Eczema

Cause

The cause of most types of eczema is unfortunately not yet known. But there are theories. It’s known that physical and mental condition and certain environmental factors affect eczema. When a person is ill, tired or very emotional or has a lot of stress, eczema can worsen. With environmental factors, one can think of heat, cold, dust mites and pollen. Eczema is not contagious.
Atopic eczema (hereditary eczema) has been present from birth and is not caused by a particular substance. The skin can overreact to various stimuli from the environment (allergens and irritants). Atopic eczema cannot be prevented. Examples are: respiratory sensitisers (such as dust mites, pollen from grasses and trees and skin cells from dogs and cats), certain foods (such as cow’s milk, fish, peanuts and nuts), strong detergents, chemicals, woolen clothing and effort and sweat.
Contact eczema is caused by contact with an irritant or by allergy. Contact of a particular substance with the skin causes rash. Contact eczema can be prevented or remedied by avoiding those substances. There are many substances which are known to frequently cause problems. For example, base metals (such as nickel and chromium in jewelry), fragrances (such as in cosmetics, perfume and other toiletries), preservatives, plants and flowers (such as chrysanthemums), rubber components and materials used in a particular profession (such as hair dye by hairdressers).

Symptoms

The signs and symptoms of eczema are as follows:

• Red, scaly, dry-looking, cracked spots on the skin. These mainly occur on hands, elbow folds, knee pits, ears, feet and legs. The size of the spots may vary.
• Burning sensation and itch with a strong urge to scratch. Especially eczema in children often leads to infections in elbow folds and knee pits.
• Small, fluid-filled vesicles which can burst into sores.
• Infections caused by scratching. In babies, this is often visible on the cheeks and forehead.
• Blisters caused by acute worsening of the eczema.
• Frequent crying in babies.
• Depigmentation.

The symptoms of eczema can vary from mild to severe.

Diagnosis

The diagnosis is made on the basis of existing skin disorders and itch symptoms. Moreover, information on the prevention of eczema, asthma or allergies in the family may be helpful in making the diagnosis. If there is evidence of acute allergic reactions, allergological investigation is desirable. This does not apply to atopic eczema.

Treatment

First, the inflammatory response of the skin has to be reduced. The best way to do this, is to use a corticosteroid cream. There are four different groups of corticosteroids, classified in strength. The more intense the inflammation, the stronger the cream that is needed. At the same time with the treatment of an inflammatory response, the skin must become soft and supple again. For this purpose, various types of cream can be used. For a successful treatment it’s necessary that the cream is regularly used for a long time. Even if the skin seems to recover after three or four weeks, it may take up to four to five months to heal entirely.

Prognosis

The eczema usually persists for several years and then disappears, sometimes for life. A small group of patients experiences eczema much longer and is still affected after the age of twenty. The eczema becomes a chronic condition then. But also with this group, the severity of the eczema usually decreases with age.

Considerations

• It’s important to avoid contact with the substances that may cause eczema. For most of the substances, there are reasonable substitutes.
• After a few weeks, the skin looks better. However, don’t stop treatment then. Follow the instructions of the doctor and proceed with the treatment schedule. Otherwise, there’s a chance that the eczema returns and the patient has to start all over again.
• Lubricate the skin consistently with the cream after bath or shower to keep the skin smoothly. Water and especially soap dry out the skin. It’s good to use bath oil. You can best dry yourself by blotting the skin with a towel, not rubbing.
• Wool and synthetic textile that’s worn on the skin, can often cause itch. Choose cotton clothing for those body parts which are affected by eczema.
• Realize that cold and dry air have a drying effect on the skin. This can manifest itself by flaking of the skin. The protection function decreases and irritant or allergic substances can penetrate more easily. So lubricate body parts that are exposed to open air in wintertime well. Particularly the face and hands.

Facts

• The term ‘eczema’ is derived from the Latin word eczema and the Greek word ékzema (rash).
• The prevalence of eczema is 1.6%.
• Atopic eczema is relatively common in young children. It usually develops in the first six months of life, but it can basically start at any age.