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Eczema

About Eczema

Eczema originates from the greek word “ekzein”, which means “to boil”. Eczema is a common, non-infectious skin rash that is exacerbated by internal and external factors.

Dermatitis (derm-, derma-, dermo-, dermat(o)- Prefix denoting the skin) is a much broader term used to describe “inflammation of the skin” in general.

The terms eczema and dermatitis are used interchangeably. Demarcation between the two skin rash conditions is at times difficult; however similar treatment protocols are used for both conditions at Tirant Good Skin Clinic.

There are many forms or subtypes of dermatitis/eczema, which occur in patterns according to age (notice the overlap of certain types over varying age groups), and require treatment in order to achieve a long term remission.

INFANCY EARLY CHILDHOOD

Seborrheic dermatitis/eczema
Atopic dermatitis/eczema
Lip-Lick eczema 

Lip-Lick eczema
Infective dermatitis
Pityriasis often confused with eczema/dermatitis
Juvenile Plantar Dermatosis
Atopic dermatitis/eczema

TEENS LATE TEENS
Infective dermatitis
Pityriasis often confused with eczema/dermatitis
Juvenile Plantar Dermatosis
Atopic dermatitis/eczema

Juvenile Plantar Dermatosis
Atopic dermatitis/eczema
Adult Seborrheic dermatitis/eczema
Pityriasis often confused with eczema/dermatitis

ADULTHOOD OLD AGE  & OTHER TYPES
Atopic dermatitis/eczema
Adult Seborrheic dermatitis/eczema
Lichen Simplex
Discoid eczema
Pityriasis often confused with eczema/dermatitis 
Lichen Simplex
Discoid eczema
Asteototic eczema Pompholyx
Hyperkeratotic palmar/plantar eczema
Erythroderma (exfoliative) dermatitis/ eczema

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Common Types of Eczema

Atopic Eczema
  • The most common form of eczema. It is a chronic skin condition that usually appears in early childhood.·  A genetic condition where the protective layer of the skin is damaged. It is often associated with a  family history of  hay fever and asthma. Food allergies/intolerance’s are also often involved.
  • Characterized by itchy, dry, red and-at times-oozing lesions. The condition waxes and wanes. Triggers include allergens (pollen, animal dander, moulds, grasses), jewellery (nickel), detergents and food allergies.
Seborrheic Dermatitis
  • Skin inflammation of unknown cause also known as cradle cap in infants and children.
  • Causes scalp dandruff in adults and children.· Characterized by yellowish, oily and scaly patches of skin, mainly on the scalp, face, around the nose and behind the ears.
Nummular Eczema (Discoid)
  • Characterized by round or coin-shaped crusted and scaling lesions of inflamed skin mainly on legs, arms, hands, buttocks and back.
Neuro Dermatitis
  • Known as lichen simplex chronicus, thought to start after a bite or wearing tight rubbing clothing.
  • Characterised by extremely itchy skin, often a single patch on the neck, ankle, and wrist or in the folds of arms and legs. Lesions are raised or rough and darker than normal skin.
Stasis dermatitis / Xerosis 
  • Also known as varicose dermatitis or varicose eczema, skin inflammation on the lower legs, generally related to a poor circulation. It worsens in dry  winter weather, and limbs and trunk are most often affected. The itchy, tender skin resembles a dry, cracked, river bed. This disorder is very common among the older population. Ichthyosis is a related disorder.
Dyshidrotic Eczema
  • Known as Pompholyx. Characterized by small, clear blisters on the fingers and palms of hands, having a sponge-like appearance (blisters can also affect the toes and soles of the feet). Blisters are intensely itchy with a burning sensation.
Contact Dermatitis (CD)
  • The most common type, affecting around 75% of dermatitis sufferers.There are two types of CD
  1. Allergic (ACD) which results from a delayed reaction to an allergen, such as a plants, jewellery (nickel) or Balsam of Peru etc.
  2. Irritant (ICD) which results from a direct reaction to:- chemical ingredients e.g. sodium lauryl sulfate,latex, solvents, alkalies and some plants e.g. daisies.

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There are three basic stages of eczema/dermatitis- acute, sub-acute and chronic. Each requires treatment in order to achieve long-term remission.  

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ACUTE dermatitis/eczema: 

Skin lesions present as

• Erythema: Redness of the skin. This type of red skin rash is present at the initial stage with lesions which have ill-defined borders determined by local swelling.

• Papules: Raised red spots. This type of red skin rash has clusters of raised red spots a few millimeters in diameter; these may be mixed with tiny vesicles, on a red background. Bloody crusts form after scratching.

• Papillovesicles: Raised red spots/blisters filled with a clear fluid (serum). This type of red skin rash has clusters of raised small “pointed” or “domed” blisters that are fluid filled on a red background. “Pinpoint” erosion occurs after eruption of the blisters (vesicles – blisters filled with a clear fluid).

• Pustular: Occur after a secondary infection i.e. staphylococcus (bacteria present on the skin) or staphylococcal (bacteria present in mucus membrane). The clear fluid present in these blisters turns putrid purulent. After rupturing, the weeping forms thick greenish/yellow “pus” crusts. Other symptoms include painful and swollen lymph nodes.

• Erosive: Constant scratching of the vesicles or pustules results in severe and bloody weeping. Excoriations (“hole”) formations occur over the scratched area. The greater the scratching, the more severe the erosion. Treatment is recommended for this condition.

• Desquamative: Fine scaling may occur after the lesions have healed.

As the condition progresses, larger areas of the body are affected. Continual scratching leads to further erosion of the skin with a corresponding increase in weeping. This causes the condition to worsen, and treatment should be sought by those experiencing symptoms.

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SUBACUTE dermatitis/eczema:
This condition often evolves from recurring acute dermatitis/eczema. It is less red in colour and swelling and presents with fewer vesicles. Papules are smaller but with a significant increase in scaling of the skin.

There may also be small areas of erosion due to scratching, some weeping of “clear” fluid, some crust formations and a significant increase and severity of itching.

Subacute dermatitis/eczema often goes on to develop into chronic dermatitis/eczema, however, given a new set of stimuli may regress and present the features of acute dermatitis/eczema.

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CHRONIC dermatitis/eczema:
Without treatment, this condition often evolves from either acute or subacute dermatitis/eczema.

Lesions present as very dry, rough thickened skin. Often flaking with deep and widening crease lines in the skin will also be present. The skin will also either be lacking pigmentation (hypopigmentation) or show excessive pigmentation (hyperpigmentation) of the skin.

The constant scratching and rubbing are done subconsciously leading to thickened skin which itches even more. Easily accessible sites or creased areas are mainly involved.

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Associated Conditions:-
Approximately 50% of children with atopic dermatitis/eczema go on to develop asthma or hay fever.

Dry skin is common in all sufferers, but up to 20% are also afflicted with Ichthyosis Vulgaris.

Atopic dermatitis/eczema sufferers also appear to be susceptible to contact urticaria (hives/nettle rash). The urticaria usually represents an immediate response to certain foods, such as tomatoes, citrus fruits and marmite/vegemite. This reaction is often misleading and the “food allergy” is often incorrectly blamed for the dermatitis/eczema as well as for the resultant hives/nettle rash of the urticaria.

In medical terms, both conditions are a delayed allergic or delayed hypersensitivity reaction which can be provoked by the interaction of both external and internal factors.

External Factors Internal Factors

• Climate: Heat, cold and dryness.
• Environmental: Animal fur, synthetic fibers, plants, chemicals and cleaners.
• Sunlight/ultraviolet light
• Cosmetics: Make-up, soaps, shampoos and facial creams.
• Food

• Chronic gastrointestinal disorders
• Stress/overexertion/emotional
• Disturbed sleep patterns/insomnia
• Infections
• Metabolic disturbances
• Endocrine dysfunction

Inherited (genetics) play only a minor role Inherited (genetic) tendencies drive the condition
• Contact dermatitis
• Irritant dermatitis
• Photo allergic contact dermatitis
• infective dermatitis
• Atopic eczema/ dermatitis
• Seborrheic dermatitis
• Lip-lick eczema
• Lichen Simplex
• Pityriasis
• Discoid eczema
• Juvenile Plantar Dermatosis
• Pompholyx and hand eczema
• Asteatotic eczema