Eczema (Atopic eczema)

Atopic eczema Description, Causes and Risk Factors: Alternative Name: Atopic dermatitis. Abbreviation: AD. Other types May Include: Allergic eczema, baker eczema, chronic eczema, dyshidrotic eczema, eczema erythematosum, eczema herpeticum, eczema intertrigo, eczema papulosum, eczema parasiticum, eczema pustulosum, eczema tyloticum, eczema verrucosum, eczema vesiculosum, flexural eczema, hand eczema, infantile eczema, lichenoid eczema, nummular eczema, seborrheic eczema, stasis eczema, tropical eczema, varicose eczema, weeping eczema, winter eczema Atopic eczema is synonymous with atopic dermatitis. It is an itchy, inflammatory skin condition that is usually chronic or relapsing. It is primarily flexural in its distribution in children and adults, but in infants facial and truncal involvement predominate. Atopic eczema is common and the prevalence is increasing. Eczema affects 15-20% of school children and 2-10% of adults. The large majority (about 80%) of cases present before the age of 5 years. Atopic eczema is often associated with a personal or family history of atopic eczema, asthma, and allergic rhinitis. In one series 60% of adults with atomic eczema had children with the same disease. Some eliciting factors in extrinsic atopic eczema are foods like eggs, milk, peanuts, fish, soybeans and wheat. Inhalants, especially dust mites and exotoxins of Staphylococcus aurous can induce eczema in predisposed individuals. Skin dehydration by frequent bathing, skin infections, winter season and woolen clothing in contact with skin and emotional stress are known to be exacerbating factors. Lifestyle and environmental factors play a role in the expression of atopic eczema. Small family, higher income and education, Western lifestyle and increased use of antibiotics are considered risk factors in developing atopic eczema. These findings have been supported by studies, which show that T-helper (Th) type 1 immune responses are responsible for fighting infections. T-helper (Th) type 2 immune responses are responsible for producing allergies. Since Th 1 immune responses deter the development of type 2 T helper cells, decreased childhood infections and thereby decreased type 1 immune signals may possibly predispose children to more allergies like atopic eczema. The following, which can be triggers that cause eczema to flare up:
  • Excessive heat.
  • Excessive cold
  • Sweating.
  • Dry air (use a humidifier).
  • Chlorine.
  • Harsh chemicals.
  • Soaps, bubble bath.
  • Grass during grass pollen season (May and June).
  • People with fever blisters.
During the first year of your child life, avoid:
  • Cow's milk products.
  • Soy.
  • Eggs.
  • Peanut butter.
  • Wheat.
  • Fish.
Symptoms:Atopic eczema
  • The main symptom of mild eczema is an area of fine, dry scales, often on the arms or legs.
  • Blisters with oozing and crusting may present.
  • The skin may or may not itch.
  • The most common areas of itching are the fronts of the elbows, backs of the knees, and face. However, any area of skin may be affected.
  • The skin may be sensitive to scratchy fabrics, especially wool.
Diagnosis: Your medical provider will examine your skin. He/she will examine your skin and will ask you about your medical history of rashes and about other problems such as allergies or asthma. The health care provider may also perform skin biopsy to rule out other possible causes, but this is not always needed to make the diagnosis. Tests May Include: Allergy Testing: The best test of whether your child's eczema is caused by a particular substance (e.g. cats, dogs, etc) is your own observation. Food allergies are sometimes more difficult to identify. If you suspect that a particular food is worsening your child's eczema, then exclude that food completely for 6 weeks and at the end of that period, give your child the food again to observe for symptoms. For more acute results perform RAST (radioallergosorbent assay test, this is a blood test that tells us if your child has antibodies in the blood, which could react to common substances that can cause allergies. A positive RAST test to a particular substance is not very helpful in predicting whether avoiding that substance will help your child's eczema. On the other hand, a negative RAST test is sometimes helpful in suggesting that your child is not allergic to that substance. Skin prick test: What happens in the prick tests may have very little to do with your child's atopic eczema, the skin prick test result may reflect another allergy linked with asthma or hay fever, and positive skin prick tests are common in people who do not have any obvious allergic disease. Patch tests: Sticky patches containing various substances are placed on your child's back. This type of test is used to investigate people with suspected contact dermatitis. Treatment: General Measures: The first principle of eczema treatment is to avoid those things that make eczema worse. Irritants like soaps and bubble bath should be avoided and substituted with an oily or emollient alternative. Allergens like dog dander must be minimised and measures taken to reduce the house dust mite in the child's environment. Clothing and bed covers should be 100% cotton if possible. Heat and perspiration may make the itch intolerable. Therefore the child's environment should be kept cool. In particular, the bedroom should be well ventilated. Keep child fingernails cut short, and wash the child's hands frequently to avoid infecting the rash. Steroid Creams: This is the primary treatment used for eczema. Use as directed by your health care provider. Apply steroid cream at the first sign of itching. Antihistamines taken by mouth may help with itching or if you have allergies. Some antihistamines can cause sleepiness, but may help with scratching while sleeping. Lubricating cream: Eczema always results in dry skin. Apply an outer layer of lubricating cream (Keri, Lubriderm, Nivea, Nutriderm, etc) cream to the entire skin surface while it is still damp after a bath. The cream should be applied after the steroid cream. Do not use ointments, petroleum jelly, or vegetable shortening; these block the sweat glands, which can cause itching and make the rash worse. Ointment may be necessary, however, in severe cases of eczema. Bathing: Water-soaked skin is far less itchy, so daily bathing is important. Small children should be cleaned without soap, because eczema is very sensitive to soaps. Teenagers must use some soap, however—particularly under the arms, on the genital area, and the feet. Shampoos must be avoided. Disclaimer: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.  


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