Information AboutEczema |
| CATEGORIES ABOUT ECZEMA | |
| autoimmune diseases | |
| skin diseases | |
| dermatology | |
Eczema is a form of ''' Dermatitis ''', a skin irritation characterized by red, flaky skin, sometimes with cracks or tiny Blisters . These blisters may also look like bubbles just below the surface of the skin. It can be extremely itchy, but scratching damages the fragile skin and exacerbates the problem so it is important for people with eczema to try to leave the area alone. TYPES ICD-10 codes are provided where available. Allergenic There are several causes of dermatitis, but the most common ones are related to Allergies .
Non-allergenic Several other forms appear unrelated to the main allergic causes.
DIAGNOSIS Eczema diagnosis is generally based on the appearance of inflamed, itchy skin in eczema sensitive areas such as face, chest and other skin crease areas. However, given the many possible reasons for eczema flare ups, a doctor is likely to ascertain a number of other things before making a judgment:
To determine whether an eczema flare is the result of an allergen, a doctor may test the blood for the levels of antibodies and the numbers of certain types of cells. In eczema, the blood may show a raised IgE or an Eosinophilia . The blood can also be sent for a specific test called Radioallergosorbent Test (RAST) or a '''Paper Radioimmunosorbent Test (PRIST)'''. In the test, blood is mixed separately with many different allergens and the antibody levels measured. High levels of antibodies in the blood signify an allergy to that substance. Another test for eczema is skin patch testing. The suspected irritant is applied to the skin and held in place with an adhesive patch. Another patch with nothing is also applied as a control. After 24 to 48 hours, the patch is removed. If the skin under the suspect patch is red and swollen, the result is positive and the person is probably allergic to that substance. Occasionally, the diagnosis may also involve a skin lesion biopsy: removal of a small piece of skin for microscopic examination in a laboratory. Blood tests and biopsies are not always necessary for eczema diagnosis. However, doctors will at times require them if the symptoms are unusual, severe or in order to identify particular triggers. TREATMENT Moisturizing Dermatitis severely dries out the skin,and keeping the affected area moistened can promote healing and retain natural moisture. This is the most important self-care treatment that one can use in atopic eczema. The use of anything that may dry out the skin should be discontinued and this includes both normal Soap s and Bubble Bath s that remove the natural oils from the skin. The moistening agents are called 'emollients'. The rule to use is: match the thicker ointments to the driest, flakiest skin. Light emollients like ''Aqueous Cream'' may dry the skin if it is very flaky and whilst it is the moisturiser traditionally prescribed by doctors in the UK, it is in fact only licensed for use as a soap substitute on washing Emollient bath oils should be added to bath water and then suitable agents applied after patting the skin dry. Generally twice daily applications of emollients work best and whilst Cream s are easy to apply, they are quickly absorbed into the skin and so need frequent re-application. Ointment s, with their lesser water content, stay on the skin for longer and so need fewer applications but they must be applied sparingly if to avoid a sticky mess. Typical emollients in the U.K. are: ''Oilatum'' or ''Balneum'' bath oils, ''Aqueous'' cream for washing with, ''Diprobase'' or ''Doublebase'' pump-action creams also used for washing and may be later applied directly to the skin. The preferred moisturiser of dermatologists is a mix of liquid and white-soft Paraffin s. ''Sebexol'', ''Epaderm'' ointment and ''Eucerin'' lotion or cream may be helpful with itching. Moisturizing gloves can be worn while sleeping. Some report improvement of symptoms after treatment of the skin with porridge oats, either directly or with an extract. Eczema and detergents The first and primary recommendation is that people suffering from eczema shouldn't use detergents of any kind unless absolutely necessary. The current medical school of thought is that people wash too much and that eczema sufferers should use cleansers only when water is not sufficient to remove dirt from skin. Another point of view is that detergents are so ubiquitous in modern environments and so persistent in tissues and surfaces, safe soaps are necessary to remove them in order to eliminate the eczema in a percentage of cases. Although most recommendations use the terms "detergents" and "soaps" interchangeably, and tell eczema sufferers to avoid both, detergents and soaps are not the same and are not equally problematic to eczema sufferers. Detergents increase the permeability of skin membranes in a way that soaps and water alone do not. Sodium lauryl sulfate, the most common household detergent, has been shown to amplify the allergenicity of other substances ("increase antigen penetration"). (For example, Corazza M, Virgili A, Allergic contact dermatitis from ophthalmic products: can pre-treatment with sodium lauryl sulfate increase patch test sensitivity? Contact Dermatitis. 2005 May;52(5):239-41.) The use of detergents in recent decades has increased dramatically, while the use of soaps began to decline when detergents were invented, and leveled off to a constant around the '60s. Complicating this picture is the recent development of mild plant-based detergents for the natural products sector. Unfortunately there is no one agreed upon best kind of cleanser for eczema sufferers. Different clinical tests, sponsored by different personal product companies, unsurprisingly tout various brands as the most skin friendly based on specific properties of various products and different underlying assumptions as to what really determines skin friendliness. The terms "hypoallergenic" and "doctor tested" are not regulated (according to Consumer Reports), and no research has been done showing that products labeled "hypoallergenic" are in fact less problematic than any others. Dermatological recommendations in choosing a soap generally include:
How to use soap when one must
Itch Relief Antihistamine medication may reduce the itch during a flare up of ezcema, and the reduced scratching in turn reduces damage & irritation to the skin (the ''Itch cycle''). Capsaicin applied to the skin acts as a counter irritant (see Gate Control Theory of nerve signal transmission). Other agents that act on nerve transmissions, like Menthol , also have been found to mitigate the body's itch signals, providing some relief. Whilst research has suggested Naloxone Hydrochloride and Dibucaine suppress the itch cycle in atopic-dermatitis model mice. Corticosteroids Dermatitis is often treated by doctors with prescribed Glucocorticoid (a Corticosteroid Steroid ) ointments or creams. For mild-moderate eczema a weak steroid may be used (e.g. Hydrocortisone or Desonide ), whilst more severe cases require a higher-potency steroid (e.g. Clobetasol Propionate ). They are highly effective in most cases, but must be used sparingly to avoid possible side effects, the most significant of which is that their prolonged use can cause the skin to thin and become fragile ( Atrophy ). High strength steroids used over large areas may be significantly absorbed into the body causing bone demineralisation ( Osteoporosis ). Finally by their immunosuppression action they can, if used alone, exacerbate some skin infections ( Fungal or Viral ). If using on the face, only a low strength steroid should be used and care must be taken to avoid the eyes. Hence a steroid of an appropriate strength to promptly settle an episode of eczema should be sparingly applied. Once the desired response has been achieved, it should be discontinued and not used for long-term prevention. Immunomodulators Topical Immunomodulators like Pimecrolimus (Elidel® and Douglan®) and Tacrolimus (Protopic®) were developed after Corticosteroid treatments, effectively suppressing the immune system in the affected area, and appear to yield better results in some populations. The US Food And Drug Administration has issued a public health advisory about the possible risk of lymph node or skin cancer from use of these products, but many professional medical organizations disagree with the FDA's findings:
Antibiotics The disruption to the skin's normal barrier protection through dry and cracked skin allows easy entry for Bacteria and Fungi . Scratching by the patient both introduces infection and spreads it from one area to another. Any skin infection further irritates the skin and a rapid detoriation in the condition may ensue; the appropriate Antibiotic should be given. Psychological Effects Eczema often comes and goes in cycles and this means that sufferers at some times of the year are able to feel normal and at other times distance themselves from social contact. Sufferers with visible marks can act normal, but when it's mentioned they become withdrawn and self-conscious at their problems. Also, when told to stop scratching the sufferer can sometimes feel annoyance at the person who said it. Since it's a condition, which is made worse by scratching the sufferer feels bad in themselves and sometimes experiences feelings that everyone is looking at them. Although scratching does give pain it can feel like a release and this leads to problems with constant scratching. Sufferers may also be able to not scratch for example at school or at work and scratch the moment they get home. In summary sufferers of eczema, especially children, may suffer psychological distress in addition to the physical discomfort of their condition. This may both be through their own embarrassment about the condition and from any teasing or social rejection by their peers. Light Therapy ''See also Light Therapy .'' Light Therapy using Ultraviolet light can help. PUVA , UVB , and Narrow Band UVB are all used. Current research seems to show that Narrow Band UVB is the most effective, in addition to having lowest risk of skin cancer. When light therapy alone is found to be ineffective, it is combined with a drug called Psoralen. This treatment is termed as photo-chemotherapy. Traditional remedies Other historical sources - notably Traditional Chinese Medicine and Western Herbalism - suggest a wide variety of treatments, each of which may vary from individual to individual as to efficacy or harm. Toxicity may be present in some.
Some alternative (and even conventional) medicine sources state that Oatmeal in solution applied topically has a healing effect. This has been noticed through occupational sources, where a person's skin is often exposed to oatmeal at work, e.g., through baking or milling. Often such people retain exceptionally soft and healthy skin into old age. The symptoms of alleviates the symptoms of eczema {Link without Title} . Patients should inform their doctor/allergist/dermatologist if they are pursuing one of these treatment routes. Future Treatments Other than direct treatments of the symptoms, no "cure" for dermatitis is presently known; even cortisone treatments and immunomodulation may often have only minor effects on what may be a complex problem. As the condition is often related to family history of allergies (and thus heredity), it is probable that Gene Therapy or Genetic Engineering might help. The March 2006 issue of the journal Nature Genetics , reports on research at the University Of Dundee identifying a gene that the researchers believe to be the cause of inherited eczema and some related disorders. The gene produces the protein Filaggrin , the lack of which causes dry skin. SEE ALSO
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