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ECZEMA.

Eczema describes a variety of inflammatory skin disorders; it is a chronic, widespread, non-infective inflammatory condition that causes severe pruritus, erythema and scaling.⁽¹⁾

ECZEMA.

Eczema describes a variety of inflammatory skin disorders; it is a chronic, widespread, non-infective inflammatory condition that causes severe pruritus, erythema and scaling.⁽¹⁾

People with eczema tend to have dry skin due to the dysfunction in the skin barrier because water evaporates more easily from the skin. They are also more susceptible to infection and their skin is easily irritated by fragrances and allergens.⁽²⁾

Though there are several distinct types of eczema, it is possible to have more than one type at a time. Dermatologists usually describe it as a group of skin conditions characterised by skin redness, skin flaking rash and itching, at times including blisters.

The most commonly observed types of eczema include:

Atopic dermatitis
Contact dermatitis
- Irritant contact dermatitis
- Allergic contact dermatitis
Seborrhoeic dermatitis
Infectious eczematoid dermatitis
Nummular eczema
Stasis dermatitis
Dyshidrotic eczema
Neurodermatitis⁽²⁾

SYMPTOMS

Symptoms of acute eczema include red and itchy skin, sometimes with blisters that easily break and then weep (leak liquid). Over time the skin may become dry and cracked, and also thicken. Its structure may also change, making it rougher. The main symptom is itching, which can often become unbearable.⁽²⁾

The areas of skin that are typically affected and the severity of symptoms vary from person to person and also depend on your age. In babies, eczema mainly appears on the cheeks and the outer surfaces of the arms and legs and – less commonly – on the back, tummy and chest.

Children, teenagers and adults who have eczema are most commonly affected on the backs of their knees, the insides of their elbows and the back of the neck.

The itchy rash may also develop on the palms of their hands and soles of their feet. It rarely affects the face.⁽²⁾

CAUSES

Atopic eczema (or atopic dermatitis) is the most common chronic inflammatory skin disease with a prevalence of about 10% to 30% of children and 2% to 10% of adults in developed countries. This prevalence has increased two to three-fold in recent decades.⁽³⁾

The main symptom of this inflammatory disease is a very itchy rash. It often affects children. In many cases eczema gets better as the years go by, and it may go away for a while or disappear altogether. Acute flare-ups can really affect quality of life. The itching can be especially bad, making it difficult to concentrate and sleep well.⁽⁴⁾

Atopic eczema is believed to have a predominantly genetic base. Researches show that genetic, more specifically one common mutation has been observed in the gene Filaggrin (a vital gene for skin maturity), as well as environmental factors play a part in the pathogenesis.⁽¹⁾

In the general population, the average prevalence of Allergic contact dermatitis with at least 1 allergen is 21.2%.⁽⁵⁾ They often have more severe skin problems, as well as hay fever or allergic asthma. Their immune system reacts to allergens by releasing antibodies, which causes inflammation. Tests can detect these antibodies in the blood. Allergens that sometimes play a role in eczema include dust mites, pollen and foods such as milk, eggs, nuts or fish.

The skin may also be irritated by environmental factors or other substances that are not allergens.⁽²⁾

Irritant contact dermatitis is the cutaneous response to the physical/toxic effects of a wide range of environmental exposures. This may be an acute (toxic) irritant dermatitis or a cumulative irritant/insult dermatitis. Irritant contact dermatitis represents nearly 80% of all contact dermatitis.⁽⁶⁾

The most frequent sources of exposure were 'unspecified' chemicals, water, detergents, dust and dirt. Occupationally, soaps, wet work, petroleum products and cutting oils and coolants. Individuals involved in mining/manufacturing, hairdressing, agriculture and medical and nursing occupations had the highest frequency of dermatitis.⁽²⁾

TREATMENT

Eczema is a chronic condition and its symptoms wax and wane with various manifestations. Individualised therapy for the patient should be implemented according to patients' age, severity, type and extent of eczema, and distribution of the lesion.⁽⁷⁾

The main management and treatment of eczema include hydration and topical anti-inflammatory medications for flare-ups.

One of the main issues in treatment is focusing on a daily hygiene comprehensing cleansing and moisturising regimen with a fragrance-free ointment that has limited preservatives with the use of bath oil as recommended by european guideline.^(7),(8)

^{⁽¹⁾ Eczema: causes, symptoms and treatment in the community. Peate Br J Community Nurs. 2011;16(7):324‐331. doi:10.12968/bjcn.2011.16.7.324}

^{⁽²⁾ Rook's Textbook of Dermatology, Ninth Edition. Edited by Christopher Griffiths, Jonathan Barker, Robert Chalmers, Tanya Bleiker and Daniel Creamer. John Wiley & Sons, Ltd. Published 2016 by John Wiley & Sons, Ltd}

^{⁽³⁾ Atopic Dermatitis Logan Kolb; Sarah J. Ferrer-Bruker. [Updated 2019 Nov 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448071/}

^{⁽⁴⁾ Eczema Valerie Nemeth; Justin Evans. [Updated 2020 Mar 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538209/}

^{⁽⁵⁾ The Epidemiology of Contact Allergy in the General Population--Prevalence and Main Findings, Thyssen J. P. et al. (2007)}

^{⁽⁶⁾ Management of contact dermatitis, Sultan T. Al-Otaibi, Hatem Ali M. Alqahtani, 2015}

^{⁽⁷⁾ Eczema: Overview Created: September 26, 2013; Last Update: February 23, 2017; Next update: 2020. https://www.ncbi.nlm.nih.gov/books/NBK279399/³ ³ Beneficial Effects of Antioxidant Furfuryl Palmitate in Non-pharmacologic Treatments (Prescription Emollient Devices, PEDs) for Atopic Dermatitis and Related Skin Disorders Paolo Daniele Pigatto. Marco Diani}

^{⁽⁸⁾ Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. 1, Tom WL1, Chamlin SL2, Feldman SR3, Hanifin JM4, Simpson EL4, Berger TG5, Bergman JN6, Cohen DE7, Cooper KD8, Cordoro KM5, Davis DM9, Krol A4, Margolis DJ10, Paller AS11, Schwarzenberger K12, Silverman RA13, Williams HC14, Elmets CA15, Block J16, Harrod CG17, Smith Begolka W18, Sidbury R19.}

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