Eczema

16 Sep 2020
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While eczema is a very well known condition, many of us are unaware of the various types, triggers and emotional effects of this skin disease. Raising awareness about eczema is vital in understanding the condition. At ProMedical, we are all about education and research, are so we are really excited to bring you the latest findings on eczema just in time for National Eczema Awareness week! 

National Eczema Week 2020 occurs during September and aims to raise awareness about eczema, and this year the National Eczema Society is unveiling the findings of significant new research undertaken with LEO Pharma. The National Eczema Society asked adults with eczema and parents of children with eczema a range of questions, to understand the impacts of living with the condition.

The research found:

  • 89% of adult respondents said that having eczema had significantly reduced their quality of life
  • nearly half admitted eczema had affected their education
  • 28% reported it had had a negative impact on their career
  • three-quarters of adults said eczema had affected their mental health, with depression and anxiety
  • 1 in 10 adult respondents said a romantic relationship had ended because of their eczema
  • one-quarter of children with eczema were reported to have low self-esteem
  • attendance and performance at school, feeling self-conscious, being bullied, and not sleeping were other commonly cited concerns
  • This survey also highlights the broader impact of eczema on families, with a third having to regularly cancel family activities or trips because of their child's eczema. At the same time, 1 in 5 parents felt it had damaged their relationship with their other children. Source- https://eczema.org/blog/new2020/

Over 1000 people responded to the survey, and the findings can be explored further at  https://eczema.org/blog/new2020/

To better understand this condition, first, it is essential to know the basics.

What is eczema?

Eczema is an inflammatory skin condition, noted by dry, pruritis (itch) and red skin. It is a common complex long-term condition that re-occurs and arises from an interaction between genes and the environment.

Affecting both children and adults; it varies in type, symptoms, and intensity from person to person.

What are the different types of eczema?

It is divided into two subtypes: 

Eczema type 1

Atopic

Atopic dermatitis is a chronic inflammatory type of eczema. While the exact cause is unknown, it happens when the immune system overreacts to an allergen or irritant. Usually starting in childhood

Frequently, atopic dermatitis is marked by dry, itchy skin, a rash on the cheeks, arms or legs and erythema (redness), among other symptoms discussed below.

Eczema type 2

Non-atopic

These subtypes differ in the level of total immunoglobulin E (IgE) in serum, response to allergens in skin prick tests, and detection of specific IgE antibodies. Non-atopic eczema will have a low level of immunoglobulin E (IgE), negative skin prick tests, and undetectable IgE antibodies. 

Other Types of Eczema

Discoid eczema – occurs when circular or oval patches appear on the skin, also known as nummular eczema.

It is very different in appearance to the usual types, and it is thought insect bites and dry skin can trigger a flare-up.

Symptoms include:

  •   Round coin-shaped spots
  •   Itching
  •   Dry or scaly skin patches
  •   Wet open sores can develop

Contact dermatitis - also known as allergic eczema – a type of eczema that presents when the body encounters a substance. While there are several types of contact dermatitis, irritant contact dermatitis and allergic contact dermatitis are the most common. Irritants can be chemicals, solvents, allergens (dander or pollen), fumes, and acidic foods.

Symptoms will usually appear on the hands or the parts of the body that touched the irritant and include:

  • Redness
  • Rash
  • burning sensation
  • swelling
  • weeping blisters that may crust 

Varicose eczema - most often affects the lower legs and is caused by problems with blood flow through the leg veins.

Varicose eczema (venous eczema), gravitational or stasis eczema, is a long-term skin condition common in people with varicose veins.

Symptoms include:

  • Itchy, swollen, dry, and flaky skin
  • Scaly or crusty skin patches
  • On lighter skin, it looks red or brown. On darker skin, it can look dark brown, purple, or grey and can be more challenging to identify.
  • There will be times the symptoms improve and times they flare-up again.

If varicose eczema goes untreated, then leg ulcers can develop. Leg ulcers are long-lasting wounds that form where the skin has become damaged.

Seborrheic eczema – a type of eczema that tends to develop on areas of the body that contain a lot of oil-producing (sebaceous) glands such as on the sides of the nose, eyebrows, upper back, ears, and scalp. Red, scaly patches develop and unlike other types, this type of dermatitis is not due to allergies. The exact cause is not known; however, hormones and genetics may well play a role.

It can affect any age group; often, infants develop this condition commonly referred to as 'cradle cap'.

Individuals with immunity disease or disease that affects the nervous system are often said to be at a higher risk of developing seborrheic dermatitis.

Symptoms include,

  • Rash on the scalp
  • Symptoms can range from dry flaky (dandruff) to a more yellow, greasy, scaly patches with reddened on the skin surface.
  • Patients can develop seborrheic dermatitis on other oily areas of their body, like the face, upper chest and back

Dyshidrotic eczema (pompholyx), also known as vesicular eczema, is a type marked by the appearance of vesicles or bullae (blisters). A similar condition can affect the feet (vesicular foot dermatitis).

Stress, allergies (such as hay fever), nickel exposure, and may trigger dyshidrotic eczema. This eczema is twice as common in females as in males.

Symptoms can include:

  •    small fluid-filled blisters (vesicles) on the hands, and feet
  •    itching
  •    redness
  •    flaking
  •    scaly, cracked skin
  •    pain 

Papular eczema – this type of eczema causes a rash of small itchy bumps to appear on the skin called papules. These little bumps distinguish between other types and prevalent eczema as this is the only type with raised lumps. They look like pimples and can appear on the torso, arms, or legs.

Presently, there is no cure for this type of eczema, but home treatments can help manage symptoms. 

Hyperkeratotic eczema -  affects the hands and feet and is a well-recognized condition that is usually chronic and resistant to therapy. The eruption is marked by dry, thick, grey plaques involving the palmar and plantar surfaces. Cracking of the dry skin or fissuring (splitting) can develop and become very painful. 

Follicular eczema / follicular dermatitis – a type of eczema affecting the hair follicles rather than the skin. The cause is unknown, but asthmatics and people with hay fever are thought to be at a higher risk of developing it.

Symptoms include:

  •   goose-bump like eruptions
  •   inflammation  showing redness
  •   swelling
  •   itching
  •   warmth to the affected area

Erythroderma –(generalized exfoliative dermatitis) – is a type that leads to an intense and reddening of the skin due to inflammation. It often is associated with exfoliation (skin peeling off in scales or layers) when it may also be known as exfoliative dermatitis (ED). 

Flexural eczema

Eczema herpeticum Is a rare skin condition caused by one of the herpes viruses that present as a blister-like painful rash. Often seen as a complication of atopic eczema, this is a severe type of eczema requiring prompt antiviral medicine.

Topical steroids are not recommended generally but may be necessary to treat active atopic dermatitis.

  • Consult an ophthalmologist  (eye doctor) when eyelid or eye involvement is seen or suspected.

Xerotic eczema / dry eczema – a common type of eczema developing when skin becomes abnormally dry, such as wintertime or in arid conditions.

Usually, the site is the shins, but asteatotic eczema can occur on the trunk and arms. Red, itchy, and dry patches will appear. 

What causes eczema?

The cause is currently unknown, but what is evident is that eczema it is not down to one single thing. Genetics, immune system abnormalities, environment, and allergies can be responsible for the development of the condition.

  • Allergies- Atopic eczema often occurs in people who get allergies. "Atopic" means sensitivity to allergens. Certain foods might need to be avoided.
  • Genetics- It can run in families, and often develops alongside other conditions, such as asthma or hay fever.
  • The symptoms of atopic eczema often have specific triggers, such as soaps, detergents, stress, and the weather. 

People with atopic eczema often have dehydrated skin because their skin is unable to retain a lot of moisture. This dryness can mean the skin is more susceptible to specific triggers, causing it to become itchy and sore.

Eczema triggers

Several things may trigger your eczema symptoms. These can vary from person to person.

  • Environmental factors - such as cold or very dry weather, dust mites, pollen, fur from pets, and cigarette smoke.
  • Food allergies - cow's milk, eggs, peanuts, soya, and wheat.
  • Irritants - such as soaps, bubble baths, shower gel, shampoos, and washing detergents.
  • Diet - such as alcohol or some dairy products.
  • Hormonal changes - women can find their symptoms get worse in the days before their period or during pregnancy
  • Skin infections and clothes wore next to the skin, such as wool. 
  • For some, if they are stressed, sweaty or in very dusty conditions, they may feel worse.

What are the symptoms of eczema?

  •  Atopic eczema causes dry, itchy skin and can even cause it to crack
  •  For some, pain and soreness can prevail.
  • Eczema is either mild, moderate, or severe and symptom severity varies from person to person.
  • Rash and red patches on the skin.
  • Inflamed skin can become red.
  • Although this condition may affect any part of the body, it tends to affect the back of the hands, insides the elbows, backs of the knees and the face and scalp in children.
  • People with atopic eczema frequently have periods when symptoms are mild or unnoticeable, as well as times when symptoms become more severe (flare-ups).

 

Treatment will depend on individual symptoms, type of eczema, severity and patient needs. Your GP and dermatologist can assess on a personal basis and develop a person-centred management plan based on needs analysis and patient preferences. 

Eczema is a complex condition that can cause emotional and physical symptoms, but for the most part if well managed, the person will be able to live a good active life with their condition. If you or your child suffer from eczema, find support and information - make yourself aware this September on all things eczema! visit www.eczema.org for more. 

If you are working in the field of dermatology, why not visit our careers page at www.promedical.co.uk/jobs where you can browse various roles available now! 

 

Sources: Varicose eczema - NHS. https://www.nhs.uk/conditions/varicose-eczema/

Varicose eczema - Illnesses & conditions | NHS inform. https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/varicose-eczema

16 Sep 2020
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