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    Eczema

    Eczema is a form of dermatitis, or inflammation of the upper layers of the skin.
    The term eczema is broadly applied to a range of persistent or recurring skin
    rashes characterized by redness, skin edema, itching and dryness, with possible
    crusting, flaking, blistering, cracking, oozing or bleeding. Areas of temporary skin
    discoloration sometimes characterize healed lesions, though scarring is rare.


    There Are Many Different Types of Eczema

    The term eczema refers to a set of clinical characteristics. Classification of the
    underlying diseases has been haphazard and unsystematic, with many synonyms
    used to describe the same condition. A type of eczema may be described by location
    (e.g. hand eczema), by specific appearance (eczema craquele or discoid), or by
    possible cause (varicose eczema). Further adding to the confusion, many sources
    use the term eczema and the term for the most common type of eczema
    (atopic eczema) interchangeably.


    More severe eczemaThe European Academy of Allergology and Clinical Immunology
    (EAACI) has published a position paper which simplifies the nomenclature of allergy-
    related diseases including atopic and allergic contact eczemas (Johansson et al.,
    2001, Allergy 56:813). Non-allergic eczemas are not affected by this proposal.

    The classification below is clustered by incidence frequency.

    More common eczemas

  • Atopic eczema (aka infantile e., flexural e., atopic dermatitis) is believed to
    have a hereditary component, and often runs in families whose members
    also have hay fever and asthma. Itchy rash is particularly noticeable on face
    and scalp, neck, inside of elbows, behind knees, and buttocks. Experts are
    urging doctors to be more vigilant in weeding out cases that are in actuality
    irritant contact dermatitis. It is very common in developed countries, and rising.

  • Contact dermatitis is of two types: allergic (resulting from a delayed reaction
    to some allergen, such as poison ivy or nickel), and irritant (resulting from direct
    reaction to, say, a solvent). Some substances act both as allergen and irritant
    (e.g. wet cement). Other substances cause a problem after sunlight exposure,
    bringing on phototoxic dermatitis. About three quarters of cases of contact
    eczema are of the irritant type, which is the most common occupational skin
    disease. Contact eczema is curable provided the offending substance can
    be avoided, and its traces removed from one’s environment.

  • Xerotic eczema (aka asteatotic e., e. craquele or craquelatum, winter itch,
    pruritus hiemalis) is dry skin that becomes so serious it turns into eczema.
    It worsens in dry winter weather, and limbs and trunk are most often affected.
    The itchy, tender skin resembles a dry, cracked, river bed. This disorder is
    very common among the older population. Ichthyosis is a related disorder.

  • Seborrhoeic dermatitis (aka cradle cap in infants, dandruff) causes dry or
    greasy scaling of the scalp and eyebrows. Scaly pimples and red patches
    sometimes appear in various adjacent places. In newborns it causes a thick,
    yellow crusty scalp rash called cradle cap which seems related to lack of biotin,
    and is often curable.

    Less common eczemas

  • Dyshidrosis (aka dyshidrotic e., pompholyx, vesicular palmoplantar dermatitis,
    housewife’s eczema) only occurs on palms, soles, and sides of fingers and toes.
    Tiny opaque bumps called vesicles, thickening, and cracks are accompanied by
    itching which gets worse at night. A common type of hand eczema, it worsens in
    warm weather.

  • Discoid eczema (aka nummular e., exudative e., microbial e.) is characterized
    by round spots of oozing or dry rash, with clear boundaries, often on lower legs.
    It is usually worse in winter. Cause is unknown, and the condition tends to come
    and go.

  • Venous eczema (aka gravitational e., stasis dermatitis, varicose e.) occurs in
    people with impaired circulation, varicose veins and edema, and is particularly
    common in the ankle area of people over 50. There is redness, scaling,
    darkening of the skin and itching. The disorder predisposes to leg ulcers.

  • Dermatitis herpetiformis (aka Duhring’s Disease) causes intensely itchy and
    typically symmetrical rash on arms, thighs, knees, and back. It is directly related
    to celiac disease, and can often be put into remission with appropriate diet.

  • Neurodermatitis (aka lichen simplex chronicus, localized scratch dermatitis)
    is an itchy area of thickened, pigmented eczema patch that results from habitual
    rubbing and scratching. Usually there is only one spot. Often curable through
    behavior modification and anti-inflammatory medication. Prurigo nodularis is a
    related disorder showing multiple lumps.

  • Autoeczematization (aka id reaction, autosensitization) is an eczematous
    reaction to an infection with parasites, fungi, bacteria or viruses. It is
    completely curable with the clearance of the original infection that caused
    it. The appearance varies depending on the cause. It always occurs some
    distance away from the original infection.

  • There are also eczemas overlaid by viral infections (e. herpeticum, e.
    vaccinatum), and eczemas resulting from underlying disease (e.g.
    lymphoma). Eczemas originating from ingestion of medications, foods,
    and chemicals, have not yet been clearly systematized.
    Other rare eczematous disorders exist in addition to those listed here.


    Diagnosis

    Eczema diagnosis is generally based on the appearance of inflamed, itchy skin in
    eczema sensitive areas such as face, chest and other skin crease areas. For
    evaluation of the eczema, a scoring system can be used (for example, SCORAD,
    a scoring system for atopic dermatitis).

    Given the many possible reasons for eczema flare ups, a doctor is likely to
    ascertain a number of other things before making a judgment:

  • An insight to family history
  • Dietary habits
  • Lifestyle habits
  • Allergic tendencies
  • Any prescribed drug intake
  • Any chemical or material exposure at home or workplace

    To determine whether an eczema flare is the result of an allergen, a doctor may
    test the blood for the levels of antibodies and the numbers of certain types of cells.
    In eczema, the blood may show a raised IgE or an eosinophilia.

    The blood can also be sent for a specific test called Radioallergosorbent Test
    (RAST) or a Paper Radioimmunosorbent Test (PRIST). In the test, blood is mixed
    separately with many different allergens and the antibody levels measured. High
    levels of antibodies in the blood signify an allergy to that substance.

    Another test for eczema is skin patch testing. The suspected irritant is applied to
    the skin and held in place with an adhesive patch. Another patch with nothing is also
    applied as a control. After 24 to 48 hours, the patch is removed. If the skin under the
    suspect patch is red and swollen, the result is positive and the person is probably
    allergic to that substance.

    Occasionally, the diagnosis may also involve a skin biopsy: removal of a small
    piece of affected skin for microscopic examination in a pathology laboratory.

    Blood tests and biopsies are not always necessary for eczema diagnosis. However,
    doctors will at times require them if the symptoms are unusual, severe or in order to
    identify particular triggers.


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