Also classified, according to some taxonomies, as dermatitis , eczema is the most frequent non-contagious skin disease .
eczema is caused by an abnormal mode of reaction of the skin with respect to factors both internal and external to the body, which trigger inflammatory phenomena. The action of elements such as chemical or physical irritants or allergens, in a framework of genetic predisposition, can determine the appearance of pads or vesicles . These evolve towards scaling of the skin. The main symptoms are itching and redness .
It affects transversally in the population, with some exceptions. L ‘ eczema seborrheic ( atopic ), which usually manifests in childhood and regresses into adulthood, and the’ occupational eczema , which affects specific categories of workers in continuous contact with chemical agents or physical irritants.
There are several classifications of this dermatological disease, which can be made according to the cause , main component or duration of symptoms.
Treatment aims to relieve symptoms but does not cure the disease . However, in some cases, eczema disappears spontaneously, in others it is resolved simply by removing the irritating factor. In still others it persists and becomes chronic, with a fluctuating trend that unfolds between periods of remission and periods of exacerbation.
The symptoms benefit from the application of emollient creams . The more persistent forms may require the use of cortisone or immunosuppressants .
The management of eczema in the long term benefits from the adoption of behaviors aimed at avoiding contact with substances (perfumes, scented creams, soaps) and situations (temperature changes, prolonged baths, washing with very hot water) that worsen the state of the skin.
Eczema: what it is
How do you get eczema? Known, according to some classifications, also as dermatitis , eczema is the most frequent non-contagious skin disease .
It is the result of an altered reaction of the skin to endogenous factors coming from within, such as stress. But also exogenous, that is, coming from the outside, such as irritants and allergens.
It is a dermatological manifestation that appears with reliefs or vesicles and is accompanied by:
After its acute phase, it can heal completely (to reappear after a variable time) or become chronic, giving rise to manifestations that change over time.
Types and forms of eczema
The different types of eczema are determined by the size of the lesions, the underlying cause of the disease and the area of the body in which they appear. There are therefore multiple classifications of eczema.
Classification based on origin
According to this classification, based on the origin, two main types of eczema can be distinguished:
- eczema caused by exogenous factors (factors coming from outside, such as irritants and allergens), such as contact dermatitis
- eczema caused by endogenous factors (produced within the body itself, such as stress), such as seborrheic dermatitis .
In some cases, both endogenous and exogenous factors can coexist in the same person at the base of eczema.
An example? An eczema due to internal factors may be exacerbated by external factors such as exposure to irritants. This is what occurs in people with seborrheic dermatitis : the skin is more sensitive than normal and reacts alteredly to generally harmless compounds.
Classification based on the cause
Based on the cause, the following types of eczema can be distinguished:
- irritative : it is an irritative contact dermatitis induced by continuous exposure to particular substances, even in professional contexts (construction, chemical industry, textiles, crafts); in the latter case it falls into the category of occupational dermatitis . The acute phase is characterized by erythema, vesicular lesions , and areas of flaking that spread to the surrounding skin ( eczema march ). The vesicles are, in a second phase, replaced by crusts. In the chronic phase, that of lichenified eczema, the skin thickens. The causes are of chemical origin (hydrogen peroxide, sodium hypochlorite, strong acids and bases, formaldehyde, resorcinol, organic solvents), physical (ionizing radiation, mechanical trauma) or biological (fig or cactus latex, insect venom).
- Allergic : it is a skin reaction caused by contact with one or more substances. Among the most frequent allergens, various compounds contained in cosmetics, skin cleansers, metal objects that come into contact with the skin (zippers, jewelery items, mobile phones), fabrics (dyes, formaldehyde) and drugs. One of the most common allergic eczemas is atopic eczema (or seborrheic dermatitis) , typical of allergic people.
- Infectious : appears more often on excoriated skin, which, having lost its protective layer, is more vulnerable to the risk of infections. It is often a complication of other eczema. The entry of bacteria causes bacterial eczema , mainly of staphylococcal or streptococcal origin. L ‘ eczema fungal (or mycotic) is related to the formation of secretions in correspondence of eczematous areas.
Duration of symptoms
Eczema can occur in a mild and transient form or in an acute and transient form or even in a chronic form .
In the latter case, the duration of the symptoms varies between a few weeks and a few months; in some patients, it can last for years.
The chronic forms do not have a continuous course, but alternate periods of remission of symptoms with periods in which these, due to seasonal changes or sudden changes in temperature, reappear.
Classification based on the main component
In this case, several conditions can be distinguished.
It is also called constitutional eczema ( or atopic dermatitis or seborrheic dermatitis) and is the most common form of eczema.
It mainly affects children but can also appear in adolescents and adults, with different characteristics depending on age.
It is often accompanied by allergic manifestations in people sensitive to allergens of food origin (milk, egg, nuts, …) or present in the air (pollen, dust, feathers, …).
The seborrheic dermatitis is a multifactorial disease, which detects genetic causes : a c hereditary omponente involves a marked reactivity of inflammatory skin to normally harmless agents. This condition alters the function of the skin’s defense barrier, which thus comes into contact with substances normally kept outside.
The most affected body parts are:
- folds (elbow, knee)
- face (especially the area around the eyes and eyebrows)
In its acute phase , which lasts from one to two months, it involves:
- formation of crusts or vesicles .
Instead, in the chronic phase, scratching and rubbing create areas of dry ( xerosis ) and thickened ( lichenified eczema ) skin . In addition, red patches appear accompanied by intense itching , which tends to worsen during the night.
Among the most impacting triggers:
- seasonal changes (sudden changes in temperature and in the degree of environmental humidity)
- psychophysical stress
- presence of Staphylococcus aureus bacteria on the skin
- presence in the air of allergens such as dust mites or some molds
- contact with some substances contained in skin care products (cosmetics, perfumes, soaps)
- clothing in irritating fabrics (especially woolen ones )
- ingestion of particular foods (this occurrence is more common in the newborn).
Also referred to as contact eczema , it occurs when the body comes into contact with an irritant, usually of chemical origin (formaldehyde, nickel, aggressive acids or bases).
It can have an allergic or irritative origin. It occurs in the area of the skin where the contact took place, although it can subsequently spread to other areas of the body.
It is also known as discoid dermatitis or nummular eczema .
This eczema owes its name to the characteristic circular or oval shape of the skin patches. The causes of nummular eczema are unknown, but this condition is frequently associated with a state of dry skin .
It mainly affects adults between the ages of 50 and 70, manifesting itself with patches that appear mainly on the forearms , back , hands and feet and spare the face and scalp.
Also called dyshidrosic dermatitis (or pompholix ), it is a characteristic condition of children with a typically seasonal course, which occurs around April-May and is accompanied by:
- abnormal sweating of the palms of the hands and soles of the feet (often also between the fingers )
- appearance of small blisters and peeling.
It is sometimes associated with atopic dermatitis or spring allergies . The causes are unknown, although the disorder is associated with excessive sweating and metal allergy.
It generally affects the legs with intense itching , redness and peeling in the areas where varicose veins appear , in patients with venous circulation disorders in the lower limbs.
The main cause is poor blood circulation in the affected area, which triggers stasis dermatitis.
Some clinical pictures characterized by extreme dryness of the skin ( xerosis ) and other factors such as nutritional deficiencies ( zinc and essential fatty acids are among the most correlated elements), thyroid or central nervous system diseases, the intake of certain drugs can create the conditions for asteatotic eczema .
The main symptom of the initial phase is itching , which triggers scratching , which in turn produces real microfissurations: this aspect makes the skin similar to craquelé porcelain (which explains the name of craquelé eczema with which it is known).
Diagnosis is mainly clinical. The disease is treated with the application of emollient and cortisone creams . If not properly treated, this disease can become chronic: in the advanced stage, when purulent fluid flows from the cracks in the skin, the prevalent symptom is pain .
How long does eczema last
The acute phase can last up to 1-2 months.
During this time, inflammation of the skin causes raised, red and itchy areas to appear in which small blisters form. When the latter break, the liquid contained comes out and gives way to small round-shaped crusts .
In the phase preceding healing, the skin undergoes desquamation , which progressively improves until total healing is achieved.
In some cases, the healing process can be interrupted by a flare-up of symptoms.
The ‘ atopic eczema is strongly influenced, in its course, the patient’s age. Present since early childhood, it often regresses within 5 years of age, to reappear with greater intensity throughout adolescence and until adulthood, when the intensity of the symptoms is very low.
In general, after the first 3-4 weeks, eczema (of any type) undergoes a progressive attenuation. In cases where the symptoms remain intense after this period, it is possible that the person is still exposed, without knowing it, to sensitizing agents (which, for example, have not yet been precisely identified) or that the therapy is no longer effective.
In these cases, the disease can become chronic, lasting over time, with a discontinuous course and alternating periods of symptom remission and periods of exacerbation, which generally coincide with the changes of season.
How eczema manifests itself
The symptoms of eczema can be very different, depending on the type of the disorder.
The common and characteristic aspects of its dermatological manifestations are those related to inflammation:
- vesicles : inflammation causes the appearance of bubbles that contain exudate; when the vesicles rupture, they give way to small , round-shaped crusts , larger in the fastest-onset forms of eczema
- peeling and dry skin (xerosis): dry skin is the main cause of itching
- redness ( erythema )
- itching : this is the predominant disorder, present in different intensity; in some patients the itching can be so violent and long-lasting that it interferes with the quality of life, causing insomnia, lack of appetite and nervousness
- swelling : the erythema that accompanies eczema has an edematous appearance, with thickened skin ( lichenification of the skin)
- abrasions: scratching lesions are often present .
The intense itching caused by eczema can limit the quality of life of patients, through a reduction in the quality of sleep (penalized by frequent awakenings and restlessness), a continuous feeling of nervousness and irritability and a sense of social inadequacy .
Like all dermatological pathologies, it affects an organ, the skin , which represents the barrier that separates us from the outside world. Especially when the symptoms appear on the face, the disease has a decisive impact on interpersonal relationships . The situation can be particularly problematic when the patient is in pediatric age. Skin manifestations and itching make eczema potentially disabling in school placement and in relationships with peers.
The situation is all the more difficult the more the vicious circle is established in which the disease produces psychological malaise, which triggers or worsens states of psychophysical and emotional tension, exacerbating the symptoms and, in fact, amplifying stress .
For these reasons, psychological support may be useful , helping to accept the disease and focus on its management and stress management .
The complications of eczema
The scratching and rubbing -induced itching and discomfort caused by skin lesions may themselves be the basis of the appearance of bruises and scratches. These represent breaches in the skin through which germs of various types can enter, responsible for skin infections that can spread to the underlying tissue and adjacent lymph nodes.
The so-called infectious eczema is often a complication of other types of eczema.
The bacterial infections are mainly caused by staphylococci or streptococci .
The viral infections can lead to the formation of warts or the appearance of so-called molluscum contagiosum , skin infection due to a transmissible Poxvirus that determines the formation of growths pink or white dome-shaped.
When the cause of the infection is a fungus, the skin easily undergoes eczematous excoriations.
One of the most dangerous complications of eczema is exfoliative dermatitis , which manifests itself in its first phase with severe inflammation spread to the entire skin surface, accompanied by intense redness and characterized by a shiny appearance. Subsequently, widespread peeling of the skin appears, which thickens and becomes covered with scabs. The epidermis , or the superficial skin layer, falls into large areas of the body, sometimes followed by nails and hair .
The disease may be accompanied by itching and enlarged regional lymph nodes.
The fever high because patients a feeling of cold and violent shivers: this phenomenon is due to the heat loss that occurs through the damaged skin. Widespread skin lesions, which deprive the skin of its protective coating, result in the evaporation of large quantities of liquids, salts (sodium and potassium), iron and proteins.
This phenomenon can be fatal, not only due to the massive loss of water and electrolytes, but also due to the risk of it developing into an infection. The exfoliative dermatitis almost always requires hospitalization, necessary to give the patient the appropriate supportive care, ie the reinstatement of fluids, salts and proteins lost, the infusion of antibiotics and nutritional supplements.
The patient is also kept under thermal blankets to prevent his body temperature from dropping below threshold levels.
There are no specific tests to diagnose eczema. Based on the possible causes of eczema, the dermatologist establishes the series of tests necessary to compose the clinical picture, choosing between different possibilities.
The best way to diagnose contact dermatitis is the patch test, which evaluates the person’s possible sensitivity to certain substances. The test is performed in the clinic, by applying to the skin of the back or the deltoid some patches ( patch ) on which they are applied minimal amounts of test substances.
The patch is removed after 48-72 hours and the skin checked for any reactions. In selected cases, after another two days, the skin is re-evaluated, as some allergens take longer to trigger reactions.
The patches used for the test are hypoallergenic, so as to avoid possible overlap with the substances tested which would give false positives on the test.
The doctor’s ability to correctly read the test result is fundamental, in particular in the distinction between an irritative-type reaction and a real allergy.
Furthermore, the test provides information only on the state of awareness present at the time of its execution. It does not allow to pronounce on the future sensitivity of the patient towards that particular allergen.
Determination of antibodies
Determination of allergen-specific immunoglobulin E ( IgE ) ( allergy screening test ) can be performed to confirm the diagnosis of allergic eczema . The test is done on a sample of venous blood taken from the arm.
IgE is a class of antibodies associated with allergies. In normal conditions they are present in the blood in very low concentrations; the concentration increases significantly when an allergic reaction is triggered . The test measures the concentration in the blood of specific IgE for the allergen under consideration.
The specificity of the test against different allergens is very high, so much so that, for example, it is able to distinguish between different species of the same plant.
The specific IgE assay is used above all to confirm the diagnosis of atopic eczema ; more discussed is its use in the diagnosis of food allergies .
The diagnostic elimination diet is prescribed to assess allergy to a certain food-borne allergen, excluding foods that contain it from the patient’s diet. Any improvement in symptoms confirms the diagnosis.
also find out about food allergies
A very common example of an elimination diet is that of infants who exhibit symptoms consistent with a cow’s milk allergy. In these cases, the pediatrician recommends a special milk based on extensive hydrolysates of cow’s milk proteins, or a milk without proteins based on amino acids or soy milk.
After a variable period of time depending on the case, the food is reintroduced and the patient’s response is evaluated. In some cases, the elimination of an allergen from the diet for a certain period of time leads to a desensitization of the subject.
Controlled provocation test
This test involves the administration of foods thought to be responsible for eczema, evaluating the patient’s response.
How eczema is treated
There is no general scheme for eczema therapy. There are a number of treatments that help relieve symptoms in the acute phase and prevent flare-ups.
How to heal from eczema? Eczema cannot permanently heal with medication. It often disappears because the substance responsible for the irritation or allergic reaction has been eliminated. Other times the eczema heals spontaneously. In still other cases, hereditary predisposition and continuous exposure to irritating factors keep the eczema present over time, resulting in a series of flare-ups and alternating remissions.
In cases where a correlation between the symptoms and an external factor has been identified, the first thing to do is to remove it.
In all cases, however, it is advisable to avoid contact with irritants (perfumes, scented creams, aggressive soaps, detergents) and to protect the skin by using emollient creams and fabrics such as cotton and linen.
Drug therapies for eczema are primarily local, but oral medications are available for larger lesions and more intense symptoms .
Medicines are prescribed when eczema produces symptoms that do not improve with the introduction of specific behaviors (which will be detailed in the dedicated paragraph).
Drug therapy is generally administered locally; the systemic approach is chosen only when it is really necessary, under strict medical supervision and for a limited time, to avoid the undesirable effects of medicines.
The cortisone allow a good management of the symptoms , but they can not eliminate the ‘ eczema at the root. Their effect is limited in time and with the suspension of the treatment relapses can occur, according to a phenomenon called the rebound effect .
What to do with atopic eczema? In severe forms of atopic eczema , an innovative treatment, the so-called wet wrap therapy, is successfully used . Once a day the patient plunges into a lukewarm bath in which delicate detergents have been dissolved; then covers the area affected by eczema with an emollient cream (the doctor may prescribe the use, in some cases, of cortisone-based ointments). Finally, he wraps it with damp gauze.
This treatment allows to maintain skin hydration, reducing the loss of water through the skin and creating a barrier that limits friction and favors the absorption of drugs and emollients.
For the treatment of some eczema, especially atopic eczema, the dermatologist prescribes drugs that reduce the reactivity of the immune system. These are immunosuppressants : the most used molecules for this purpose are tacrolimus and pimecrolimus .
The European Medicines Agency ( EMA ) recently approved the first biologic drug indicated for adult patients with moderate to severe atopic dermatitis .
Dupilumab was effective in relieving intense itching and related lesions already after the first administrations, with a significant improvement in the quality of life of treated patients. Dupilumab works by inhibiting the molecules that trigger and maintain the inflammation underlying eczema.
It is administered with subcutaneous injections to be repeated every 15 days. After the first 12-16 weeks, a symptom assessment is performed.
To relieve itching, local or systemic drugs based on antihistamines can be used, the same ones that are prescribed for the treatment of allergic reactions.
Antibiotic therapy, either by mouth or for topical use, is instituted for the treatment of infectious eczema . It is a disease caused in most cases by staphylococcus , which responds well to the use of mupirocin .
In acute forms of eczema , in particular atopic, phototherapy has been used with good results . The ultraviolet light (generally using the narrow-band UV) activates shows in alleviating the itching when other treatments are ineffective.
The psychological support can be useful to manage the disease when it occurs on the face and when the itching generates interference with social life , produces irritability and nervousness and reduces the quality of sleep .
Eczema: how to cure it naturally and prevent flare-ups
Natural remedies, which consist in adopting appropriate behaviors to improve symptoms and prevent any exacerbations, can be applied in the case of mild or moderate eczema and consist of:
- cold or warm compresses with saline solution.
- daily use of creams based or ssido zinc or emollient , which keep the skin moisturized and applied at the first sign of discomfort, generate an immediate feeling of relief; emollient creams should always be applied after a shower, when the skin is still damp
- wear cotton or linen garments in direct contact with the skin , preferring them over wool and synthetic fabrics; opt for comfortable clothing, consisting of non-tight clothing, to prevent the effect of friction on the already weakened and damaged skin
- follow a balanced diet that includes adequate amounts of foods rich in polyunsaturated fatty acids (avocado, fish such as salmon, mackerel, oily fish, vegetable seeds, nuts)
- expose yourself to the sun in non-critical hours
- carry out an anti-mite remediation of your home in cases of atopic eczema (apply anti-mite mattress covers, periodically dry-clean clothes, keep the filters of air conditioners clean)
- keeping nails short , especially in children : this habit minimizes scratching injuries and the risk of infection
- for a correct management of dyshidrosic foot eczema , avoid rubber shoes and take advantage of the summer to keep the feet immersed in salt water
- keep right degree of humidity in the rooms and avoid too sharp temperature changes.
Applying natural remedies for eczema such as lemon juice and garlic , which is (wrongly) believed to be effective at some sources for treating , is of no benefit and can cause microbial contamination responsible for infections, which can worsen the course of the disease.
Hygiene and hydration
Patients are advised to reduce the number of washes . In the most severe forms, ablutions must be suspended, in order not to worsen the symptoms, and the patient can resort to dry cleansing using a soft cloth moistened with an astringent and antiseptic solution (usually a solution of of potassium permanganate ).
In all cases of eczema it is good to limit the number and duration of washes, prefer a shower to the bathroom and use lukewarm water , since hot water produces a more decisive removal of the protective phospholipid layer of the epidermis.
In order to avoid additional skin irritation, mild cleansers are recommended . The surfactants contained in normal soaps can have an aggressive action and weaken the skin’s natural defenses. There are formulated products that contain mild surfactants (such as betaines ) and eudermic substances, which are skin-friendly compounds.
In addition, cleansing oils are also valid , which dissolve superficial impurities deposited on the skin gently and by affinity.