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INDICATION – BRIEF
Eczema, also known as atopic dermatitis, is a common skin condition often characterized by itchy, inflamed skin. The cause is believed to involve a mix of genetic and environmental factors. Clinically, it’s linked to an overactive immune response and defects in the skin barrier, making skin more susceptible to irritants and infections. Non-clinical triggers include irritants (like soaps, detergents), allergens (like dust mites, pets), microbes, certain foods, climate conditions, and stress. Despite the condition not being contagious, it tends to run in families due to its strong genetic component. Always consult a healthcare provider for diagnosis and treatment.
INDICATION – DEFINITION
Eczema, also known as atopic dermatitis, is a common skin condition characterized by itchy, inflamed, and occasionally peeling skin. Eczema usually appears in early childhood and is often more severe in people who have a family history of the condition.
The exact cause of eczema is unknown, but it is believed to involve a combination of genetic and environmental factors. Eczema is not contagious, but it has a strong genetic component, meaning that it tends to run in families.
Clinically, eczema is related to an overactive immune system response when exposed to irritants. It’s also associated with other conditions caused by immune system imbalances, such as asthma and allergies.
People with eczema have a defect in their skin barrier that makes their skin more susceptible to irritants, changes in temperature, and low humidity. This defective skin barrier also makes the skin more susceptible to bacterial, viral, and fungal infections.
Non-clinically, several factors can trigger or worsen eczema. These include:
- Irritants: Soaps, detergents, shampoos, disinfectants, juices from fresh fruits, meats, or vegetables can worsen the condition.
- Allergens: Dust mites, pets, pollens, mold, and dandruff can lead to an eczema flare.
- Microbes: Certain bacteria, viruses, and fungi can cause an eczema flare.
- Climate: Hot weather, high and low humidity, and perspiration from exercise can trigger or worsen eczema.
- Stress: This is not exactly a cause, but it can worsen the condition.
- Foods: Dairy products, eggs, nuts and seeds, wheat, and soy products can cause eczema flares in some people.
SYMPTOMS AND DIAGNOSIS
- Dry skin: One of the most common symptoms of eczema is chronically dry, itchy skin.
- Inflamed, red, or discolored skin: The affected areas may be red (especially in light-skinned people) or dark brown, purple, or ashen (especially in dark-skinned people).
- Itching: The affected areas may itch, sometimes intensely, especially at night.
- Scaly, cracked, or thickened skin: Prolonged scratching or the chronic nature of eczema can result in skin that becomes thick and leathery to protect itself.
- Blisters or bumps that can ooze or crust over: In some types of eczema, small fluid-filled bumps or larger weeping blisters may form that can ooze when scratched and then crust over.
Eczema is typically diagnosed by a physical examination and review of medical and family history. Your dermatologist may ask about your symptoms, past health, and family health to help determine if you have eczema or another skin condition.
In some cases, a skin biopsy may be needed to confirm a diagnosis or to rule out other skin diseases. Allergy tests may be performed, particularly for people who also have asthma or hay fever or who have a history of food allergies.
Prognosis and Impact
The prognosis of eczema can vary greatly from person to person. Many children with eczema outgrow the condition by their teens, though they may still need to take special care of their skin and manage occasional flare-ups.
However, for some people, eczema continues into adulthood or may even start in adulthood. The condition can sometimes significantly impact a person’s quality of life. Persistent itching, the need to constantly moisturize the skin, and visible rashes can be challenging for both children and adults, leading to difficulties in daily life and even causing psychological stress such as anxiety or depression.
Furthermore, people with eczema often have allergies or asthma, which need to be managed concurrently. Also, skin affected by eczema is more vulnerable to infections from bacteria, fungi, and viruses, including the herpes simplex virus.
Despite these challenges, with the right treatment and management plan, most people with eczema can lead healthy, active lives. This often includes a skin care regimen to keep the skin moisturized, avoiding known triggers, using prescribed medications as directed, and maintaining open communication with healthcare providers to adjust treatments as needed.
Living with eczema also often means educating oneself, one’s family, and others about the condition to foster understanding and support. This includes understanding that eczema is not contagious and that flare-ups are not due to a lack of personal hygiene.
Treatment Options
There’s currently no cure for eczema, but there are several effective treatment strategies:
- Skin Care Regimen: Regular bathing with gentle, fragrance-free cleansers and moisturizing can help manage symptoms and prevent flare-ups. It’s generally recommended to apply moisturizer within a few minutes of bathing to lock in moisture.
- Avoiding Triggers: This can include a wide range of things, such as certain types of food, fabrics, fragrances, soaps, or environmental factors like dust or pollen. Stress management can also play a role.
- Topical treatments: These include corticosteroid creams or ointments, which can help to reduce inflammation and itching. Non-steroidal treatments, such as topical calcineurin inhibitors or phosphodiesterase-4 inhibitors, are other options.
- Systemic treatments: Oral or injected medications, like corticosteroids or immunosuppressants, can be used for severe eczema. More recently, biologic therapy (like Dupilumab) has been shown effective in severe cases. These are drugs that target specific parts of the immune system.
- Phototherapy: Exposing the skin to controlled amounts of natural or artificial light can improve eczema symptoms in some people.
- Wet Wrap Therapy: This involves applying water-soaked fabric wraps to the skin to lock in moisture, followed by a layer of dry wraps, usually after applying topical medication.
Remember, each person with eczema is unique and may respond differently to different treatments. The best approach often involves a combination of treatments and preventive measures. It’s crucial to work with a healthcare provider or dermatologist to create a personalized treatment plan.
Risks and Side Effects
Each treatment for eczema has its potential risks and side effects:
- Skin Care Regimen: Generally, a skin care regimen carries minimal risk. However, some people might experience irritation or allergic reactions to certain products, especially those with fragrances or certain preservatives. It’s important to use products designed for sensitive skin or specifically labeled as suitable for eczema.
- Avoiding Triggers: There’s usually no risk in avoiding known triggers. However, if dietary modifications are made (like removing dairy or eggs), it’s essential to ensure that the diet remains balanced and nutritionally adequate.
- Topical treatments:
- Corticosteroids: Prolonged use can lead to skin thinning, stretch marks, and skin color changes.
- Calcineurin inhibitors: These can cause skin burning or itching initially, and there’s a boxed warning about a potential risk of skin cancer and lymphoma, although a direct link is not confirmed.
- PDE4 inhibitors: May cause skin burning or itching.
- Systemic treatments:
- Oral corticosteroids: Long-term use can lead to serious side effects like osteoporosis, high blood pressure, and diabetes.
- Immunosuppressants: These can increase the risk of infections and potentially some types of cancers.
- Biologic therapy: Possible side effects include injection site reactions, eye problems, and an increased risk of infections.
- Phototherapy: Repeated treatments may lead to premature skin aging and an increased risk of skin cancer, particularly with long-term use.
- Wet Wrap Therapy: This is generally safe but can lead to skin infections if not done properly. It should be conducted under the guidance of a healthcare professional.
It’s crucial to discuss these potential risks and side effects with your healthcare provider before starting any treatment.Â
FAQ Section
Q: What is eczema?Â
A: Eczema, also known as atopic dermatitis, is a common skin condition characterized by itchy, inflamed, and often peeling skin. It’s generally associated with an overactive immune system response and a defective skin barrier.
Q: What causes eczema?Â
A: The exact cause of eczema is unknown, but it’s believed to involve a combination of genetic and environmental factors. Triggers can include irritants like soaps, allergens like dust, microbes, weather changes, stress, and certain foods.
Q: Is eczema contagious?Â
A: No, eczema is not contagious. It’s an immune system reaction and cannot be transmitted from person to person.
Q: How is eczema diagnosed?Â
A: Eczema is typically diagnosed by a physical examination and review of medical and family history. In some cases, a skin biopsy or allergy tests may be conducted.
Q: How is eczema treated?Â
A: Eczema treatment focuses on relieving symptoms and preventing outbreaks. This includes regular skin care, avoiding triggers, topical treatments, systemic treatments, phototherapy, and in some cases, wet wrap therapy.
Q: Are there side effects of eczema treatments?
A: Each treatment can have potential side effects. For example, topical treatments like corticosteroids may cause skin thinning with prolonged use, while systemic treatments like immunosuppressants can increase the risk of infections. It’s important to discuss these risks with your healthcare provider.
Q: Can eczema be cured?Â
A: While there’s currently no cure for eczema, it can often be well managed with a combination of skin care, medication, and avoidance of known triggers. Many children with eczema outgrow the condition by their teens.
Q: Does having eczema mean that I will develop asthma or allergies?Â
A: While eczema, asthma, and allergies often occur together, not everyone with eczema will develop these conditions. If you have eczema and are concerned about asthma or allergies, consult with your healthcare provider.
Q: Can eczema affect my quality of life?Â
A: Eczema can impact your quality of life due to its symptoms and the need for regular skin care. However, with appropriate management and treatment, most people with eczema can lead healthy, active lives.
Reference
- The American Academy of Dermatology (AAD) Website – Provides up-to-date information on a variety of dermatological conditions, including eczema.
- The National Eczema Association (NEA) Website – Offers extensive resources on understanding, managing, and living with eczema.
- “Fitzpatrick’s Dermatology” – This textbook is a comprehensive resource for dermatology.
- “Rook’s Textbook of Dermatology” – Another key resource in the field of dermatology, offering in-depth coverage of a wide range of skin conditions.