Eczema

What is Eczema?

Eczema is a general term describing a variety of skin disorders, all of them showing inflamed patches of skin, with scaling or tiny oozing blisters (vesicles). Eczema means "weeping," though the moist drainage is usually seen only in the early stages of the various conditions that cause eczema.

Eczema is a response to one or a combination of genetic factors and external triggers. Eczema can also occur for no known reason. It can be a single episode or an ongoing (chronic) process. Eczema can effect any age or sex. The rash is not contagious, and it is the most common skin problem for which people seek medical treatment.

Almost 50% of occupational diseases are due to work-related skin injury. Examples of other skin disorders are contact dermatitis and atopic dermatitis, a common condition associated with allergies. Eczema may be associated with varicose veins and venous insufficiency in lower extremities.

How is it diagnosed?

History: The most common complaint of eczema is the itchiness (pruritus), with a scaly, wet or dry rash. The rash may be a new problem of short duration or a chronic condition.

Hand eczema is seen in persons with frequent exposure to hand washing, such as food handlers and health care workers, or any occupation that exposes the hands to moisture and soaps.

Nummular eczema occurs most frequently in middle-aged men. The cause is unknown but seems to be related to dry skin and exposure to irritants.

People with poor circulation and varicose veins can develop a condition called stasis eczema or dermatitis. Individuals will report dark red discoloration of the skin on the lower leg, ankle, and top of the foot.

Asteatotic eczema, also known as "winter itch," commonly occurs on the lower legs of elderly people during dry times of the year.

Physical exam: Hand eczema may present with dryness and cracking of the skin, some redness and swelling. A variation of this condition, dyshidrotic eczema, has small, very itchy bumps along the fleshy parts of the palms and sides of the fingers. Nummular eczema has round scaly patches that look similar to ringworm and are found on the trunk, the back of the arms and hands, and the shins. Stasis dermatitis shows as dark red discoloration of the skin on the lower leg, ankle, and top of the foot. These areas can become irritated and inflamed, with skin ulcers in many cases. Asteatotic eczema looks like fine cracks over the front surface of the thighs and shins. The skin may also have a dry, shiny appearance. Lichen simplex chronicus, a late stage of eczema, consists of thickened, scaly skin due to chronic rubbing or scratching. Common areas are the back of the neck, tops of the feet, and the ankles.

Tests: Though most of the eczemas are diagnosed through the history and physical exam, a scraping of the lesion will be examined under the microscope to rule out different skin disorders. Skin biopsy is done in cases of persistent cases of eczema not responding to treatment. Elevated total IgE denotes underlying allergy.

How is Eczema treated?

All cases of eczema involve a degree of skin damage that leaves the individual susceptible to skin infections, and antibiotics are always an option.

Hand eczema may improve if vinyl gloves are worn at any time the hands come in contact with irritants. Rubber gloves should be avoided or worn over a pair of cotton gloves, as chemicals used in processing the rubber may aggravate the eczema or cause contact dermatitis. After washing, the hands should be thoroughly patted dry. Unscented hand cream should be applied throughout the day. If condition becomes severe, corticosteroid creams may be prescribed.

Nummular eczema does not respond well to treatment with moisturizers or steroid preparations. Antibiotics are sometimes given, even if there is no overt infection of the lesions.

Asteatotic eczema responds well to moisturizers or emollients, particularly those containing urea or alpha-hydroxy acids.

Temporary relief from stasis eczema can be achieved with mild corticosteroid ointments. Swelling of the legs may be controlled by wearing compression bandages or special stockings.

In general, irritating fabrics (wool, silk, and rough synthetics) should be avoided. Absorbent, non-irritating fabric (cotton) should be worn next to the skin. Soothing ointment should be applied to any affected area and it should be covered with a dressing to prevent scratching.

Medications

• Ointments containing coal tar or cortisone drugs to decrease inflammation. These may help more if used at night under occlusive plastic wrap.
• Antihistamines to decrease itching.
• Antibiotics for complicating infections, if they occur.
• Sedatives or tranquilizers (rarely).

Information	Brand	Generic	Label	Rating
	Deltasone	Prednisone
	Prograf	Tacrolimus
	Ilosone	Erythromycin
	Sinequan	Doxepin
	Atarax	Hydroxyzine
	Periactin	Cyproheptadine
	Decadron	Dexamethasone
	Medrol	Methylprednisolone

What might complicate it?

Secondary infection is very common from the Staphylococcal and Streptococcal bacteria.

Predicted outcome

As a chronic condition, episodes of eczema may be relieved by appropriate treatment but are prone to relapse and recurrence.

Alternatives

Contact dermatitis, fungal infections like tinea corporis, and scabies (lice) are other possibilities.

Appropriate specialists

Dermatologist, allergist, and immunologist.

Last updated 6 October 2011