Allergic eczema: Description
Eczema: Generic term for inflammatory conditions of the skin, particularly with vesiculation in the acute stage, typically erythematous, edematous, papular, and crusting; followed often by lichenification and scaling and occasionally by duskiness of the erythema and, infrequently, hyperpigmentation; often accompanied by sensations of itching and burning; the vesicles form by intraepidermal spongiosis; often hereditary and associated with allergic rhinitis and asthma.
Eczema is used as a general term for many types of skin inflammation (dermatitis) and allergic-type skin rashes. There are different types of eczema, like allergic, contact, irritant, and nummular eczema. Several other forms have very similar symptoms. The diverse types of eczema are listed and briefly described below. Atopic dermatitis is typically a more specific set of three associated conditions occurring in the same person including eczema, allergies, and asthma. Not every component has to be present at the same time, but usually these patients are prone to all of these three related conditions.
Allergic eczema: Macular, papular, or vesicular eruption due to an allergic reaction, e.g., contact dermatitis.
Alternative Names: Infantile eczema; Atopic dermatitis; Dermatitis - atopic.
Atopic dermatitis is a very common, often chronic (long-lasting) skin disease that affects a large percentage of the world's population. It is also called eczema, dermatitis, or atopy. Most commonly, it may be thought of as a type of skin allergy or sensitivity. The atopic dermatitis triad includes asthma, allergies (hay fever), and eczema. There is a known hereditary component of the disease, and it is seen more in some families. The hallmarks of the disease include skin rashes and itching.
The word "dermatitis" means inflammation of the skin. "Atopic" refers to diseases that are hereditary, tend to run in families, and often occur together. In atopic dermatitis, the skin becomes extremely itchy and inflamed, causing redness, swelling, cracking, weeping, crusting, and scaling. Dry skin is a very common complaint and an underlying cause of some of the typical rash symptoms.
Although allergic eczemacan occur in any age, most often it affects infants and young children. In some instances, it may persist into adulthood or actually first show up later in life. A large number of patients tend to have a long-term course with various ups and downs. In most cases, there are periods of time when the disease is worse, called exacerbations or flares, which are followed by periods when the skin improves or clears up entirely, called remissions. Many children with atopic dermatitis enter into a permanent remission of the disease when they get older, although their skin may remain somewhat dry and easily irritated.
Multiple factors can trigger or worsen allergic eczema, including dry skin, seasonal allergies, exposure to harsh soaps and detergents, new skin products or creams, and cold weather. Environmental factors can activate symptoms of atopic dermatitis at any time in the lives of individuals who have inherited the atopic disease trait.
Allergic eczema is very common worldwide and increasing in prevalence. It affects males and females equally and accounts for 10%-20 % of all referrals to dermatologists (doctors who specialize in the care and treatment of skin diseases). Atopic dermatitis occurs most often in infants and children, and its onset decreases substantially with age. Scientists estimate that 65% of patients develop symptoms in the first year of life, and 90% develop symptoms before the age of 5. Onset after age 30 is less common and often occurs after exposure of the skin to harsh conditions. People who live in urban areas and in climates with low humidity seem to be at an increased risk for developing atopic dermatitis.
About 10% of all infants and young children experience symptoms of allergic eczema. Roughly 60% of these infants continue to have one or more symptoms of atopic dermatitis even after they reach adulthood. This means that more than 15 million people in the United States have symptoms of the disease.
Atopic dermatitis is the most common of the many types of eczema, and sometimes people use the two terms interchangeably. But there are many terms used to describe specific forms of eczema that may have very similar symptoms to atopic dermatitis. These are listed and briefly described below.
Allergic eczema appears in individuals who have a family history of allergy. Besides eczema, they may be have other manifestations of allergies such as asthma or seasonal sneezing as well.
No matter which part of the skin is affected, Allergic eczema is almost always itchy. Sometimes the itching will start before the rash appears, but when it does the rash most commonly occurs on the face, knees, hands or feet. It may also affect other areas as well.
Affected areas usually appear very dry, thickened or scaly. In fair-skinned people, these areas may initially appear reddish and then turn brown. Among darker-skinned people, eczema can affect pigmentation, making the affected area lighter or darker.
In infants, the itchy rash can produce an oozing, crusting condition that occurs mainly on the face and scalp, but patches may appear anywhere.
With children, it begins in the first year of life. The skin on the cheeks, scalp and at the creases of the body is dry and cracked. Because of itching and irritation, it is red and sometimes oozing.
Initial lesions consist of dryness and redness over the skin with uniform pinhead-size eruptions. There is an oozing of serum from these lesions.
Crusts form oozing vesicles there and the whole area gets infected with bacteria, producing pus. At this stage, the child not only has irritation locally but may also have a general reaction in the body in the form of fever.
If the eruptions become chronic are aggravated by continued rubbing and scratching, swelling and thickening of the skin may result. Chronic lesions darken the colour of the skin as well.
Causes and Risk factors:
The exact cause of allergic eczema is not known. Although it is activated by the immune system and is related to allergic reactions, it is not the same as other allergic reactions. People with eczema do have the IgE antibodies (immunoglobulin E) produced by the immune system as part of allergic reactions.
Contact with the external trigger (allergen) causes the skin to become inflamed. The duration of the contact is not important. Eczema can develop on first contact (in days to weeks) or over time with repeated contact (in months to years).
Causes of allergic eczema may be susceptibility to certain foods, pollens and dusts or to certain substances with which the skin comes in contact, and in latent allergens in adults. Wool and nylon clothes are also known to aggravate the lesions in some cases.
Allergic contact eczema (dermatitis) is caused by an external substance - the allergen coming into contact with the skin of someone who is allergic to this particular substance. The allergen itself is not usually harmful, but the skin's immune system gets confused, and 'attacks' the allergen as if it were fighting an infection. The allergen does not have any effect on someone who is not allergic or sensitized to it, and it is possible to develop an allergy after many years of trouble-free contact with the allergen. In fact, someone rarely becomes allergic to an allergen if they have only been in contact with it a few times. Most everyday allergens only trigger allergies after repeated exposure.
Among factors which often have an unfavourable influence on the course of the disease are rapid changes in temperature, emotional tensions, dusty environments, alkaline cleansing agents, including common toilet, soaps, contact with greasy topical medicaments and infections like cold and sinusitis. Diseases associated with high fever, however, often exert a temporary beneficial action.
Common triggers of allergic eczema include the following:
Severe forms of eczema are caused by powerful allergic responses to external agents that cannot be eliminated from the environment. Risk factors for allergic eczema include the following:
- Weather (hot, cold, humid, or dry).
- Environmental allergens.
- Food handling.
- Emotional or mental stress.
Many factors or conditions can intensify the symptoms of atopic dermatitis, including dry skin, winter or cold weather, wool cloths, and other irritating skin conditions. These factors may further trigger the itch-scratch cycle, further stimulating the many times already overactive immune system in the skin. Repeated aggravation and activation of the itch-scratch cycle may cause further skin damage and barrier breakdown. These exacerbating elements can be broken down into two main categories: irritants and allergens. Emotional factors and some infections can also influence atopic dermatitis.
Atopic dermatitis is generally easily diagnosed based on a physical exam and visual inspection of the skin by a physician or dermatologist. Additionally, the history given by the patient and contributory family history help to support the diagnosis. A physician may ask about any history of similar rashes and other medical problems including hay fever (allergies) and asthma. While currently there may be no single specific laboratory test that says unequivocally "this is atopic dermatitis," a skin biopsy (a sample of a small piece of skin that is sent to the lab for examination under the microscope) may be helpful to establish the diagnosis in harder cases. Additionally, gentle skin swabs (long cotton tip applicator or Q-tip) samples may be sent to the lab to exclude infections of the skin which may mimic atopic dermatitis.
Since itching tends to be the main common symptom of the disease for many patients, it is not possible to say all itching is atopic dermatitis. Itching may be seen in many other medical conditions that have nothing to do with eczema. Each patient experiences a unique combination of symptoms, and the symptoms and severity of the disease may vary over time. The doctor bases the diagnosis on the individual's symptoms and may need to see the patient several times to make an accurate diagnosis. It is important for the doctor to rule out other diseases and conditions that might cause skin irritation. In some cases, the family doctor or pediatrician may refer the patient to a dermatologist or allergist (allergy specialist) for further evaluation.
A valuable diagnostic tool is a thorough medical history, which provides important clues as to the possible causes of the patient's ailment. The doctor may ask about all of the following: a family history of allergic disease, whether the patient also has diseases such as hay fever or asthma, exposure to irritants, sleep disturbances, any foods that seem to be related to skin flares, previous treatments for skin-related symptoms, use of steroids, and the effects of symptoms on schoolwork, career, or social life. Sometimes, it is necessary to do a biopsy of the skin or patch testing to determine if the skin's immune system overreacts to certain chemicals or preservatives in skin creams. A preliminary diagnosis of atopic dermatitis can be made if the patient has three or more characteristics from each of two categories: major features and minor features. Some of these characteristics are listed in the box below.
Skin scratch/prick tests (which involve scratching or pricking the skin with a needle that contains a small amount of a suspected allergen) and blood tests for airborne allergens generally are not as useful in diagnosing atopic dermatitis as a medical history and careful observation of symptoms. However, they may occasionally help the doctor rule out or confirm a specific allergen that might be considered important in the diagnosis. Negative results on skin tests are reliable and may help rule out the possibility that certain substances are causing skin inflammation in the patient. However, positive skin scratch/prick test results are difficult to interpret in people with atopic dermatitis and are often inaccurate. In some cases, where the type of dermatitis is unclear, blood tests to check the level of eosinophils (a type of white blood cell) or IgE (an antibody whose levels are often high in atopic dermatitis) are helpful.
- People with severe eczema usually also have hay fever and asthma.
- Eczema is probably hereditary and often is found in other family members.
- Eczema is not contagious.
The goal of treatment is to relieve and prevent itching, which can lead to infection. Since the disease makes skin dry and itchy, lotions and creams are recommended to keep the skin moist. These solutions are usually applied when the skin is damp, such as after bathing, to help the skin retain moisture. Cold compresses may also be used to relieve itching.
Over-the-counter or prescription creams and ointments containing corticosteroids, such as hydrocortisone, are often prescribed to reduce inflammation. For severe cases, your doctor may prescribe oral corticosteroids. In addition, if the affected area becomes infected, your doctor may prescribe antibiotics to kill the infection-causing bacteria.
Other treatments include antihistamines to reduce severe itching, tar treatments (chemicals designed to reduce itching), phototherapy (therapy using ultraviolet light applied to the skin) and the drug cyclosporine for people whose condition doesn't respond to other treatments.
The FDA recently approved two new drugs known as topical immunomodulators (TIMs) for the treatment of mild-to-moderate eczema. The drugs, Elidel and Protopic, are skin creams that work by altering the immune system response to prevent flare-ups.
Good skin care is a key component in controlling eczema. Proper care of the skin can often be enough in many milder cases of eczema.
In treating allergic eczema, most doctors will start patients on basic therapies. A good moisturizer (in cream, lotion, or ointment form) helps conserve the skin's natural moisture and should be applied immediately after showering or bathing and one other time each day.
Corticosteroid creams and ointments have been used for many years to treat eczema. Your doctor may recommend application of over-the-counter hydrocortisone cream in mild cases but often will prescribe a stronger steroid cream when the eczema is more severe. When other measures have failed, the doctor may prescribe oral corticosteroid medication; steroids should always be taken with caution and never without medical supervision.
Newer drugs called topical immunomodulators are available to help treat eczema. These medicines help control inflammation and reduce immune system reactions when applied to the skin. Examples include Elidel and Protopic. These drugs are thought to be as effective as corticosteroids.
The FDA has issued its strongest "black box" warning on the packaging of Elidel and Protopic. The warning advises doctors to prescribe short-term use of Elidel and Protopic only after other available eczema treatments have failed in adults and children over the age of 2. Younger children should not take these medications.
Taking oral antihistamines may also help relieve symptoms. Some of these may cause drowsiness, which may be of benefit if nighttime itching is a problem.
For extreme cases of allergic eczema, therapy using ultraviolet light may be prescribed. In adults, drugs that suppress the immune system may also be an option in the more severe cases. These medicines, such as cyclosporine or methotrexate, may be used in cases when other treatments have failed.
To relieve stress and improve circulation, it also helps to take a brisk walk or exercise on a regular basis. Set aside time for other relaxing activities.
Home remedies for eczema may be as simple as changing your laundry detergent or as difficult as moving to a new climate or changing jobs. Removing whatever is causing the allergic reaction is the easiest and most effective treatment.
- Prevent dry skin by taking warm (not hot) showers rather than baths. Use a mild soap or body cleanser. Dry yourself very carefully and apply moisturizing skin lotions all over your body. Avoid lotions with fragrances or other irritating substances.
- Avoid wearing tight-fitting, rough, or scratchy clothing.
- Avoid scratching the rash. If you can't stop yourself from scratching, cover the area with a dressing. Wear gloves at night to minimize skin damage from scratching.
- Anything that causes sweating can irritate the rash. Avoid strenuous exercise during a flare.
If the allergy-causing agent cannot be removed or identified, the next step is to lessen the allergic inflammatory response.
Medicine and medications:
- Apply a nonprescription steroid cream (hydrocortisone) along with anti-itching lotion (menthol/camphor, such as calamine). The cream must be applied as often as possible without skipping days until the rash is gone.
- Diphenhydramine (Benadryl) in pill form may be taken for the itching. Caution - you should not take this medication if you need to drive a car or operate machinery as it will make you sleepy.
- Clean the area with a hypoallergenic soap every day. Apply lubricating cream or lotion after washing.
Emollients and moisturizers: These skin moisturizing creams and ointments, the mainstay of allergic eczema treatment, are completely safe and should be applied liberally at least two or more times per day to hydrate and protect the skin. Some people may find that a few of these preparations irritate their skin; if this occurs another product should be tried. Different emollients include Emulsifying Ointment (HEB), White Soft Paraffin, Aqueous cream (UEA), Diprobase and Lipobase with Cetomacrogol, Epaderm, and Oilatum cream. Sometimes coal tar is applied to treat thickened skin. Oilatum Plus is an excellent bath emollient. Aveeno is an oatmeal based emollient for very dry skin. Balneum contains soya oil. Beware of emollients containing peanut or Arachis oil - these may trigger peanut allergy. Lanolin containing creams may trigger Contact Dermatitis.
Cortisone and Steroid Creams
: These produce rapid relief and are used for short periods to settle eczema flare-ups. They may also be used for longer periods when diluted in an emollient in which case treatment should be tapered off slowly. However, their long-term use may lead to thinning of the skin. Some of the newer steroid preparations seem to be much safer. Cortisone tablets or injections are very rarely, if ever, used in eczema.
Wet Wraps: These are applied at night to keep moisture in the skin, aid absorption of creams and to protected against scratching. First of all, emollients and steroid creams are applied to the eczematous areas. Elasticated cotton-based tubular dressings are soaked in luke-warm water and then cut to size so that they cover the affected areas. These can be applied overnight to the limbs, trunk, neck and even face (holes are cut in the dressing to allow apertures for eyes, ears, nose and mouth). This treatment is highly successful for severe weepy allergic eczema, which is non-responsive to emollients and steroid creams.
Antibiotics: Allergic eczema sufferers are more prone to skin infections such as staphylococcal bacterial, fungal and viral infections, including the common wart). Antibiotic creams and occasionally oral antibiotics are prescribed to treat infected eczema, which may present with sudden development of crusting, oozing and redness of the skin.
Antihistamines: The older sedating type antihistamine tablets or syrup such as Chlorpheniramine (Piriton) will reduce itching especially at night. Antihistamine creams may sensitise the skin and should be avoided. Newer long acting anti-histamines such as Cetirizine, Fexofenadine and Desloratidine have also proved to be very good for reducing skin inflammation. Avoid antihistamine creams on the skin as these can sensitise the skin and actually cause rashes.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.