Information AboutEczema |
| CATEGORIES ABOUT ECZEMA | |
| autoimmune diseases | |
| skin diseases | |
| dermatology | |
Eczema is a form of Dermatitis , or Inflammation of the upper layers of the Skin . The term "eczema" is broadly applied to a range of persistent or recurring skin Rash es characterized by redness, skin Edema , itching and dryness, with possible crusting, flaking, blistering, cracking, oozing, or bleeding. Areas of temporary skin discoloration sometimes characterize healed Lesion s, though Scar ring is rare. TYPES ICD-10 codes are provided where available. The term eczema refers to a set of clinical characteristics. Classification of the underlying diseases has been haphazard and unsystematic, with many Synonym s used to describe the same condition. A type of eczema may be described by location (e.g. hand eczema), by specific appearance (eczema Craquele or discoid), or by possible cause (varicose eczema). Further adding to the confusion, many sources use the term eczema and the term for the most common type of eczema (atopic eczema) interchangeably. The European Academy of Allergology and Clinical Immunology (EAACI) has published a position paper which simplifies the nomenclature of allergy-related diseases including atopic and allergic contact eczemas (Johansson et al., 2001, Allergy 56:813). Non-allergic eczemas are not affected by this proposal. The classification below is clustered by incidence frequency. Common Eczemas
Less common eczemas
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. For evaluation of the eczema, a scoring system can be used (for example, SCORAD , a scoring system for atopic dermatitis). 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 Eosinophil ia. 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 examination in a Pathology 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 Eczema can be exacerbated by dryness of the skin, so keeping the affected area moistened can promote healing and relief. Moisturizing is one of the most important self-care treatments for sufferers of eczema. Because they can strip natural skin oils and lead to excessive dryness, harsh detergent Soap s should not be used on affected skin. Instead, the use of moisturizing body wash, or an emollient like Aqueous Cream , will maintain natural skin oils and may reduce some of the need to moisturize the skin. Another option is to try bathing using colloidal oatmeal bath treatments. In addition to avoiding soap, other products that may dry the skin, such as powders or perfume, should also be avoided. Moistening agents are called ' Emollients '. In general, it is best to match thicker ointments to the driest, flakiest skin. Light emollients like Aqueous Cream may not have any effect on severely dry skin. Some common European emollients for the relief of eczema include ''Oilatum'', ''Balneum'', ''Medi Oil'', ''Diprobase'', bath oils and aqueous cream. ''Sebexol'', ''Epaderm'' ointment and ''Eucerin'' lotion or cream may also be helpful with itching. Lotions or creams may be applied directly to the skin after bathing to lock in moisture. Moisturizing gloves (gloves which keep emollients in contact with skin on the hands) can be worn while sleeping. Generally, twice-daily applications of emollients work best. While Cream s are easy to apply, they are quickly absorbed into the skin, and therefore need frequent reapplication. Ointment s, with less water content, stay on the skin for longer and need fewer applications, but they can be greasy and inconvenient. For broken skin, direct application of waterproof tape with either an emollient or prescription ointment can improve moisture levels and skin integrity and allow skin to heal. It can also help prevent skin from cracking and stop the itch cycle, which reduces lichenification (the roughening of skin from repeated abrasion). One alternative treatment, fashionable in the Victorian and Edwardian eras, was the topical application of sulfur. Recently sulfur has regained some popularity as a homeopathic alternative to steroids and coal tar. However, there is currently no scientific evidence for the claim that sulfur treatment relieves eczema. {Link without Title} Eczema and skin cleansers The first and primary recommendation is that people suffering from eczema shouldn't use detergents of any kind on their skin unless absolutely necessary. Eczema sufferers can reduce pruritus by using cleansers only when water is not sufficient to remove dirt from skin. However, detergents are so ubiquitous in modern environments in items like tissues, and so persistent on surfaces, "safe" soaps are necessary to remove them from the skin in order to control eczema. Although most eczema recommendations use the terms "detergents" and "soaps" interchangeably, and tell eczema sufferers to avoid both, Detergent s and Soap s are not the same and are not equally problematic to eczema sufferers. Detergents, often made from petrochemicals, 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").Corazza, M., Virgili, A. (2005) Allergic contact dermatitis from ophthalmic products: can pretreatment with sodium lauryl sulfate increase patch test sensitivity? ''Contact Dermatitis'' 52(5), 239-41. PMID 15898995 Unfortunately there is no one agreed-upon best kind of skin 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, Murphy, L.A., White, I.R., Rastogi, S.C.(2004) Is hypoallergenic a credible term? ''Clinical and Experimental Dermatology'', 29(3), 325-7. PMID 15115531 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 Anti-itch Drug s, often Antihistamine , may reduce the itch during a flare up of eczema, 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. Recent research suggests Naloxone Hydrochloride and Dibucaine suppress the itch cycle in atopic-dermatitis model mice as well. Corticosteroids Dermatitis is often treated by doctors with prescribed Glucocorticoid (a Corticosteroid Steroid ) ointments, creams or lotions. 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 ). Corticosteroids do not cure eczema, but are highly effective in controlling or suppressing symptoms in most cases.Hoare C., Li Wan Po A., Williams H. (2000) Systematic reviews of treatments for atopic eczema. ''Health Technology Assessment'' 4, 1-191. Corticosteroids must be used sparingly to avoid possible side effects, the most common of which is that their prolonged use can cause the skin to thin and become fragile (, may be significantly absorbed into the body, causing Hypothalamic-pituitary-adrenal Axis suppression (HPA Axis suppression). Lee, N. P., Arriola, E. R. (1999) Topical corticosteroids: back to basics. ''Western Journal of Medicine'', 171(5-6), 351–353. Finally by their immunosuppressive action they can, if used without Antibiotic s or Antifungal Drug s, lead to some skin infections ( Fungal or Bacteria l). Care must be taken to avoid the eyes, as topical corticosteroids applied to the eye can cause Glaucoma . {Link without Title} Because of the risks associated with this type of drug, a steroid of an appropriate strength should be sparingly applied only to control an episode of eczema. Once the desired response has been achieved, it should be discontinued and replaced with emollients as maintenance therapy. Corticosteroids are generally considered safe to use in the short- to medium-term for controlling eczema, with no significant side effects differing from treatment with non-steroidal ointment.Van Der Meer, J. B., Glazenburg, E. J., Mulder, P. G., Eggink, H. F., Coenraads, P.J. (1999) The management of moderate to severe atopic dermatitis in adults with Fluticasone Propionate. ''British Journal of Dermatology'', 140, 1114-21. Immunomodulators Topical Immunomodulator s 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. However, such Suppression is believed by alternative health practitioners to have possible adverse health effects. The US Food And Drug Administration has issued a public health advisory {Link without Title} 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 . 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 deterioration in the condition may ensue; the appropriate Antibiotic should be given. Light therapy Light Therapy using Ultraviolet light can help control eczema. Polderman M., Wintzen, M., le Cessie, S., Pavel, S. (2005). UVA-1 cold light therapy in the treatment of atopic dermatitis: 61 patients treated in the Leiden University Medical Center. ''Photodermatology, Photoimmunology, Photomedicine'', 21(2), 93. UVA is mostly used, but UVB and Narrow Band UVB are also used. Ultraviolet light exposure carries its own risks, particularly eventual skin cancer from exposure. {Link without Title} When light therapy alone is found to be ineffective, the treatment is performed with the application (or ingestion) of a substance called Psoralen . This PUVA (Psoralen + UVA) combination therapy is termed photo-chemotherapy. Psoralens make the skin more sensitive to UV light, thus allowing lower doses of UVA to be used. However, the increased sensitivity to UV light also puts the patient at greater risk for skin cancer.Stern, R. S. (2001). The Risk of Melanoma in Association with Long-term Exposure to PUVA. ''Journal of the American Academy of Dermatology'', 44(5), 755-61. Diet and Nutrition Recent studies provide hints that Food Allergy may trigger atopic dermatitis. For these people, identifying the allergens could allow an avoidance diet, although this approach is still in an experimental stage.Kanny G. Atopic dermatitis in children and food allergy: combination or causality? Should avoidance diets be initiated? ''Ann Dermatol Venereol'' 2005; 132 Spec No 1: 1S90-103. PMID 15984300 Dietary elements reported to trigger Eczema by sufferers include dairy products and coffee (both caffeinated and decaffeinated), soya, eggs, nuts, wheat and maize (sweetcorn), though food allergies may vary from person to person. Alternative therapies Non-conventional medical approaches include traditional herbal medicine and others. Patients should inform their doctor/allergist/dermatologist if they are pursuing one of these treatment routes. Patients can also wear clothing designed specifically to manage the itching, scratching and peeling associated with eczema. Sulfur has been used for many years as a treatment in the alleviation of eczema, although this could be suppressive. Many patients find that swimming in the ocean will relieve symptoms and clear up the red patchy scales. Oatmeal is a common kitchen remedy to relieve itching, and can be applied topically as a cream or, as a Colloid , in the bath. Pseudoceramides On August 27, 2007, Scientists led by Jeung-Hoon Lee created in the Laboratory synthetic lipids called pseudoceramides which are involved in Skin Cell growth and could be used in treating Skin Diseases such as Atopic Dermatitis , a form of eczema characterized by red, flaky and very itchy skin; Psoriasis , a disease that causes red scaly patches on the skin; and glucocorticoid-induced epidermal atrophy, in which the skin shrinks due to skin cell loss.[http://www.sciencedaily.com/releases/2007/08/070827184713.htm Science Daily, New Skin-healing Chemicals] Herbal Medicine 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 of these remedies are for topical use.
Behavioural approach In the 1980's a Swedish dermatologist Dr Peter Noren developed a behavioural approach to the treatment of long term atopic eczema. This approach has been further developed by a dermatologist, Dr Richard Staughton and psychiatrist Christopher Bridgett at the Chelsea and Westminster Hospital in London.C.Bridgett - Dermatology and Psychosomatics Vol. 1, No. 4, 2000 Psychodermatology and Atopic Skin Disease in London 1989-1999 - Helping Patients to Help Themselves> Patients undergo a 6 week monitored programme involving scratch habit reversal and self awareness of scatching levels. For long term eczema sufferers, scratching can become habitual, sometimes it becomes a reflex without even consciously knowing, and does not always result from the feeling of itchiness itself. The habit reversal programme is done in conjunction with the standard applied emollient/cortiseroid treatments in order that the skin can heal so that future reduced scratching reduces the likelihood of further flareups. The behavioural approach can give an eczema sufferer some control over the degree of severity of eczema RESEARCH Other than direct treatments of the symptoms, no cure is presently known for most types of dermatitis; 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. Damage from the Enzymatic activity of allergens is usually prevented by the body's own Protease Inhibitor s, such as, LEKTI , produced from the gene SPINK5 . Mutations in this gene are known to cause Netherton’s syndrome, which is a Congenital Erythroderma . These patients nearly always develop atopic disease, including hay fever, food allergy, urticaria and asthma. Such evidence supports the hypothesis that skin damage from allergens may be the cause of eczema, and may provide a venue for further treatment.Walley, A.J. ''et al.'' (2001) Gene polymorphism in Netherton and common atopic disease. ''Nature Genetics'' 29(2), 175-8. PMID 11544479 Another study identified 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 and impaired skin barrier function.Palmer, C.N. ''et al.'' (2006) Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. ''Nature Genetics'' 38(4), 441-6. PMID 16550169 A recent study indicated that two specific chemicals found in the blood are connected to the itching sensations associated with eczema. The chemicals are Brain-derived Neurotrophic Factor (BDNF) and Substance P .'Blood chemicals link' to eczema on http://news.bbc.co.uk/2/hi/health/6962450.stm PSYCHOLOGICAL EFFECTS Eczema often comes and goes in cycles, meaning that at some times of the year sufferers are able to feel normal, while at other times they will distance themselves from social contact. Sufferers with visible marks generally feel fine (physically) and can act normally, but when it is mentioned, they may become withdrawn and self-conscious. Since it is a condition made worse by scratching, a sufferer with highly visible sores aggravated by scratching often feels as if everyone is looking at the marks and that they are self-induced. Although scratching does give a sense of relief, it is usually a temporary solution and can lead to problems with constant scratching. Sufferers often shy away from scratching in public, but the solution is to scratch in privacy. In some cases, sufferers may hide visible patches of Eczema under articles of clothing, such as gloves or hats. These solutions may mask the visible signs, but can worsen the condition due to agitation by rubbing or sweating. In cases of children with eczema, visible scars or scratch marks can lead to suspicion of home abuse or self-mutilation, which causes possible peer rejection and may add to a general level of stress. VULNERABILITY TO LIVE VACCINIA VIRUS In June, 2007, Science magazine reportedKaiser, J. (2007) A tame virus runs amok ''Science'' 316(5830), 1418-9. that an American soldier who had been vaccinated for smallpox-- the vaccine that contains live vaccinia virus-- had transmitted vaccinia virus to his two-year-old son. The soldier and his son both had a history of eczema. The son rapidly came down with a rare side effect, eczema vaccinatum, which had been seen during the 1960s when children were routinely vaccinated against smallpox. The child developed a severe full-body pustular rash, his abdomen filled with fluid, and his kidneys nearly failed. Intense consultation with experts from the Centers for Disease Control and Prevention and a donation of an experimental antiviral drug by SIGA Technologies saved the child's life. Those with a family history of eczema are advised not to accept the smallpox vaccination, or any other that contains live vaccinia virus. REFERENCES EXTERNAL LINKS
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