Eczema is a very common skin problem that is encountered on a daily basis by dermatologists. It actually a broad term that describes a range of chronic or persistent skin conditions. Eczematous is a term used by skin doctors to describe dry, red, angry and inflamed skin that tends to be itchy and sore. Dryness can lead to cracking, fissuring and flaking; itching can lead to scratch marks (excoriations) and bleeding, and severe (and sometimes infected) eczema can cause swelling, blistering, weeping, oozing and crusting.
The words eczema and dermatitis are considered to mean the same ting by most dermatologists in the United Kingdom
There are different types of eczema. The more common variants encountered include atopic eczema, seborrheic eczema, contact dermatitis, eczema craquelé and venous stasis eczema.
Atopic eczema is usually seen in childhood and is a very common form. It tends to coincide with asthma and hay fever and these conditions frequently exist in other family members.
It is an inherited condition with environmental triggers. Of the 25000 or so pairs of genes that you inherit from your parents that make up your characteristics, there are some that contain the blueprint for skin structure and some for the way the immune system may react. It is thought that skin conditions like eczema are inherited when we have certain combinations of these genes. There is one protein, called fillagrin, which seems to be changed in at least 50% of people with severe eczema. It is thought that the normal barrier function of the skin is compromised because of the changes in this protein: as a result, dirt, bugs and allergens can penetrate the skin surface and trigger the immune system.
Allergies are often seen running alongside the skin problem and sometimes the two interact with one another. Young children with cow’s milk allergy are typical of this- drinking the milk can make them itchy, causing them to rub their skin and make their eczema worse. Fortunately, many people grow out of such allergies in early childhood.
Treatment of atopic eczema involves avoiding the things that make it worse and using creams to calm the immune system down when it flares. Most of all, it’s very important to reinstate that barrier function of the skin by applying emollients and avoiding detergents and soaps, no matter how mild they are. Creams to suppress the immune system include steroid creams and the newer topical immunomodulators. Dermatologists have huge amounts of experience with these creams and are able to recommend which are the safest and most effective to use for individual patients. When the creams are not working, you may not be applying them in sufficient amounts or you may have a contact allergy, which can be tested for.
In very severe cases there are other treatments available, including phototherapy (treatment with ultraviolet light that is very strictly controlled and monitored) and tablets that suppress the immune system. There are injections in development that also appear to be very promising for the treatment of severe atopic eczema.
Seborrheic eczema is thought to be the poor cousin of psoriasis- in fact many people with psoriasis have a first degree relative (sibling, parent or child) who has seborrheic dermatitis. It can affect the scalp, behind the ears, the eyebrows, the face and the armpits and groins. Depending on its site and severity, it can be treated with shampoos, creams and, occasionally, tablets. Although there is no cure, it can be kept under control with these measures.