Eczema










About Eczema



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Eczema, also known as topic dermatitis, is a chronic inflammation of the skin that produces redness, warmth, swelling, and itching. It is a rash that, if it lasts long enough, causes the skin to become scaly, thick and hard. This is known as lichenification. First episodes of eczema are usually noticed in infancy or early childhood. They are recognized by extreme itchy patches of skin anywhere on the body that are dry, red and flaky but are most commonly found inside the elbows or behind the knees. Other common areas affected by this condition are the face, back of the hands and feet, and the neck. Ten percent of children are affected by atopic dermatitis. In 85% of childhood cases, the first instance occurs between six weeks and five years of age. In 70% of cases, this condition will persist into later childhood and even into adulthood.

Eczema is an atopic condition, or an allergic disease which is inherited to some extent and frequently appears in families where asthma and hay fever is prominent. Individuals with an atopic condition produce large amounts of different IgE antibodies when certain conditions are met such as after eating certain foods: eggs, soy, milk, peanuts, wheat and fish. Those individuals with atopic dermatitis can also produce IgE antibodies in response to bacteria, Staphylococcus aureus, and to allergens such as dust mites.



Phases



Eczema can be grouped into three phases. The first phase is known as the infantile phase which begins at four to six months. In this phase, the rash appears on the face and, later, on the abdomen, forearms and legs. The rash may disappear on its own or it may continue into the next phase.

In the childhood phase, the rash is distinguishable by the small, itchy bumps, dry skin and a thickening or hardening of the skin. It usually appears in the folds of skin such as the insides of the elbows, backs of the knee, or the backs of the hands or feet. Eczema during this phase may improve during puberty but it can also persist into the final phase. In adult atopic dermatitis, the rash is itchy, and the skin is thick and hard.



Symptoms



For those suffering from eczema, symptoms will come and go. The rash can appear to almost fade completely and then flare up and cover a large part of the body. Symptoms are also usually worse during the winter months when the air is much drier. Typically, the condition begins with a rash that is red, warm and swollen. The rash can cover a small area or a significant portion of a body. It can also appear almost anywhere on the body. If the rash from this condition is present for an extended period of time, the skin may become thick, hard and brownish.

Due to the skin being so dry, scaly and itchy, rashes from eczema can very easily become infected if not treated. Excessive scratching can eventually lead to the skin breaking open, allowing bacteria to enter which will make the location of the infection even itchier. Atopic dermatitis needs to be effectively treated before this occurs as once the infection begins, it can very quickly become a generalized skin infection, spreading to a larger area. Once the infection has occurred, it will need to be treated with antibiotics.






Diagnosis



For a doctor to diagnose an individual with eczema, a combination of personal history, physical exam, and test results may be conducted. The types of questions a physician may ask the patient include:

  • Is your rash itchy?
  • Does your rash seem to come and go, but with repeated flare ups?
  • Do you have more itching and rash during the winter months?
  • Does your skin itch more when you feel stressed and when you perspire?
  • Do you often have oozing and crusting of the skin?
  • Do you or any of your family members have allergic rhinitis or asthma?



A physician will look for certain signs during a physical examination for eczema, such as: Patches of rash-affected skin that have darkened, thickened and become scaly; A rash located on parts of the body commonly affected by this condition, such as the face, hands, neck, folds of the arms, and backs of the knees; and Dermographism, where the skin can be written on by scratching it with a dull instrument. Based on the personal / family history and the physical examination, if the physician feels that it might be atopic dermatitis, then skin, blood or food allergy tests can be performed to determine the diagnosis.



Allergy Testing



Skin Tests

Skin tests are useful if the eczema is caused by inhaled allergens. Tests for pollens, molds, or animal dander can be performed. Interestingly, a person might have a sensitivity to a substance which causes the dermatitis but not have a true allergy to that substance. In cases like this a false positive skin test result. It is due to these false positive tests that physicians will prefer to run other tests or use information from the personal history or physical exam to determine the diagnosis.


Blood Tests

A doctor may prefer to perform a blood allergy test, especially if the patient is experiencing a rash. A RAST blood test will be conducted to indicate whether patients have elevated levels of IgE antibodies in the blood. If so, an allergy is likely to be present and eczema is identified.


Food Allergy Tests

If the doctor suspects that food might play a role in the occurrence of atopic dermatitis, an elimination diet might be prescribed to confirm. This requires minimizing the type of food eaten initially to see if the condition flares up (for approximately two weeks). If no flare ups, new foods are introduced to the diet and any reactions are monitored. This process is more time consuming and will take a longer time but it is a reliable way of determining what foods are causing the dermatitis.



Treatment



Eczema is not a curable condition but there are steps an individual can take to control the symptoms. Treatment will not prevent the condition from progressing but it will relieve the itch and aid in clearing up the rashes when they occur. The most common treatment would be avoiding contact with the substances that cause the symptoms. If that is not possible, doctors will prescribe medications to manage the symptoms.

Commonly, topical corticosteroid creams and ointments will be recommended by your doctor for use on atopic dermatitis. The creams are rubbed onto the affected area and soothe the skin by reducing inflammation and itching. There are side effects associated with overusing the cream such as the thinning, discoloring or aging of the skin. Physicians may also prescribe an oral antihistamine to relieve itchiness. If symptoms are severe, oral corticosteroids can also be administered. Note that allergy shots are not recommended for those individuals who suffer from eczema as they can worsen the condition.

Other things that an individual can do to minimize the itching and other symptoms of dermatitis are to:


  • Avoid using harsh soaps, detergents, and lotions
  • Avoid over-drying your skin. Note that taking long showers or baths and using hot water can actually dry the skin
  • Pat, do not rub, your skin dry with a towel after bathing
  • Apply a hypoallergenic moisturizer before and after using chlorinated water (e.g. a public swimming pool). Chlorine will dry out the skin
  • Wear loose fitting cotton clothing that will not rub the skin to minimize itching
  • Wear clothing that protects your skin during colder weather as the cold weather will dry out the skin
  • Maintain moderate humidity levels in your home, especially during the cold weather when the heat is turned on
  • Avoid excessive sweating, which can irritate the skin
  • Apply cold water compresses to relieve itching and inflammation
  • Avoid excessive exposure to the sun (i.e. sunburns) which can worsen a rash




Prevention



Eczema is not curable, but there are steps that individuals can take to minimize the symptoms. Ideally, avoiding the substance that is causing the flare up is recommended. This is not always possible and therefore, taking prescribed creams, keeping the skin moisturized, and avoiding dry climates will make the symptoms more manageable.



Conclusion



Although eczema is not a life threatening condition, it can cause a great deal of discomfort for an individual suffering with it. Despite being incurable, steps can be taken to minimize dermatitis outbreaks and symptoms can be treated with creams and other measures to alleviate the itchiness and rashes. If symptoms worsen or an infection sets in, a physician should be consulted and appropriate treatment will be prescribed.

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