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Eczema: Causes, Symptoms and Treatment

Eczema is an inflammatory skin condition characterized by redness, itching, and blistering. It occurs in several forms, including atopic eczema and contact dermatitis.

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Things worth knowing about "Eczema"

Eczema is an inflammatory skin condition characterized by redness, itching, and blistering. It occurs in several forms, including atopic eczema and contact dermatitis.

What is Eczema?

Eczema (also known as dermatitis) is an inflammatory skin condition that can occur in both acute and chronic forms. It is one of the most common skin disorders worldwide, affecting people of all ages. Typical features include red, itchy, and scaly patches of skin that may also weep or crust over in some cases.

Types of Eczema

There are several distinct types of eczema, each with its own causes and clinical appearance:

Atopic Eczema (Atopic Dermatitis): The most common chronic form, often linked to a genetic predisposition and an overactive immune system. It frequently occurs alongside asthma and hay fever.
Contact Dermatitis: Caused by direct skin contact with irritating substances (irritant contact dermatitis) or an allergic reaction to specific materials (allergic contact dermatitis).
Seborrhoeic Dermatitis: Affects oily skin areas such as the scalp, face, and chest. It is associated with the yeast Malassezia.
Dyshidrotic Eczema: Presents as small, intensely itchy blisters on the hands and feet.
Microbial Eczema: Often develops as a response to bacterial or fungal skin infections.

Causes and Risk Factors

The causes of eczema vary depending on the type and may include:

Genetic predisposition and impaired skin barrier function
Immune system overreactions
Contact with allergens (e.g., nickel, fragrances, latex) or irritants (e.g., detergents, soaps)
Environmental factors such as dry air, heat, or cold
Stress and psychological strain
Infections caused by bacteria, viruses, or fungi

Symptoms

Symptoms vary depending on the type and severity of eczema. The most common include:

Intense itching
Redness and swelling of the skin
Scaling and skin dryness
Blister formation and weeping
Crusting in chronic cases
Thickening and roughening of the skin (lichenification) in long-standing cases

Diagnosis

Eczema is primarily diagnosed through a clinical examination of the affected skin areas by a dermatologist. Depending on the suspected type, the following tests may be carried out:

Patch Test (Epicutaneous Test): To detect contact allergies
Blood Tests: e.g., measurement of IgE antibodies in atopic eczema
Skin Biopsy: In unclear cases, for histological analysis
Allergy Tests: Prick test or specific IgE determination

Treatment

Treatment depends on the type and severity of the eczema. The goals are to relieve itching, reduce inflammation, and restore the skin barrier.

General Measures

Regular skin care with emollient and moisturizing creams or lotions
Avoidance of known triggers (allergens, irritants)
Use of mild, fragrance-free skin care products

Medical Treatment

Topical Corticosteroids: Anti-inflammatory creams or ointments used for short-term treatment
Calcineurin Inhibitors: Alternatives to corticosteroids, e.g., tacrolimus or pimecrolimus
Antihistamines: To relieve itching, especially at night
Biologics: e.g., dupilumab for severe atopic eczema unresponsive to other therapies
Systemic Immunosuppressants: e.g., ciclosporin or methotrexate for severe cases

Light Therapy

UV phototherapy can be used for certain forms of eczema to reduce the inflammatory response and relieve itching.

References

European Academy of Dermatology and Venereology (EADV): Guidelines on Atopic Eczema (2022). Available at: https://www.eadv.org
National Institute for Health and Care Excellence (NICE): Atopic eczema in under 12s - Diagnosis and management (2023). Available at: https://www.nice.org.uk
Weidinger S., Novak N. - Atopic dermatitis. In: The Lancet, 387(10023):1109-1122, 2016. DOI: 10.1016/S0140-6736(15)00149-X

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