Eczema

Eczema is a chronic, inflammatory skin disorder. It can appear as blisters that crust over to become scaly, itchy rashes, or as dry, thick patches of skin with scales. The main symptom is itching, and symptoms can come and go. Although eczema is not contagious, it is very common. People with eczema often have a personal or family history of allergies. There is no cure, however, treatments can reduce symptoms and help prevent outbreaks.

The word atopic describes people with certain allergic tendencies. However, atopic eczema is not just a simple allergic condition. People with atopic eczema have an increased chance of developing other atopic conditions, such as asthma and hay fever. Other types include –

• Allergic contact eczema – The skin gets red, itchy, and weepy because it touches something that the immune system knows is foreign, like poison ivy.
• Contact eczema – The skin has redness, itching, and burning in one spot because it has touched something allergy-causing, like an acid, cleaner, or other chemical.
• Dyshidrotic eczema – The skin on the palms of hands and soles of the feet is irritated and has clear, deep blisters that itch and burn.
• Neurodermatitis – Scaly patches on the head, lower legs, wrists, or forearms are caused by a localized itch (such as an insect bite).
• Nummular eczema – The skin has coin-shaped spots of irritation. The spots can be crusted, scaling, and very itchy.
• Seborrheic eczema – This skin has yellowish, oily, scaly patches on the scalp, face, and sometimes other parts of the body.
• Stasis dermatitis – The skin is irritated on the lower legs, most often from a blood flow problem.

The most common type of eczema is atopic dermatitis. When people say “eczema,” this is often what they mean. Using moisturizers and cortisone-based ointments can help ease the symptoms. It is also important to avoid skin irritants, such as soap, hot water and synthetic fabrics. Children with eczema have a higher risk of developing food allergies, asthma and hay fever later in childhood. Eczema often runs in families with a history of eczema or other allergic conditions such as hay fever and asthma.

Causes

Eczema is caused by a person’s inability to repair damage to the skin barrier. This is due to a mutation in the gene called filaggrin. Filaggrin is important for formation of the skin barrier. Normally, every cell in the skin has two copies of the filaggrin gene. However, people who are susceptible to eczema only have one copy of this gene.

Although you only need only one copy of the gene to form a normal skin barrier, two copies are important for skin barrier repair. If a person’s skin is exposed to irritants and their skin barrier is affected, a person with only one copy of the gene may find that their ability to repair the skin barrier is limited.

Once the skin barrier is disrupted, moisture leaves the skin and the skin will become dry and scaly. Environmental allergens (irritants from the person’s surrounds) can also enter the skin and activate the immune system, producing inflammation that makes the skin red and itchy.

Some things make eczema more likely to appear. These include –

• Contact with irritants in the environment
• Heat, which can aggravate the itch and make affected people more likely to scratch
• Allergic reaction to particular foods – this is rare. Food allergy appears as redness and swelling around the lips within minutes of eating the offending food.

Who is at Risk?

• Exposing skin to harsh conditions
• Living in a climate with low humidity
• Personal or family history of allergies to plants, chemicals, or food
• Not getting enough of certain vitamins and minerals (for example, zinc)
• Living in an urban, rather than rural, area
• Adolescent obesity

Stress can make eczema worse. Other irritants that can make eczema worse include –

• Wool or synthetic fibers
• Certain soaps and detergents, as well as perfumes and some cosmetics
• Dust or sand
• Cigarette smoke
• Traffic-related air pollution

Symptoms

The most common signs of eczema are –

• Dry, extremely itchy skin
• Blisters with oozing and crusting
• Red skin around the blisters
• Raw areas on the skin from scratching, which can cause bleeding
• Dry, leathery areas that are either darker or lighter than their normal skin tone (called lichenification)
• Scaling, or thickened skin

Eczema in children under 2 years old generally starts on the cheeks, elbows, or knees. In adults, it tends to be found on the inside surfaces of the knees and elbows.

Treatment

The goals when treating eczema are to heal the skin, reduce symptoms, prevent skin damage, and prevent flares. Developing skin care routines, identifying what triggers flares, and avoiding triggers are a large part of any treatment plan.

• Mild anti-itch lotions (Caladryl or Calamine), or topical corticosteroids (hydrocortisone), may soothe mild, dry, scaly patches.
• Area where skin is thickened may be treated with ointments or creams that contain tar compounds (such as Psoriasin), corticosteroids, and ingredients that lubricate or soften the skin.
• Oral corticosteroids may be prescribed to reduce inflammation in severe cases. Examples include prednisone (Deltasone) and methylprednisolone (Medrol).
• Rarely, in severe cases where adults have not shown improvement with oral corticosteroids, physicians may prescribe medications that suppress the immune system.
• Your doctor may prescribe antihistamines at night, such as diphenhydramine (Benadryl), to prevent scratching. These medications may cause drowsiness. Topical (on the skin) antihistamine preparations are also available.
• Topical immunomodulators (TCIs) are newer drugs that are applied to the skin to reduce inflammation. They are steroid free. The most commonly prescribed TCIs are tacrolimus (Protopic) and pimecrolimus (Elidel). Doctors recommend these drugs only after other therapies have not worked.
• Oral antibiotics may be helpful if signs of secondary infection, such as pustules, purulent material, and crusts are present.

Alternative Treatment

Fish oil – In one study people taking fish oil equal to 1.8 g of EPA (one of the omega-3 fatty acids found in fish oil) experienced significant reduction in symptoms of eczema after 12 weeks.

Probiotics (bifidobacteria and lactobacillus) may boost the immune system and control allergies, especially in children.

Evening primrose oil (EPO) – In some studies, EPO helps reduce the itching of eczema.

Borage oil, like EPO, contains the essential fatty acid gamma-linolenic acid (GLA), which acts as an anti-inflammatory

Vitamin C can act as an antihistamine. In one study, it helped reduce symptoms of eczema.

Bromelain, an enzyme derived from pineapple, helps reduce inflammation. Bromelain may increase the risk of bleeding, particularly in people who take blood-thinning medications, such as warfarin (Coumadin) and aspirin, among others.

Flavonoids, antioxidants found in dark berries and some plants, have anti-inflammatory properties, strengthen connective tissue, and may help reduce allergic reactions.

Vitamin D – Preliminary studies suggest that low vitamin D status during pregnancy may be a risk factor for developing eczema in the first year of life.

Topical creams and salves containing one or more of the following herbs may help relieve itching and burning, and promote healing.

Witch hazel (Hamamelis virginiana) cream can relieve itching. Liquid witch hazel can help with “weeping” or oozing eczema.

St. John’s wort (Hypericum perforatum), used as a topical cream, has shown promise in one study.

Traditional Chinese medicine (TCM), which uses a variety of herbs often combined with acupuncture, seems to be effective for treating eczema in children and adults.

Other herbs that have been used to treat eczema include sarsaparilla (Smilax sp.) and marshmallow.

Exercise -.In one clinical study, participating in regular group sporting activities for 3 weeks improved eczema symptoms. Exercise may improve symptoms because of the positive impact it has on emotions. Sports should be avoided during the worst stages of an outbreak.

Climatotherapy – Climatotherapy uses sunlight and water (such as the ocean) as therapy. The Dead Sea in Israel is known for its healing properties, and many people with eczema go there to sit in the sun and swim in the water. Scientific studies support the benefits.

 

Reference –

http://www.aocd.org/?page=Eczema

https://www.healthychildren.org/English/health-issues/conditions/skin/Pages/Eczema.aspx

https://www.allergyuk.org/skin-allergy/atopic-eczema

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/eczema-atopic-dermatitis

http://familydoctor.org/familydoctor/en/diseases-conditions/eczema-and-atopic-dermatitis.html

http://www.nhs.uk/Conditions/Eczema-(atopic)/Pages/Introduction.aspx

http://www.mayoclinic.org/diseases-conditions/eczema/basics/definition/con-20032073