Eczema

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Eczema is a group of skin disorders that present as red, itchy, scaly rashes. The word is often used interchangeably with dermatitis, which means inflamed skin. It is also commonly used for a type of eczema called atopic dermatitis.

The skin is the body's largest organ. It functions as barrier that maintains fluid balance and temperature. It also keeps out infectious agents, irritants, and allergens. When someone has eczema the skin barrier is compromised. This creates inflammation which results in a rash.

Types of Eczema

Eczema can be further divided into seven different types.

Atopic Dermatitis

Atopic dermatitis is the most common type of eczema. It tends to start in infancy and get better with age. Adults, however, also suffer with atopic eczema. Atopic dermatitis has a genetic predisposition. It commonly occurs in people or families who also have allergies, hay fever, asthma, and hives. People with atopic dermatitis have naturally drier skin. When the skin gets dry it becomes inflamed, itchy, and develops eczema. One could say that people with atopic dermatitis have a “head start.” Atopic dermatitis tends to flare in cold, dry climates. Some patients with atopic dermatitis tend to flare in their body folds in very humid weather.

Why Eczema Flares Up

Atopic dermatitis flares can be triggered by the weather. Usually cold, dry weather causes dry skin triggering an eczema flare up. In some people, high humidity causes eczema, particularly in skin folds. Certain fabrics or fragrances can irritate the skin. People with environmental allergies may notice eczema flares when the pollen count goes up. Food allergies, particularly in children, have been associated with eczema flares. This is sometimes why environmental and food allergy testing may be of value in patients with atopic dermatitis.

Contact Dermatitis

Contact dermatitis is a type of eczema that is caused by direct contact with a substance that either causes an allergic reaction (eg. poison ivy)  or breaks down the skin barrier causing an irritant reaction (eg. bleach) Allergic contact dermatitis tends to itch whereas irritant dermatitis tends to burn. Diaper dermatitis is a form of irritant contact dermatitis.

Neurodermatitis

Neurodermatitis, also known as lichen simplex chronicus, begins with an itch. Chronic scratching of the skin causes it to develop thick, leathery plaques. It tends to be localized.

Dyshidrotic Eczema

Dyshidrotic Eczema presents itself as small, fluid-filled blisters that form on the palms of the hand, sides of the fingers, and sometimes the bottom of the feet. People sometimes describe it as looking like tapioca pudding. Ironically, it can be associated with sweaty hands and feet.

Nummular Eczema

Presenting as small "coin" shaped patches that are itchy and sometimes oozing, Nummular Eczema forms circular shapes scattered around the skin. The condition can be triggered by dry skin, can happen at any age, and seems to affect males more than females.

Seborrheic Dermatitis

Seborrheic dermatitis is a type of eczema that appears on the oilier parts of the body such as the scalp, face, upper chest, upper back, and sometimes arm pits and genitals. Also known as "dandruff," it’s a hypersensitivity to normal yeast that live on the skin. The condition seems to flare seasonally, most commonly in the spring, fall, and in very cold weather.  This type of eczema is more common in people who are immunocompromised and neurologically compromised.

Stasis Dermatitis

Stasis dermatitis is a type of eczema that develops from circulatory problems. It occurs most commonly in the legs. When the veins are unable to circulate the blood back to heart as effectively, pressure builds up and blood leaks out of the skin causing not only eczema but sometimes ulcers.

Diagnosis for Eczema

Your dermatologist will take a history and do a physical examination to determine what kind of eczema you have.

What are Causes of Eczema

The cause of eczema depends on the type of eczema, as discussed above.

Symptoms for Eczema

Most types of eczema share the symptom of itch and sometimes burning. Signs commonly seen are redness and scaling. Sometimes we see excoriation or scratches on the skin. When the skin is scratched chronically it can become thick and leathery as well as discolored.

 

Is Eczema Contagious?

None of the types of eczema are contagious. Atopic dermatitis can be passed down genetically through family members. Contact dermatitis can be spread if someone is a carrier of the agent and spreads it to someone else. For example, some people may develop contact dermatitis after petting their dog who had been rolling around in poison ivy.

Eczema on Black Skin

African Americans and other people with skin of color may be more likely to complain of skin discoloration, either lighter or darker, when they have eczema. Some types of atopic dermatitis, such as follicular eczema, are more common in African Americans. Some studies show that atopic dermatitis is more common in Asians and blacks. It appears to be caused by different mutations.

Hand Eczema

Hand eczema is a common problem in adults, particularly in those with atopic dermatitis, in professions where employees have to wash their hands frequently such as health care and food services. New parents and pet owners are also more prone to hand eczema. In addition to atopic hand eczema people may have allergic or irritant contact hand eczema. Hand eczema may also be dyshidrotic.

 

Shop: hand eczema creams

 

Prevention of Eczema

Prevention of eczema will depend on the type of eczema that one has. Good barrier care, or gentle skin care, can be beneficial to all types of eczema as it prevents inflammation in the skin. People with atopic eczema, dyshidrotic eczema, and nummular eczema should especially keep their skin from getting dry. People with seborrheic dermatitis must keep excess oil off their skin and scalp. People with contact dermatitis must avoid the substances they react to. People with stasis dermatitis may need to wear compression stockings and elevate their legs. Other factors such as managing allergies and gut health may play a role.

Eczema Treatment

The treatment of eczema will depend on the type and severity. The foundation of eczema treatment is good barrier care, also known as gentle skin care. This involves personal hygiene practices that don’t allow the skin to dry:

 

  • Avoid bathing more than once a day.
  • Use a gentle cleanser.
  • Avoiding hot water.
  • Using moisturizer shortly after bath, shower, or hand washing.
  • Humidifying the environment.

 

Most types of eczema respond to steroids. Topical or systemic steroids will used depending on severity. Because steroids can have side effects, some steroid sparing agents, both topical and systemic, are used in chronic situations. Some types of eczema can be treated with light therapy. Antihistamines may be used to manage itch.  As chronic scratching breaks the skin barrier and increases the risk of infection antibiotics may be necessary.

 

Eczema and Algow Dermatology

Eczema comes in many different types and forms. Each case is unique and cannot always be understood or treated without doctor care.

If you need to see an eczema doctor or a doctor for rashes, Dr. Dina Strachan is a board-certified dermatologist and eczema specialist in NYC. If you have any questions or concerns about eczema or your skin, please call Aglow Dermatology at 212-627-1004 or click here to schedule a consultation.

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