underarms, scalp, and tops of feet are also common places to develop contact dermatitis.
Symptoms include:
Itchy skin (often intense), Rash (skin discolored, swollen, and hot), Excessively dry skin that may crack, Tender skin, Burning or stinging, Hives (round welts on the skin that itch intensely), Fluid-filled blisters, Oozing blisters that leave crusts and scales.
To relieve your discomfort and help clear the rash, medication prescribed by dermatologist can be applied to the rash. Cool compresses and Calamine lotion or colloidal oatmeal baths help in relief.
Dyshidrotic eczema
This type of eczema causes tiny, intensely itchy blisters on the hands or feet. It is also called pompholyx. The blisters of dyshidrotic eczema may last for three to four weeks before clearing. For most people, having dyshidrotic eczema falls somewhere in between having it once and living with a chronic, debilitating condition. You can only get this type of eczema on your hands, feet, or both. Having wet hands for long periods can also trigger dyshidrotic eczema.
Symptoms include:
Itching, burning sensation, prickly feeling, or pain, Tiny, itchy, fluid-filled blisters, Dry, scaly skin, Dark spots, Nail changes, Dry, thick skin that itches all the time, Sweat where you have blisters.
Treatment plan needs to be tailored to individual’s needs and may include Soaks and cool compresses, Corticosteroids that you apply to your skin, Anti-itch medicine, Moisturizer or a barrier repair cream.
A prescription antiperspirant you apply to the area of concern for excessive sweating.
Hand eczema
Hand eczema can also be caused by an allergic reaction. Anything that irritates your skin can cause hand eczema. For example, whenever some chefs handle garlic, hand eczema develops. Some health care workers get hand eczema from wearing latex gloves. Because it often looks like dry skin, hand eczema can easily be mistaken for dry skin. It may cause burning sensation. Unlike dry skin, you need more than a good moisturizer to get rid of hand eczema.
Symptoms include:
Dry, chapped skin (often the first sign), Patches of red (or dark brown) irritated skin, Scaly and inflamed skin that may itch, Burning sensation, Itchy blisters, Deep, painful cracks, Bleeding or weeping skin, Crusts, pus, and pain.
Avoiding irritants and having a moisturizing skin care routine are the best ways to treat hand eczema. In some cases, medicated ointment, systemic medication, or phototherapy may be necessary.
Neurodermatitis
Neurodermatitis is a skin condition characterized by chronic itching or scaling. Another name for this skin condition is lichen simplex chronicus. This itchy patch often develops on an arm, leg, back of the neck, scalp, or groin area. When it begins in the groin area, it tends to develop on the anus, scrotum, or vulva. It’s common for the itch to be most intense during relaxation periods or right before falling asleep. Neurodermatitis is rare in children. A few children who have eczema (atopic dermatitis) develop neurodermatitis.
Symptoms include:
Pain, Intense itch, Raised, rough patch that is violet (in dark skin tones) or red (in light skin tones), Open sores that bleed, Infection, Skin thickens and looks leathery, Hair loss or breakage, Scarring.
The goal in treating neurodermatitis is to stop the itch-scratch-itch cycle. For treatment to be effective, you must stop scratching, rubbing, and touching the itchy skin. To relieve the itchy skin, you may need to use Corticosteroid, Cool compress, Antihistamine that makes you drowsy, Moisturizer, Coal tar preparation, Capsaicin cream or doxepin cream.
Nummular eczema
Nummular eczema causes itchy, raised, and round to oval spots on the skin that can grow together to form large, slightly raised patches. It is common in people with atopic dermatitis, stasis dermatitis, or contact dermatitis. Once you have it, it can return and tends to appear in the same place.
Symptoms include:
Tiny bumps and blister-like sores, Coin-shaped raised spots, Spot color varies with skin tone, Itchy, extremely dry skin, Spots flatten, Flat dark spots, New flare-ups.
The main goals of treatment are to clear your skin and ease your discomfort. Steps to be followed include Hydrate your skin, Avoid irritating your sensitive skin, Get rid of infection.
Stasis dermatitis
This is a common type of eczema that develops in people who have poor blood flow. It’s also called gravitational dermatitis, venous eczema, or varicose eczema. Poor blood flow usually develops in the lower legs, stasis dermatitis often appears near your ankles.
Symptoms include:
Itchy, dry, and discolored skin, especially over varicose veins, skin feels irritated, discolored, and sore, Heaviness or aching in one or both legs when you stand or walk, Swelling, often on the inside of the ankle, at the end of the day, Swelling in your leg that clears when you sleep, but reappears once you get out of bed.
While treatment can help ease pain and discomfort at any stage, treatment cannot cure stasis dermatitis. The earlier you catch and treat it, the better. If stasis dermatitis spreads to the tops of the feet, wearing shoes can be painful — even with treatment. Elevating your legs and wearing a compression stocking or wrap can also help improve your blood flow. Massage can help improve circulation. Always check with your dermatologist before starting massage therapy. If you’re bothered by itch, your dermatologist may prescribe an antihistamine (pill form), a corticosteroid that you apply to the area, or both.
Keeping surroundings clean and being in contact with a dermatologist, following precautions can help you get relief from Eczema.
