Eczema: Symptoms

ECZEMA Dermatitis, also known as eczema, is a group of diseases that results in inflammation of the skin.[1] These diseases are characterized by itchiness, red skin, and a rash.[1] In cases of short duration there may be small blisters while in long-term cases the skin may become thickened.[1] The area of skin involved can vary from small to the entire body

symptoms Most people develop atopic dermatitis before the age of 5 years. Half of those who develop the condition in childhood continue to have symptoms as an adult. However, these symptoms are often different to those experienced by children. People with the condition will often experience periods of time where their symptoms flare up or worsen, followed by periods of time where their symptoms will improve or clear up. Symptoms in infants under 2 years old Rashes commonly appear on the scalp and cheeks. Rashes usually bubble up before leaking fluid. Rashes can cause extreme itchiness. This may interfere with sleeping. Continuous rubbing and scratching can lead to skin infections. Symptoms in children aged 2 years until puberty Rashes commonly appear behind the creases of elbows or knees. They are also common on the neck, wrists, ankles, and the crease between buttock and legs. Over time, the following symptoms can occur: Rashes can become bumpy. Rashes can lighten or darken in color. Rashes can thicken in a process known as lichenification. The rashes can then develop knots and a permanent itch. Symptoms in adults Rashes commonly appear in creases of the elbows or knees or the nape of the neck. Rashes cover much of the body. Rashes can be especially prominent on the neck, face, and around the eyes. Rashes can cause very dry skin. Rashes can be permanently itchy. Rashes in adults can be more scaly than those occurring in children. Rashes can lead to skin infections.

Adults who developed atopic dermatitis as a child but no longer experience the condition may still have dry or easily-irritated skin, hand eczema, and eye problems.

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Atopic dermatitis: This health condition has a genetic basis and produces a common type of eczema. Atopic dermatitis tends to begin early in life in those with a predisposition to inhalant allergies, but it probably does not have an allergic basis. Characteristically, rashes occur on the cheeks, neck, elbow and knee creases, and ankles. Irritant dermatitis: This occurs when the skin is repeatedly exposed to excessive washing or toxic substances. Allergic contact dermatitis: After repeated exposures to the same substance, an allergen, the body's immune recognition system becomes activated at the site of the next exposure and produces a dermatitis. An example of this would be poison ivy allergy. Stasis dermatitis: It commonly occurs on the swollen lower legs of people who have poor circulation in the veins of the legs. Fungal infections: This can produce a pattern identical to many other types of eczema, but the fungus can be visualized with a scraping under the microscope or grown in culture. Scabies: It's caused by an infestation by the human itch mite and may produce a rash very similar to other forms of eczema. Pompholyx (dyshidrotic eczema): This is a common but poorly understood health condition which classically affects the hands and occasionally the feet by producing an itchy rash composed of tiny blisters (vesicles) on the sides of the fingers or toes and palms or soles . Lichen simplex chronicus: It produces thickened plaques of skin commonly found on the shins and neck. Nummular eczema: This is a nonspecific term for coin-shaped plaques of scaling skin most often on the lower legs of older individuals. Xerotic (dry skin) eczema: The skin will crack and ooze if dryness becomes excessive. Seborrheic dermatitis: It produces a rash on the scalp, face, ears, and occasionally the mid-chest in adults. In infants, in can produce a weepy, oozy rash behind the ears and can be quite extensive, involving the entire body.

Risk factors The primary risk factor for atopic dermatitis is having a personal or family history of eczema, allergies, hay fever or asthma. Complications   

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Asthma and hay fever. Eczema sometimes precedes these conditions. More than half of young children with atopic dermatitis develop asthma and hay fever by age 13. Chronic itchy, scaly skin. A skin condition called neurodermatitis (lichen simplex chronicus) starts with a patch of itchy skin. You scratch the area, which makes it even itchier. Eventually, you may scratch simply out of habit. This condition can cause the affected skin to become discolored, thick and leathery. Skin infections. Repeated scratching that breaks the skin can cause open sores and cracks. These increase the risk of infection from bacteria and viruses, including the herpes simplex virus. Irritant hand dermatitis. This especially affects people whose work requires that their hands are often wet and exposed to harsh soaps, detergents and disinfectants. Allergic contact dermatitis. This condition is common in people with atopic dermatitis. Sleep problems. The itch-scratch cycle can cause poor sleep quality.

diagnosis An accurate diagnosis requires an examination of the entire skin surface and a careful health history. It is important for a doctor to rule out curable conditions caused by infectious organisms. Occasionally, a sample of skin (biopsy) may be sent for examination in a laboratory.

Home care There are numerous things that people with eczema can do to support skin health and alleviate symptoms, such as:         

taking lukewarm baths applying moisturizer within 3 minutes of bathing to "lock in" moisture moisturizing every day wearing cotton and soft fabrics, and avoiding rough, scratchy fibers and tight-fitting clothing using a mild soap or a non-soap cleanser when washing air drying or gently patting skin dry with a towel, rather than rubbing the skin dry after bathing where possible, avoiding rapid changes of temperature and activities that make you sweat learning and avoiding individual eczema triggers using a humidifier in dry or cold weather

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keeping fingernails short to prevent scratching from breaking the skin

Prevention The following tips may help prevent bouts of dermatitis (flares) and minimize the drying effects of bathing: Moisturize your skin at least twice a day. Creams, ointments and lotions seal in moisture. Choose a product or products that work well for you. Using petroleum jelly on your baby's skin may help prevent development of atopic dermatitis. Try to identify and avoid triggers that worsen the condition. Things that can worsen the skin reaction include sweat, stress, obesity, soaps, detergents, dust and pollen. Reduce your exposure to your triggers. Infants and children may experience flares from eating certain foods, including eggs, milk, soy and wheat. Talk with your child's doctor about identifying potential food allergies. Take shorter baths or showers. Limit your baths and showers to 10 to 15 minutes. And use warm, rather than hot, water. Take a bleach bath. The American Academy of Dermatology recommends considering a bleach bath to help prevent flares. A diluted-bleach bath decreases bacteria on the skin and related infections. Add 1/2 cup (118 milliliters) of household bleach, not concentrated bleach, to a 40-gallon (151-liter) bathtub filled with warm water. Measures are for a U.S.-standard-sized tub filled to the overflow drainage holes. Soak from the neck down or just the affected areas of skin for about 10 minutes. Do not submerge the head. Take a bleach bath no more than twice a week. Use only gentle soaps. Choose mild soaps. Deodorant soaps and antibacterial soaps can remove more natural oils and dry your skin. Dry yourself carefully. After bathing gently pat your skin dry with a soft towel and apply moisturizer while your skin is still damp.

Medications There is little evidence for antihistamine; they are thus not generally recommended.[4] Sedative antihistamines, such as diphenhydramine, may be tried in those who are unable to sleep due to eczema.[4] Colloidal oatmeal Oatmeal contains avenanthramide (anthranilic acid amides), which can have an antiinflammatory effect.[46] Corticosteroids If symptoms are well controlled with moisturizers, steroids may only be required when flares occur.[4] Corticosteroids are effective in controlling and suppressing symptoms in most cases. [47] Once daily use is generally enough.[4] For mild-moderate eczema a weak steroid may be used (e.g., hydrocortisone), while in more severe cases a higher-potency steroid (e.g., clobetasol propionate) may be used. In severe cases, oral or injectable corticosteroids may be used. While these usually bring about rapid improvements, they have greater side effects. immunosuppressants

Topical immunosuppressants like pimecrolimus and tacrolimus may be better in the short term and appear equal to steroids after a year of use When eczema is severe and does not respond to other forms of treatment, systemic immunosuppressants are sometimes used. Immunosuppressants can cause significant side effects and some require regular blood tests. The most commonly used are ciclosporin, azathioprine, and methotrexate Light therapy Light therapy using ultraviolet light has tentative support but the quality of the evidence is not very good.[54] A number of different types of light may be used including UVA and UVB;[55] in some forms of treatment, light sensitive chemicals such as psoralen are also used. Overexposure to ultraviolet light carries its own risks, particularly that of skin cancer  Antihistamines such as diphenhydramine (Benadryl) can control the itch.   Corticosteroid cream or ointment can reduce the itch. For a more severe reaction, you can take steroids like prednisone (Rayos) by mouth to control swelling.   Calcineurin inhibitors such as tacrolimus (Protopic) and pimecrolimus (Elidel) reduce the immune response that causes red, itchy skin.   Antibiotics treat skin infections.   Light therapy exposes your skin to ultraviolet light to heal your rash.   Cool compresses applied before you rub on the corticosteroid cream can help the medicine get into your skin more easily.

Alternative medicine Limited evidence suggests that acupuncture may reduce itching in those affected by atopic dermatitis Neither evening primrose oil nor borage seed oil taken orally have been shown to be effective pset. Probiotics do not appear to be effective.There is insufficient evidence to support the use of zinc, selenium, vitamin D, vitamin E, pyridoxine (vitamin B6), sea buckthorn oil, hempseed oil, sunflower oil, or fish oil as dietary supplements. Chiropractic spinal manipulation lacks evidence to support its use for dermatitis. There is little evidence supporting the use of psychological treatments.While dilute bleach baths have been used for infected dermatitis there is little evidence for this practice.