Eczema
Ira Shah
Consultant Pediatrician, Nanavati Hospital, Mumbai, India
First Created: 01/17/2001 

Introduction

An eczema is a form of dermatitis. Dermatitis means inflammation of the outer layer of the skin. Though commonly used to describe atopic dermatitis, it is characterized by a variety of skin conditions that cause the skin to become dry, red, irritated, and itchy.

Types of eczema

Eczema has been classified into various subgroups: the commonest one is atopic eczema (atopic dermatitis). Other types of eczema include contact dermatitis, xerotic eczema (winter itch: eczema that worsens in winter), seborrheic dermatitis (also called as cradle cap in infants and is closely related to dandruff) and other less common variants such as pompholyx (occurs only on palms, soles, and sides of fingers and toes), discoid eczema, venous eczema, dermatitis herpetiformis, lichen simplex chronicus, etc.

Causes of eczema

The cause of most types of eczema is not completely understood. In some types of eczema, the cause is clear-cut. In case of irritant contact dermatitis, after exposure to a mild irritant such as a detergent, the child may develop a rash. Another type, allergic contact dermatitis develops when an allergen (a substance to which a person is allergic) touches the skin. Common allergens include poison ivy and nickel. In other types of eczema, a variety of genetic and environmental factors play a role.

Presentation

Eczema can occur acutely. However, it is a chronic problem with acute flares. It is characterized by hot, red, itchy skin affecting either no particular area or the whole body. Acute eczema presents as redness and swelling, papules, vesicles or large blisters, exudation and crusting, and scaling. Chronic eczema is less vesicular, more scaly but also pigmented and thickened and more likely to develop painful blisters.

Investigations

The diagnosis of eczema is usually made clinically. However, sometimes the doctor may do a skin biopsy to rule out other skin conditions.

Treatment

Treatment of eczema is to prevent itching, inflammation, and worsening of the condition. It consists of avoiding precipitating factors, hydrating the skin, preventing scratching of skin, and drugs that control atopic dermatitis.

Treatment of eczema consists of drugs that control itching and steroid creams. Antihistamines are commonly used if the itching is severe and even at night. Steroid creams should be used sparingly and in low concentration.

In case of severe eczema where steroids are not working, other drugs that are used are Pimecrolimus and coal tar (Tar shampoo can be used for scalp involvement). Children who receive pimecrolimus are predisposed to sun-induced damage so adequate sun protection and sunscreen should be used. Phototherapy with ultraviolet B (UVB) can be used for severe resistant cases.

Eczema - Prevention

Avoid excessive use of soap. Use cotton clothing. Avoid perfumes and scented soaps, washing powders, and fabric softeners. Choose a soap that has an oil or fat base. Avoid extremes of temperature and excessive sweating. Use emollients and moisturizers especially after bathing.


Eczema Eczema 01/17/2001
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