An inflammatory condition of the skin characterized by redness, itching, and oozing vesicular lesions which become scaly, crusted, or hardened.
Doctors don’t know exactly what causes eczema. The most common type of eczema — atopic dermatitis — resembles an allergy. But the skinirritation, which is more often seen in children rather than adults, is not anallergic reaction.
The current thinking is thateczema is caused by a combination of factors that include:
- Abnormal function of the immune system
- Activities that may cause skin to be more sensitive
- Defects in the skin barrier that allow moisture out and germs in.
Despite recent advances in the understanding of the genetics of atopic dermatitis (AD), the pathophysiology remains poorly defined. Two main hypotheses have been proposed regarding the development of inflammation Despite recent advances in the understanding of the genetics of atopic dermatitis (AD), the pathophysiology remains poorly defined. Two main hypotheses have been proposed regarding the development of inflammation that leads to AD. The first suggests a primary immune dysfunction resulting in IgE sensitization and a secondary epithelial-barrier disturbance. The second proposes a primary defect in the epithelial barrier leading to secondary immunologic dysregulation and resulting in inflammation.
In healthy individuals, balance exists between important subsets of T cells (eg, Th 1, Th 2, Th 17, Th22). The primary immune dysfunction hypothesis invokes an imbalance in the T-cell subsets, with Th 2 cells predominating; this results in the production of Th 2 cytokines such as interleukin (IL)–4, IL-5, and IL-13, causing an increase in IgE from plasma cells and diminished interferon-gamma levels. Later, in persons with chronic AD, the Th 1 cells have been shown to predominate. More recently, Th 17 cells have been found to be elevated in patients with acute AD. Although primarily considered a Th 2–mediated disease, the precise contributions of Th 1 and Th 17 cell responses remain to be fully defined.
Almost all patients with eczema complain of itching. Since the appearance of most types of eczema is similar, the distribution of the eruption can be of great help in distinguishing one type from another. For example, stasis dermatitis occurs most often on the lower leg while atopic dermatitisoccurs in the front of the elbow and behind the knee.
To diagnose eczema, your doctor will first talk to you about your symptoms and medical history.
He or she will also ask about your family’s history of rashes and other allergy-related medical conditions, such as asthma and hay fever.
While there is no single test to diagnose eczema, a good medical history and an exam of your skin are usually all that is needed.
The treatment of acute eczema requires repeated cycles of application of dilute aqueous solutions followed by evaporation. This is most often conveniently performed by placing the affected body part in front of a fan after the compress. Once the acute weeping has diminished, then topical steroids (such as triamcinolone cream) application can be an effective treatment. In extensive disease, systemic steroids may need to be utilized either orally or by an injection (shot).
Over-the-counter hydrocortisone cream or ointment may help mild eczema. Prescription steroid cream may be needed for more severe eczema.
Oral antihistamines such as Benadryl are available over-the-counter and may help relieve symptoms. Some of these cause drowsiness, which may be of benefit if nighttime itching is a problem. There are also non-drowsy antihistamines.
If other treatments fail, your doctor may prescribe oral corticosteroids. Always follow your doctor’s directions when taking oral steroids.
ULTRAVIOLET LIGHT THERAPY.
People with very severe eczema may benefit from therapy using ultraviolet light.
Drugs that suppress the immune system may also be an option. These medicines, such as cyclosporine, azathioprine, or methotrexate, may be used when other treatments have failed.
This type of medicated cream helps treat eczema by controlling inflammation and reducing the immune system reactions. Examples include Elidel and Protopic.
These replace the barrier of the skin. Examples include Hylatopic Plus, Mimyx, and Epiceram.