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Eczema: Pictures, Types, Diagnosis, Treatment, Precautions and Home remedies of Eczema

Although not an indication of poor health, eczema causes much misery and suffering. Hand eczema is a huge cause of lost time at work. There is no cure for eczema but there is much that can be done to treat it. If you have eczema, you're not alone. About one out of every 10 kids develops eczema. Most kids who have eczema got it before they turned 5 years old, but you can get it when you're older than 5. The good news is that more than half of the kids who have eczema today will be over it by the time they are teenagers. These are among the most common dermatological problems accounting for 25-30 percent of all derma­toses. The terms 'dermatitis' and 'eczema' are used synonymously by most of the dermatologists.

What is Eczema ?

The Greek term eczema means "boil out". Eczema is also called atopic dermatitis. Eczema is a form of dermatitis, a skin irritation characterized by red, flaky skin, sometimes with cracks or tiny blisters. Eczema is defined as a reaction pattem of the skin characterized by erythema, edema, vesiculation, oozing, crusting, papules, scaling and lichenification. It is extremely itchy, but scratching damages the fragile skin and exacerbates the problem Depending upon the stage the eczema may be acute, subacute or chronic. The causes may be exogenous, endogenous, or a combination of both.

Types of Eczema:-

There are 2 main types of eczema, but it is not uncommon to have a mixture of both:

• Endogenous Eczema
• Exogenous Eczema

Endogenous Eczema :- Endogenous eczemas include atopic eczema, nummular eczema, seborrhoeic eczema, pityriasis alba, lichen simplex chronicus, stasis eczema, and pompholyx or dyshydrotic eczema.

Atopic Eczema, (Besnief's prurigo)

Atopy is a genetically determined disorder in which there is increased susceptibility to develop allergic manifestations such as bronchial asthma, hay fever and atopic eczema. The manifestations vary depending on the age. Atopic eczema of infancy starts between the second and sixth month, mostly on the face, and may extend to the scalp, extensor aspects of the extremities and buttocks. The lesions are exudative and erythematous.

Atopic eczema in adults occurs mainly in the flexural aspects of the limbs and it is characterized by lichenification. Intensive pruritus is a feature of all atopic eczemas. Climate, environmental factors and psychological factors aggravate the lesions. Increased levels of IgE have been found in patients with atopy and they have higher incidence of Type I allergic cutaneous reaction. Eosinophilia is also a feature commonly seen in them.

Nummular eczema: The term nummular is derived from Latin and the term pertains to "coin". Nummular eczema is a form of endogenous eczema characterized by coin-shaped or discoid configuration. Genetic factors, food allergy, focal sepsis, emotional stress and many others have been incriminated as etiological agents. Most common sites of involvement are the dorsum of the hands and fingers, extensor aspects of forearms, dorsum of the feet, the legs and thighs

Seborrhoeic Dermatitis: Syn: Seborrhoeic eczema

Seborrhoeic dermatitis is an easily recognizable entity, yet poorly understood. The seborrhoeic diathesis is genetically determined but the mode of inheritance is not known. Seborrhoeic dermatitis manifests during the phase of maximum seborrheic activity, which is commonly seen between the ages of 18 and 40 years. During neonatal life seborrhoeic dermatitis may develop and this is attributed to maternally derived antigens. Such eczema is seen in areas where there are more sebaceous glands such as the scalp, face, presternal area, intrescapular area, axillae and groins.

Pityriasis alba: It is common in children and may occur in all races. Streptococcal infection, fungal infection, nutritional deficiency, intestinal parasitism, etc. have been suggested as etiological factors, but not definitely proved. It may be associated with dry skin and atopy. Lesions are oval, round or irregular patches of hypopigmentation with fine lamellar or brain-like scales. Lesions are seen most often over the face, but they may be seen in other parts such as the trunk and limbs.

Lichen Simplex Chrollicus: Syn: Neurodermatitis

This may be defined as lichenification caused by chronic scratching and rubbing of the skin under emotional stress, This is characterized by a well-defined chronic lichenified lesion. The common sites are around the ankles or elbows in Indian subjects, back of the neck is also commonly involved in other races.

Stasis dermatitis: This is eczema seen in people with venous stasis occurring as a result of varicose veins. Medial aspect of the lower portions of the legs is commonly affected. Pigmentation is a characteristic feature. Sometimes a stasis ulcer may be seen in the centre, with eczema surrounding it.

Pompholyx: Syn: Dyshydrotic Eczema

Pompholyx is an acute, recurrent or chronic vesicular eruption occurring in the palm, soles or both. In some cases excessive sweating, occlusion of sweat ducts and retention of sweat may be the factor responsible for the eruption. Emotional stresses, focal infection, fungal infections of the feet and acute contact dermatitis may also result in pompholyx. Vesicles usually occur in crops and because of the thick stratum corneum, they may resemble sago grains. Itching may precede the eruption. Spontaneous clearance may occur in 2 to 3 weeks.

Exogenous Eczema Syn: Contact dermatitis :- Exogenous eczemas include contact dermatitis (which may be primary irritant dermatitis or contact allergic dermatitis), photodermatitis (which may be phototoxic or photoallergic) and infectious eczematoid dermatitis.

Irritant dermatitis: This is an acute dermatitis charac­terized by erythema and vesicles due to contact with a primary irritant. It occurs in the majority of subjects at the first encounter itself, and the manifestation may be immediate. Mild irritants can also cause eczema OIl prolonged contact. Housewife's eczema is a classical example.

Allergic contact dermatitis: This is a type IV hypersensitivity reaction which is a cell-mediated immune response. The offending agent is usually a happen which combines with skin protein to become antigenic. This induces T-cell proliferation. Once sensitized, any further contact with similar antigen produces an eczema at the site of contact, usually after 48 hours. Depending on the irritant the site of eczema vanes. Contact dermatitis due to slippers is a common example. Hair-dyes, lotions, perfumes, finishings of clothes and elastic bands are common offending agents. Contact dermatitis caused by cement is one of the common occupational eczemas seen in Kerala. Potassium dichromate contained in cement is the offending agent responsible for most cases. Several metals like nickel and chromium also cause contact dermatitis.

Photodermatitis :- Photodermatitis could be due to endogenous causes such as drug intake, metabolic disorders such as porphyria, or vitamin deficiencies such as pellagra. In endogenous photodermatitis all the areas exposed to the sun are involved. In photocontact dermatitis the areas of contact with the chemical and exposure to sun only are involved. Photodermatitis could be due to phototoxic action or photoallergic reaction. Pbotodermatitis is characterized by erythema. Vesiculation, eczema and pigmentation over the sun­exposed areas. The face, V -area of the neck, extensor aspects of the forearms and dorsum of the hands are affected, while the upper eyelid and undersurface of the chin which are shaded, escape.

Infectious eczematoid dermatitis : An infection develops in the skin and products of infection sensitize the surrounding skin to produce dermatitis around. Primary infection may be in the skin, ears or nose.

Diagnosis of Eczema:-

Effective treatment requires a correct 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. To diagnose eczema, dermatologists examine the skin and ask certain things before making a judgment:

• When the skin condition first appeared
• Dietary habits
• Lifestyle habits
• Allergic tendencies
• Any prescribed drug intake and p ersonal medical history
• Any chemical or material exposure at home or workplace
• Circumstances that may aggravate the condition, such as excessively dry air or emotional stress

Dermatologists may use a "patch test" to determine if the patient has allergic contact dermatitis, a type of eczema that develops when the person has an allergic reaction to a substance that contacts the skin

Treatment of Eczema:

Treatment of all acute eczemas are similar irrespective of their etiology. Antibiotics should be given systemically to treat secondary infection. Local treatment consists of applying wet dressings or compresses. Normal saline, 1/8000 potassium pennanganate solution or 1 % boric acid solution can be used for wet dressing. This will remove the crust, promote drainage and also provide comfort. Once the oozing stops, a cream containing steroid and antibiotic can be applied. During the subacute phase, creams are the ideal topical agents and during the chronic phase ointments containing steroids are preferable. In chronic thickened lesions steroid ointment with occlusive dressings at night help to clear the lesions early. In recurrent and chronic eczemas the predisposing factor should also be found out and eliminated.

Some basic precautions during eczema:-

• Excessive washing should be avoided. Try to avoid long showers. Use of a soap substitute such as Aqueous Cream can help.
• Wool and nylon against the skin aggravate eczema. Cotton is best.
• Some careful sun exposure can help in many cases.
• The most important components of an eczema treatment routine is to prevent scratching.
• Keep your fingernails short to prevent your skin break if you scratch an itch.
• Avoid things that can irritate your skin, such as contact with scratchy fabrics (like wool) or dust mites in your bedsheets
• Avoid contact with active cold sores, e.g. relatives with cold sores kissing children with eczema.

Home remedies for the treatment of eczema

• An ice pack made by putting ice cubes in a plastic bag and placing it on the itchy area makes an inexpensive and effective itch fighter.
• Apply a teaspoon of sandalwood paste mixed with a teaspoon of camphor to the affected areas.
• Apply Coconut oil to the portions with eczema.
• Carrot juice and spinach juice in combination is highly beneficial for eczema.
• Orange juice and plenty of water is beneficial in eczema.
• Take 10 g of bur marigold, 100 g of strawberry leaf and 100 g of chamomile. Mix together . take one tbsb of mixture with 200 gm boiling water instead of tea.
• Put 2 tsp of crushed chicory root put in 1 cup of boiling water and boil for 10 min, steep 1 hour and strain. Take 1 tbsp 3 times a day. Also use externally to wash eczema spots.
• Apply burdock, comfrey, dandelion, goldenseal, and slippery elm tea to the affected area five or six times daily.
• Neem has been extremely effective in curing eczema treatment and eczema cure.
• Rub affected skin with fresh cranberry juice. Combine 1 part of licorice root powder with 1 part of unsalted butter.
• Apply fresh made ghee (from cow milk only) on a fresh patch of dry eczema and washing the area six- seven times, relieves the itch.