Eczema and Dermatitis


The word eczema comes from the Greek meaning ‘to boil over’. Dermatitis comes from the Greek word for skin and both refer to exactly the skin condition. These are the most common skin conditions seen by family doctors. The eczemas are a varied group of diseases and present as itchy inflammation of the skin and may encompass some of the following symptoms at varying degrees: redness of affected area, generally very dry skin, lumps and or blisters in affected areas, and or infection such as weeping or crusty deposits. Course of the disease In early disease the skin remains intact so the eczema appears as a red smooth oedematous or swollen plaque. With worsening disease the oedema becomes more severe as tense blisters appear on the plaques and they weep plasma. If less severe or if the eczema becomes more chronic scaling and skin breakdown occurs. Acute eczema is characterised by weeping and crusting, blistering and in severe cases large blisters. Redness, papules, swelling and scaling may occur. Chronic eczema may show some or all of the signs of acute eczema, however, it tends to be more scaly, pigmented and thickened. Chronic eczema is more likely to show lichenification (a dry leathery thickened state with increased skin markings, secondary to repeated scratching or rubbing and the skin is more likely to break). All severe forms of eczema have a huge effect on the quality of life. An itchy sleepless child can wreck family life. Eczema can interfere with work, sporting activities and sex lives. Jobs can be lost through it. Irritant contact dermatitis or eczema This form of eczema occurs if the skin is routinely exposed to irritants over very long periods of time. Irritant contact dermatitis accounts for over 80% of contact dermatitis cases and a the degree of the eczema depends on the concentration of toxic substances and also the duration of contact with the irritants. The common culprits are: detergents, alkalis, solvents, cutting oils and  abrasive dusts. Individuals who are fair or have dry skins tend to be more vulnerable. People who have children can also be affected as they too can react to certain toxic substances at home e.g. bath foams or soaps or even play doh.

  • Hairdressers
  • Cleaners
  • Catering workers
  • Food processors
  • Fish handlers

These workers are susceptible as prolonged contact with water swells the skin and weakens the structure exposing the more vulnerable deep layers. The need to continue with work often prevents the skin from regaining its normal healthy barrier status. It can take several months for the skin to heal. What is the treatment for irritant contact dermatitis? The best treatment is avoidance of the irritant if known. Often this is not possible so protective gloves, clothing is sensible. Barrier creams seldom help chronic cases. Once started irritant contact eczema can persist long after contact with offending substances has ceased despite the vigorous use of specialist creams (emollients and topical corticosteroids). Vulnerable people should be advised to avoid jobs which involve heavy exposure to skin irritants. Allergic contact dermatitis This is an allergic reaction to specific substances. The body responds to the specific substance or allergen by initiating an immunological response which releases chemicals such as histamines for example. At first this causes rash and inflammation at the site of skin contact with the allergen. It will spread later on and may occur in a completely different area from the site of initial contact. This is because the immune cells become activated and migrate through the blood stream to other areas. The original site of the eruption usually provides clues to the culprit e.g. individuals with a nickel allergy will have eczema under jewellery, bra clips or jean studs. Allergic contact dermatitis should be suspected if:

  • certain areas are involved, e.g. eyelids, hands feet
  • there is known contact with the allergens.
  • the individuals work carries a high risk, hair dressing, working in a flower shop, dentistry.

It is sometimes necessary to check the patient’s history as this can be useful for locating the allergen. What is the treatment for allergic contact eczema?

  • Topical steroids
  • Avoidance of the concerned allergen is important.

Atopic eczema This is a chronic extremely itchy form of eczema with a strong genetic cause. Usually beginning at infancy and frequently associated with rhinitis and asthma. 75% of cases of atopic eczema (AE) begin before the age of 6 months. 80-90% of AE cases occur before 5 years of age. At least 3% infants are affected but the onset may be delayed until childhood or adult life. For some 60-70% of children AE will clear by their early teens, although relapses are possible. AE currently affects up to 20% of children in the UK. Main feature is itching and scratching. Children sleep very poorly due to constant itching, and can be hyperactive and sometimes emotional and attention seeking. 60% of those who have AE first develop it in infancy. It may appear as early as 6 weeks with apparently itchy scaly lesions on the scalp, face and trunk. The infant will be irritable and wakeful and tries to rub the affected areas. In babies the wrists, cheeks and hands are usually red, scaly and scratched. In toddlers and older children the common sites includes elbow, knee, buttocks flexures (folds), ankles, the dorsa of the feet under straps of shoes. In severe cases there may be extensive involvement of all 4 limbs with secondary infection. In a high proportion of affected children AE clears spontaneously between the ages of 2 and 5 years but if it continues in adolescence and adult life it becomes more chronic with more generalised dry skin. Problems associated with Atopic dermatitis Dermatological:

  • Bacterial infection (increased colonization of the epidermis by staphylococcus aureus)
  • Especially prone to viral infections
  • Dry skin
  • Dry and prominent hair follicles particularly on upper arms
  • Juvenile plantar dermatosis and shiny tender soles of feet
  • In female adults nipple dermatitis
  • Increased incidence of persistent and stubborn warts
  • Cataract
  • Food intolerance and allergy

Clinical diagnosis Usually a thorough medical examination of the affected areas and the history of the patient is taken. Treatment The aim is to manage and control the disease rather than cure.

  • Emollients; reduce discomfort and itch and can be used for both in and after the bath or shower. It is advisable to try out different preparations of different textures to ascertain what suits best.
  • Topical steroids; weak and moderately potent steroids are of great value in the regular management of atopic dermatitis. Need to understand that while red skin needs some topical steroid dry skin only needs an emollient.
  • Antibiotics, used in combination with steroids, help combat infection which is associated with clinical improvement.
  • Antihistamines; sedating antihistamines help control the itch of atopic dermatitis and prevent night time scratching.
  • Wet wraps; specialised bandaging technique which uses a damp stockinet body suit held in place by a dry suit with either a weak antiseptic or diluted topical steroid. Easiest to use at night and beneficial as it provides good hydration and double layer prevents scratching. It is good for small children and infants.

Other types of therapy are sometimes necessary for severe cases:

  • Environmental change: advisable to reduce the allergen exposure as much as  possible. The house dust mite collects in carpets, curtains, and bedding so wooden floors, blinds to replace curtains, non-permeable cover for the mattress and quilt may help.
  • Low temperature and humidity helpful.
  • Hair bearing pets discouraged and clothing cotton rather than wool which can be very irritable.

There is no reliable, proven effective and safe method of permanently suppressing symptoms. Fortunately for many the condition clears spontaneously by the age of 5 yrs. Seborrhoeic eczema Seborrhoeic eczema (SE) is a common and benign condition which mainly affects the hairy areas, and often showing characteristic greasy yellowish scales. Common signs and symptoms of seborrheic dermatitis include: ·         Inflammation (redness) of the skin ·         Patchy scaling or thick crusts on your scalp ·         Yellow or white flakes (dandruff) on your scalp or your hair, eyebrows, beard or mustache ·         Red, greasy skin covered with flaky white or yellow scales on other areas of your body, including your chest, armpits, the area where your thigh meets your abdomen (groin) or the male scrotum ·         Itching or soreness Seborrheic dermatitis most often affects your scalp, but it can occur between skin folds and on skin rich in oil glands. It can develop in and between your eyebrows, on the sides of your nose and behind your ears, over your breastbone, in your groin area, and sometimes in your armpits. In most people, it's a chronic condition. You'll likely experience periods when your signs and symptoms improve alternating with times when they worsen. This is not a serious condition but rather an uncomfortable and embarrassing one when visible. It is not infectious and is not a sign of poor hygiene. There is no true cure so there will be periods where the condition is at bay and other time it will recur. It can be managed via over the counter health care medications. Treatment It cannot be cured but remissions for varying amounts of time do occur naturally or as the result of treatment. It is managed by keeping the condition under control with shampoos which requires experimentation to find the most suitable one to the individual.

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