What is Eczema & how is it treated?

Atopic dermatitis, or eczema, is a chronic, intensely itchy rash that most commonly develops during early childhood, known as baby eczema. Symptoms of eczema can include rash, itching, scratching and impaired sleep.

Baby eczema, which manifests commonly on the face, can persist into adolescence as well as into adulthood. Furthermore, it is not uncommon for eczema to start in adolescence or adulthood.

In adulthood eczema, they may itch at night, cannot sleep, and go work tired—known as Presenteeism, when focus is decreased because of their disease, or even absenteeism—seen frequently in the atopic dermatitis population because the severe eczema.

For about 70% of children who develop atopic dermatitis, their eczema may go away by the time they are ten years old. However, the other 30% may have a chronic case that waxes and wanes for life.

What are the differences between Eczema and Psoriasis?

Eczema is not psoriasis.  For one, eczema is associated with asthma and hay fever, whereas psoriasis is associated with arthritis. Psoriasis is a result of an increase in the growth rate of the epidermal cells (kertinocytes) whereas eczema is due to a separation of the epidermal cells. Scientists have shown that psoriasis and eczema are caused from two different parts of the immune system.

What are the causes of eczema?

The causes of eczema may be genetic, or due to a defect in the epidermis, as well as immunological abnormalities in the dermis (second layer of the skin). 

The causes of eczema is due to two basic factors. In the epidermis (the upper layers of the skin) the epidermal cells (keratinocytes) are held together by a sticky substance. In eczema, one of the molecules (fillagrin) is lacking. The lack of fliagrin results in openings between the epidermal cells (keratinocytes) and then foreign substances from the outside world (such as allergens, microbes and irritants) can percolate through the abnormal epidermis and arrive into the dermis. In the dermis these outside world agents activate the immune system. The activated immune system start producing excessive amounts of histamine which result in itching and eczema.

Though not contagious, eczema can often become infected. The reason for this is because the eczematous skin does not produce adequate protection from bacteria, and subsequently the skin becomes infected with staph. A good home remedy for infected eczematous skin is to soak in a bleach bath for 20 minutes, containing a quarter cup of Clorox in a bath tub full of water every other day for a week but make sure to contact your Dermatologist before starting bleach baths.

What are the different types of eczema?

There are a few variations of eczema.

Dyshidrotic eczema is an extremely itchy rash that manifests as coalesced vesicles (eczema blisters). Most severe cases of dyshydrosis tend to be brought on by stress. Many medical students get dyshidrosis when applying to residency programs, and many people who get divorced or lose their job get dyshidrosis eczema.

Another type is nummular eczema which manifests itself as quarter-size patches scattered all over the body. 

An eczema flare up can also be brought on by a contact allergen. The allergen can be dust, pollen, perfume, or preservatives in various products, such as formaldehyde, that are exposed to the skin.  We can perform tests such as patch testing to rule out any potential contact allergen.

Where does eczema show up on the body?

In adults the common locations for eczema are:

  • Scalp
  • Ears
  • Face
  • Nipples
  • Neck
  • Legs
  • Feet
  • Elbows
  • Lips
  • Genitals

Severe eczema can manifest on the entire skin surface. 

Hand dermatitis and finger dermatitis are very common and can be itchy and difficult to work with. Cracking, bleeding, itching skin on the hands due to eczema can impair quality of life. Most people with hand dermatitis tend to wash their hands too frequently, such as more than 5 times per day.

Home Remedies for Eczema

A great home remedy to help improve hand dermatitis is to stop washing hands with soap and water and switch to washing hands with cetaphil cleanser (no soap, no water) and then apply Neutrogena Hand Cream Norwegian Formula.

Excellent skin care remains the cornerstone to eczema therapy. Especially in the colder months when the eczematous skin is dryer it is preferable to bathe with Aveeno powder three times a weeks rather than showering. Throughout the year, pat dry gently when leaving the shower or bath and while the skin is moist immediately apply moisturizing cream and then apply a second time each day, as well.

Avoid wool clothing if you have eczema, whether it be mild or severe eczema. Avoid perfumes and fragrances as they may induce your immune system to activate, produce more histamine and make you itch.

African American patients have an increased frequency of eczema. Eczema on black skin requires special attention. Applying moisturizer, and the best creams for eczema, such as Cetaphil cream, Aveeno cream, or Aquaphor ointment daily or twice daily will help prevent drying of the skin and decrease itching.

Treatment depends on the severity of your atopic dermatitis and how extensive it is on your body, such as appearing on your face or hands.

Once you realize your home remedies are not improving your symptoms, it is time to see a dermatologist who specializes in eczema.

When searching for a dermatologist to treat your eczema, look specifically for a dermatologist who specializes in eczema treatment.

You can go online and look up if any dermatologists in your area are on the National Eczema Association. You can also call up dermatology offices in your area and ask if they do clinical trials in Eczema. If they do, you do not have to do a clinical trial, but it gives you a good idea that they treat a lot of people with eczema

For mild eczema, face eczema, nipple eczema, ear eczema and genital eczema, a low-potency topical corticosteroid treatment or topical calcineurin phosphatase inhibitor ointments may be prescribed because these areas are thin. These prescriptions are generally effective at treating eczema. 

For localized areas on the rest of the body, higher-potency topical corticosteroids are helpful but are limited to a 2- to 4-week treatment period due the fact that higher potency topical steroids may thin out the skin resulting in stretch marks.

Contact Windsor Dermatology

Windsor Dermatology physicians can provide a proper diagnosis and treatment plan to manage your eczema and control flare-ups. Schedule your consultation today!

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