Dermatology
Eczema

Overview:

  • It is a chronic condition where the skin is dry, causing itchy and red patches of the skin.
  • Anyone can get eczema; however, it is more common in children.
  • There are several types of eczema, and you can get more than one type at the same time.
  • It is not exactly known why eczema occurs, but it may be a mixture of genetic and environmental factors. 
  • Hay fever and asthma are top risk factors.
  • Identifying the type of asthma you have and its triggers are essential for starting treatment an controlling the condition.

What is allergy?
It is a reaction of the immune system of a person who is allergic to some substances (e.g., vaccines, mites, fungi, some food, etc). These substances don’t normally affect people who don’t have allergies.
The immune system usually fights off harmful substances that enter the body; however, in the case of allergies, it wrongly fights off some substances that aren't usually harmful (false alarm) by producing anti-histamines, which, in turn, cause allergy symptoms. People with allergies are usually allergic to more than one substance.

What is eczema?
A generic name for some types of allergies that affect the skin, some due to genetic factors and the other acquired. Symptoms range from skin dryness to redness and the formation of small water bubbles and crusts associated with severe itching. It comes in a variety of forms and shapes, and varies from one person to the other.

Names: Eczema, dermatitis, atopic dermatitis

Types of eczema:
  1. Endogenous eczema (atopic/ structural inflammation): A common condition that affects children at an early age starting from the first forty days of age and lasts for several years. Its first sign is redness in the cheeks with the formation of scales and vesicles associated with itching, often due to a family history of infection with one of the types of allergies such as: allergies in the chest, eyes and nose (hay fever), similar to dry milk in front of the head that expands with age and often disappears before school age. Its types include:
    • Fatty eczema:
    • A common condition that often affects the scalp or fatty areas of the body (e.g., nose, ear, eyelashes, eyebrows, and chest) causing redness, itching and dandruff. In infants, it can cause cortical spots in the head, and fungi may play a role in that.
    • Dyshidrotic eczema: often appears in the form of small bubbles accompanied by itching of the skin, and the most common places for its appearance are on the fingers and toes, palm and sole.
    • Discoid eczema: a skin problem that leads to blisters in the form of red scaly tablets that cause itching or burning.
    • Chronic simple allergy
  2. Exogenous eczema (contact): The reaction of the immune system towards touching certain irritants that come in contact with the skin, causing redness and itching in the area. Exogenous eczema is of two types:
    1. Allergic contact dermatitis: This requires prolonged and repeated exposure to the allergen.
    2. Toxic Contact dermatitis: This appears immediately after exposure to the allergen (like Henna painting) and is severe taking the form of large skin bubbles.
  3. Stasis eczema: Occurs in people with poor circulation, usually appearing in one or both legs as it is the furthest area the blood can reach. it is rare to appear in other areas. Swelling of the ankle, which disappears upon sleep and appears during the day, is the first of its signs.
  4. Neurodermatitis: Begins with itchy attacks that appear in any area of the skin (often affecting the back of the neck, arms, legs, or genital areas and around it). The attack may be severe and persistent, causing scratches and ulcers on the skin. Mostly, attacks happen in times of relaxing or sleeping, causing the person to wake up. A person may develop several types of eczema at the same time.

Cause:
The exact cause of eczema is unknown, but doctors believe it is a combination of genetic and environmental factors. 
People with eczema may have an imbalance in the gene responsible for the formation of a protein that contributes to the building of a protective layer of the skin. When it does not form enough, the skin moisture fades and bacteria enter, so the skin of the infected is very dry and more susceptible to infection.

Symptoms:
The symptoms of eczema can be anywhere from mild to severe. These symptoms can also vary from a person to another. They include: 
  • Dry sensitive skin
  • Skin redness and irritation
  • Severe itching
  • Skin color change
  • Scales or rough spots
  • Swelling of some areas

A person with eczema can have some or all of these symptoms, and they may go away after a while. It is advisable to see a doctor to check if it was eczema.

When to see a doctor?
  • Your symptoms hinder you from going about your normal daily routine or makes it difficult for you to sleep.
  • You find signs of eczema like red lines, pus, or yellow scales.
  • Your symptoms don't go away despite treatment.

Risk factors:
  • Personal or family history of eczema, or any type of allergies (hay fever or asthma).
  • Milk does not cause eczema at any age but may affect its severity from some types of formula and additives or preservatives.

Who is at high risk?
Eczema affects all age groups and often appears in children, and those who recover from childhood are more likely to develop it in the future.

Complications:
  • Possibility of getting a bacterial or viral infection.
  • Asthma and hay fever.
  • Chronic itching and skin scaling. 
  • Sleep problems: Frequent waking up at night due to itching may cause sleep problems.

Diagnosis:
Your doctor will make a diagnosis by examining your skin and reviewing your medical history. 
Patch testing or other tests may be performed to rule out other skin conditions or identify the causes of your eczema.

Treatment:
Knowing the type of eczema and its triggers is the best way to start treatment and control so as not to impede normal life, and attempts to try different methods may require several months or years, however, even in response to treatment may show signs and symptoms.

If normal hydration and other self-care steps are not enough, your doctor may recommend one of the following treatments and medicines:
  • Creams that control itching and inflammation
  • Infection control medications (e.g., antibiotic ointments)
  • Oral antipruritic drugs

Skin care:
  • Avoid the following causes of eczema:
    • Some skin irritants (e.g., some types of soap, some fabrics, creams)
    • Psychological stress
    • Substances to which the patient is allergic (e.g., some foods, animals, pollen).
  • Avoid extreme heat and extreme cold.
  • Ensure continuous moisturizing with suitable and fragrance-free creams.
  • Avoid itching as much as possible and know its causes.

FAQs:
Does taking long showers trigger or treat eczema?
Water can be the best treatment for many skin conditions if you:
  • Take lukewarm showers.
  • Avoid soap or use only mild soap.
  • Avoid rubbing your skin with coarse towels and loofahs. 
  • Moisturize your skin immediately after a shower.
  • Avoid all kinds of soaps when your skin is irritated.
  • It is best to take your showers in the evening to maintain skin moisture for as long as possible.
  • Moisturize your hands after every wash.
  • Wear cotton gloves to maintain the moisture of your hands.
  • Avoid long and daily showers as these can cause dry skin.

How can I relieve itching?
  • Make sure you wear cotton clothes as these can allow your skin to breath. Avoid synthetics and wool, which can easily irritate your skin.
  • Wash new colored clothes before wearing them to remove residue dye.
  • Clip your nails.
  • Moisturize your skin regularly.
  • Sleep in a colder room.
  • If you find that your child is itching, distract them.
  • Cover your baby's hands with cotton gloves during sleep.

What is a patch test?
In this test, substances that the patient is suspected to be allergic to is added to a patch (looks like an adhesive tape) and then placed on the patient’s back where there is no eczema. The patch remains on for 48 hours and then gets removed. After two days, the doctor examines the location of the patch to see if there is any irritation on the skin so the patient's sensitivity to that substance can be confirmed.

Is it true that adding bleach (e.g. chlorine), salt, oatmeal, vinegar, or baking soda to bath water cures eczema?
Adding these substances does not treat eczema. On the other hand, using Vaseline and oils on your body after showering while your skin is wet can be beneficial.

Myths & Truths
Eczema is contagious.
Truth: Eczema is not a contagious condition.


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Last Update : 16 July 2021 05:00 AM
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