Eczema

Eczema

Eczema is the name given to a broad clinical variety of common, itchy, inflammatory skin diseases.
The spectrum of clinical features range from redness or oedema, mimicking urticaria or angio-oedema to a profusion of signs with blistering, weeping and crusting, or thickened pigmented areas of skin with scaling.

Whatever the cause of the eczematous process, it involves both the dermis and the epidermis layer of the skin. If the eczematous reaction is severe there will be damage and eventual destruction of the epidermal cells. Whatever the degree of inflammation in the epidermis there is disordered keratinization.

The Causes of Eczema

Eczema is often triggered by an allergy to food, pollen, animal fur or other substances and is likely to run in allergy-prone families. In fact, many people with eczema have (or later develop) hayfever. Most have higher than normal amounts of histamine in their bodies. Eczema can also be triggered or aggravated by dry air, too much sun and stress.

General Features of Eczema

While atopic eczema itches severely, most eczemas only itch moderately and some not at all. Eczematous skin completely reverts to normal on healing. This means that any anatomical damage is confined to the epidermis.

Varieties of Eczema

A major textbook of dermatology lists 25 named varieties; the most common are:

Irritant and allergic contact Eczema: Irritant contact eczema is five times more frequent than allergic contact eczema. Any irritant penetrating into the epidermis can produce eczema. Allergic eczema is a cell-mediated immunological reaction.

Seborrhoeic Eczema: The lesions are red, sharply marginated (unlike many other forms of eczema) and covered with greasy scales. They appear in areas richly supplied with sebaceous glands.

Asteatotic Eczema: Asteatotic means without fat and this form of eczema is associated with a decrease in skin surface lipids.

Gravitational Eczema: This is the preferred term for eczema of the lower leg related to venous hypertension.

Pompholyx: Pompholyx (vesicular eczema of the palms and soles) means a bubble, cheiropompholyx refers the palms and pedopompholyx to the soles.

Discoid Eczema: Nummular Eczema, This condition is characterised by discoid lesions of eczema, a chronic inflammation of connective tissue.

Atopic Eczema: Most common type and generally associated with asthma and hayfever, very itchy. The chronic phase is characterised by lichenification and marked xerosis.

Treatment of Eczema

To the uninitiated the spectrum of clinical features of eczema can be as confusing as the choice of treatment. Successful treatment requires a skilful appreciation of aetiological factors, the psychological impact of the disease and the ability of the patient to carry out the therapeutic procedures correctly. Foremost, it also requires the therapist to be conversant with a variety of therapeutic agents that he or she has at his or her disposal since several can be associated with contra-indications and side-effects which can be systemic or local.

Therapeutic Agents:
Topical/Systemic Corticosteroids, Antihistamines, Antibiotics, Anti-virals, Anti-microbials, Keratolytics, Emollients, Lotions, Wet Dressings, Soaks, Tars, Paste bandages, PUVA therapy and Environmental measures.

Some of the side effects could be:
Skin atrophy, Steroid-induced rosacea, inhibition of melanocyte activity, allergic contact eczema, glaucoma, spread of infection, effects of occlusion (folliculitis, candidiatis).