Monthly Archives: March 2016

History: The most common complaint of eczema is itchiness (pruritus), redness, and tiny bumps or blisters. If untreated, the skin can become thick, scaly, and dry, with areas of hair loss and color changes. The individual may relate a history of work or recreational activities in which the skin is exposed to water, moisture, sun, or new personal care products.

Physical exam: In general, eczema presents with redness, warmth, swelling (edema), tenderness, weeping, crusting, scratches and cracks (excoriations), and thickened and scaling skin with a diffuse border.

Skin changes associated with atopic dermatitis are variable and include excoriations; wet, raised bumps (papules); thickened, red, gray, or scaly skin (lichenification); red, fluid-filled bumps (vesicles); and crusted lesions.

Contact dermatitis presents as areas of reddened (erythematous) and swollen (edematous) skin that later develop small and large blisters (vesicles and bullae, respectively). The pattern, shape, and location of the contact dermatitis rash help identify the causative substance. Hand eczema may present with dryness and cracking of the skin, with some redness and swelling. A variation of this condition, dyshidrotic eczema, has small, very itchy bumps along the fleshy parts of the palms and sides of the fingers. Nummular eczema has round scaly patches that look similar to ringworm and are found on the trunk, the back of the arms and hands, and the shins. Stasis dermatitis often exhibits dark red discoloration and swelling of the skin on the lower leg, ankle, and top of the foot. Stasis dermatitis lesions can become irritated and inflamed and in many cases can result in skin ulcers.

Asteatotic eczema (winter itch) presents with fine cracks over the front surface of the thighs and shins and possibly a dry, shiny appearance. Scabies presents with the classic eczematous lesions found primarily on the ankles, webs of fingers and toes, scalp, wrists, bellybutton (umbilicus), genitals, or the nipples. Seborrheic dermatitis presents as red, itchy, scaly areas, primarily on the face, scalp, groin, anogenital region, and/or below the breasts. Lichen simplex chronicus is a late stage of eczema and consists of thickened, scaly skin due to chronic rubbing or scratching. Common areas for lichen simplex chronicus are the back of the neck, tops of the feet, and ankles.

Tests: Though most eczemas are diagnosed through the history and physical exam, a scraping of the lesion should be examined under the microscope to rule out certain other skin disorders. Skin biopsy is done when persistent eczema does not respond to treatment. Skin patch tests, provocative challenges, and some immunological testing may be required. Elevated total IgE denotes an underlying allergy.

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Eczema - Medical Disability Guidelines

What is Eczema? Eczema (pronounced as 'EK-zeh-ma') comes from two Greek words, 'ek' meaning out and 'zema' meaning boils. Basically eczema, which is also called dermatitis, is a medical condition wherein the skin swells. The discomfort and pain arising from the small blisters of the skin makes it feel as if it is boiling. Both children and adults may contract eczema, but it usually occurs in infants. The cause of eczema is not yet known, but it often affects those having a family history of allergies. A lot of people suffering from eczema have asthma or allergic rhinitis, or have relatives who do. According to the National Institute of Health, approximately 15 million people have eczema in the United States alone. Around 10 to 20 percent of babies have eczema, but the condition will greatly improve by the time they are 5 and 15 years old in nearly have of them. Others will continue to have the said condition for the rest of their lives. Common Types of Eczema There are many types of eczema, each having different symptoms and causes. The most common are the following:

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Eczema / Exzema - Information and treatment

Eczema is a common skin problem in individuals with brown skin including those of Asian, Latino and African descent. It is felt to be the second most common skin disease in African-Americans. Although it is unknown if the incidence of eczema is increased in Latinos, one study found a significantly higher percent of Mexican American adolescents with eczema than white and African American adolescents. A study of Chinese, Vietnamese and white infants found a higher incidence in the Chinese and Vietnamese infants. Eczema can be a difficult and embarrassing challenge for anyone, but for a person of color with eczema, there are multiple concerns including disfiguring discoloration of the skin (hyperpigmentation or hypopigmentation). Also, in brown skin, eczema may appear differently than in white skin thus making the correct diagnosis more difficult.

In cases in which eczema is inherited along with the conditions, asthma and hay fever, it is termed, atopic dermatitis. Eczema usually appears in childhood or adolescence and frequently continues throughout adulthood. The course of eczema varies with intermittent flares which are precipitated by the following factors:

Eczema is a diverse disease that can range from mild skin irritation to severe rashes. In skin of color, eczema may not have the typical appearance of red, flaky patches. Instead, it may appear as dry ashen, brown or gray patches. In addition, in black skin, eczema may appear as rough, brown papules (bumps) near follicles which is termed, follicular papules.

There are three stages of eczema: acute, subacute and chronic. An individual with eczema may have only one stage or the stages may progress from one to another.

Acute Eczema

A major symptom of eczema is very intense itching. Scratching is a natural response to the itching. However, melanin in brown skin makes it more reactive to itching, irritation and inflammation. When scratched or rubbed, the inflamed skin can become hyperpigmented, thickened and crusted. It is important to break the itch-scratch cycle to prevent further hyperpigmentation.

Treatment Once eczema flares in brown skin, treating it promptly is key to not only eliminating the itch, but also avoiding hyperpigmentation or hypopigmentation. While there is no cure for eczema, the condition can be kept under control by modifying certain daily routines and receiving prompt treatment.

Prevention of eczema is as important as prescription medication. Understanding the causes of eczema, trigger factors and proper skin care techniques are the first step to treating eczema. Some individuals with eczema will need to avoid certain foods, allergens or medicines.

Avoiding skin irritants, including chemicals and clothing, is an important preventative measure for individuals with eczema.

All individuals with eczema will need to modify bathing habits, skin care products and other chemicals that come into contact with the skin. The following patient education tips are commonly recommended by dermatologists.

Corticosteroids topical, oral and injected are the mainstay of treatment of eczema. The selection of the formulation depends upon the severity of the eczema. For mild to moderate eczema, topical corticosteroids, formulated as creams, ointments, lotions, foams or oils are commonly prescribed. These agents, which come in many different strengths from class 1 (superpotent) to class 7 (low potency), are usually prescribed twice daily for a two to three week period. Low potentcy corticosteroids are commonly used to treat the face, body folds (groin, axillary) and in the diaper area. More potent steroids are applied on other parts of the body. For lichenified plaques and regions such as the palms and soles superpotent steroids are often prescribed. Although topical steroids treat the inflammation that is characteristic of eczema, serious complications can develop from overuse or prolonged use, especially those that are superpotent.

Complications of topical steroidsThinning of the skin

For severe eczema, oral steroids (Prednisone) or injected steroids (Kenalog, Aristocort) may be necessary. They are prescribed for a limited period of time only and are reserved for the most severe cases.

TIMS or Topical Immunomodulators are topical agents (calcineurin inhibitors) that are used for the treatment of eczema. They do not contain steroids and therefore do not carry the risks associated with that medications. There are two types of immunomodulator creams: Tacrolimus (0.03% and 0.1% Protopic) and pimecrolimus (1% Elidel). Immunomodulators are applied twice daily until the eczema clears. Itching, burning and irritation are possible side effects. There has been concern raised regarding cancers in laboratory animals fed immunomodulators orally. Further long-term human studies are needed to completely understand the side effects with topical immunomodulator therapy.

Non-TIMS are non-steroid, non-tims topical creams that have been recently developed for the treatment of eczema. One of the most recently approved is Mimyx. It is not only a good emollient, but treats eczema and can be used for chronic cases or eczema.

Phototherapy or light treatment is an effective treatment for eczema. With phototherapy, various wavelengths of sunlight (UVB, UVA, combined UVA/UVB, UVA1, or narrow-band) are administered in a unit that is similar to a telephone booth but which is lined by fluorescent appearing light bulbs. The type of phototherapy that you will receive will be determined by your dermatologist. It is usually administered twice weekly. Possible side effects of phototherapy are redness, sunburn, or dryness. Long-term side effects, which are more likely with white skin, are possible skin cancers and enhanced aging.

Antihistamine pills relieve itching associated with eczema. There are three classes of antihistamines (H1, H2, H3). Type H1 antihistamines (e.g. hydroxyzine, diphenhydramine) are helpful in breaking the itch-scratch cycle. Since they may cause drowsiness, they should be given at bedtime. Type H2 and H3 antihistamines are generally non-sedating and are also helpful in treating eczema. Your doctor will select the antihistamine that is most appropriate for your eczema.

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Eczema - Skin Problems

Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Dermatitis affects about one in every five people at some time in their lives. It results from a variety of different causes and has various patterns.

The terms dermatitis and eczema are often used interchangeably. In some cases the term eczematous dermatitis is used. Dermatitis can be acute or chronic or both.

An in-between state is known as subacute eczema.

Psychological stresses can provoke or aggravate dermatitis, presumably by suppressing normal immune mechanisms.

An important aspect of treatment is to identify and tackle any contributing factors (see above).

Dermatitis is often a long-term problem. When you notice your skin getting dry, moisturise your skin again and carefully avoid the use of soap. If the itchy rash returns, use both the moisturiser and the steroid cream or ointment. If it fails to improve within two weeks, see your doctor for further advice.

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Dermatitis (eczema). DermNet NZ

If you had atopic eczema as a child, you may find it improves as you get older. However, certain triggers may still cause it to flare up. There are many different ways of keeping your eczema under control, depending on how severe your symptoms are.

Keeping a diary about your eczema symptoms may help you spot any triggers that make your eczema worse. Common triggers include stress, pets and temperature changes.

If your eczema becomes itchy, try not to scratch it. Scratching can make your eczema worse and may cause your skin to thicken. Anti-scratch mittens for babies and young children can be helpful. If you need to relieve an itch, gently rub your skin with your fingertips instead of using your nails. Keep your nails short.

If your eczema isnt getting better, its especially important to avoid skin irritants such as soaps, shower gels and bubble baths.

Although theres no cure for eczema, theres a range of medicines available from your pharmacist or GP to help control your symptoms. Always ask your pharmacist or GP for advice and read the patient information leaflet that comes with your medicine.

Emollients soothe and soften dry skin. They moisturise your skin by preventing water loss and adding water back into your skin. They can also help to repair any skin damage. Using emollients can ease itching and prevent your skin becoming infected.

Emollients are most effective at preventing flare-ups of eczema if you use them all the time, even when you dont have any eczema symptoms. Apply them as often as you need to ideally at least every four hours or up to three to four times a day. It can also really help to use emollients during and after a bath or shower.

Smooth emollients onto your skin rather than rubbing them in. Always apply them in the direction of hair growth. This will reduce your risk of developing an infection at the bottom of your hair follicles.

Emollients are available as creams, lotions, oils or washes. There are many different types of emollient. Examples are shown in the table below.

Emulsifying ointment, BP

Hydrous ointment, BP

Liquid and White soft paraffin ointment, NPF

Aveeno

E45

Hydromol Cream

Ultrabase Cream

Epaderm

Hydromol Ointment

Zeroderm Ointment

Dermamist spray application

Doublebase gel

QV lotion

Aveeno colloidal bath additive

Cetraben emollient bath additive

Oilatum emollient bath additive

Generally, most emollients will help improve the appearance of your eczema. However, if your eczema is severe, you may need to try a greasier emollient formulation, such as an ointment rather than a cream. Emollient products containing urea may be particularly helpful for severe eczema or in older people. Dont use emollients containing antibacterial ingredients unless your skin is infected or your doctor recommends it.

Different products suit different people. You may have to try several different emollients before you find the best one for you. For emollients that come in pots, use a clean spoon or spatula to get it out when youre applying the emollient to your skin. This will stop the emollient inside the pot becoming contaminated with bacteria.

Sometimes, emollients on their own aren't able to control your eczema symptoms. If this is the case, you may need to use a steroid cream for a short time. Steroid creams reduce inflammation and help to relieve itching. There are different strength steroid creams, from mild to very potent. Mild steroid creams (such as hydrocortisone) are available over the counter. Your pharmacist can offer advice about how much you can use and how often you can apply it. Use the mildest cream that works for you.

If your GP prescribes a steroid cream, always follow their advice about how much to use. You can apply a steroid cream directly to your skin, but only use it on areas with visible eczema. You will usually only need to apply the cream once a day. However, if this doesnt help to relieve your symptoms, your GP or dermatologist may recommend using the cream twice a day.

Always continue using your emollients while you are using the steroids. You can use steroid creams before or after applying your emollient, but you need to leave around half an hour between applying the two different creams. This prevents the active ingredients in your steroid cream from being diluted by your emollient.

Potent or very potent steroid creams, such as betamethasone valerate, are available on prescription. Using stronger steroid creams too often, or on delicate skin (such as on your face), can thin your skin. This can make your skin bruise more easily. Always follow your GP or dermatologists advice about using any type of steroid cream. For more information, see our FAQs.

If emollients or steroid creams dont help your eczema, your GP or dermatologist may prescribe some other medicines. These include the following.

If you have severe eczema, you may need to use medicated paste bandages to soothe and protect your skin. These contain emollients and other medicines, such as ichthammol, to help relieve itching and reduce thickening of your skin. You usually apply them to your arms or legs, and they act as a barrier to prevent scratching.

Your doctor may also recommend using wet wraps, which are cooling bandages that can help to soothe severe eczema. Once you have smoothed an emollient onto your skin, you cover the emollient with wet bandages and then a layer of dry bandages. These wet wraps help to prevent you from scratching and allow your skin to absorb as much of the emollient as possible. These are often useful when treating young children with severe eczema, particularly at night. Dont use bandages or wet wraps if your eczema is infected because this can cause the infection to spread.

Your doctor may suggest trying ultraviolet light (UV) treatment (phototherapy), to relieve your symptoms. This is usually given in hospital by a dermatologist.

Some people consider trying complementary treatments, such as herbal creams and homeopathy. But there isnt any good evidence that these therapies are effective in treating eczema. If you do try them, remember that even products marketed as natural arent necessarily harmless. Herbal remedies contain active ingredients and may interact with other medicines or cause side-effects. Always speak to your pharmacist or GP before trying complementary therapies. If you do decide to try a complementary therapy, check that your therapist belongs to a recognised professional body.

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Atopic eczema symptoms, treatment and causes - Bupa UK