OVERVIEW

Skin allergies are common and present in different forms at different age and body sites. Skin allergies are also called “dermatitis” or “eczema”. Both the terms are used interchangeably. Usually eczema term is used for atopic eczema and dermatitis is typically used with qualifiers (contact dermatitis).
The term “eczematous” also used to describe skin changes in form of scaling, crusting or oozing of serous fluid with itching.
We are describing common skin allergies or eczema or dermatitis here so you will be able to identify type, cause, clinical features and treatment of our skin allergy.

Types of Eczema

There are different classifications of eczema but one of the simplest and most acceptable classifications of main types of eczema is based on exogenous or endogenous nature. Exogenous eczemas are those where some external factor is triggering eczema and endogenous eczemas are mainly due to internal causes. Exogenous eczema can be managed by removing the cause if possible, whereas endogenous eczemas more often require regular pharmacological intervention.

Atopic Dermatitis

Atopic dermatitis is a chronic, itchy inflammatory skin disease that occurs most frequently in children but also affect adults. The main features of atopic dermatitis are dry skin, severe itching and hyper reactivity of skin to various external environmental factors like dust, fragrance, fabric, skin products, food, temperature etc. Clinical features varies with age:

• In Below 2 years (Infant and toddlers), atopic dermatitis present with itchy, red, oozy crusted skin lesions on extensor surface of limbs (elbow, knee), trunk, face and scalp.
• In older children and adolescents, it presents with eczema lesions in skin folds (elbow fold or knee fold or wrist joint), ankles and neck.
• In adults, atopic dermatitis is usually localized thick scaly skin lesions but skin lesions with oozing can also be seen. Sometimes patient may have generalized eczema.

In patients of atopic dermatitis, few skin findings support the diagnosis. Presence of features of atopy (palmer hyperlinearity, excess sneezing in morning or with dust exposure, ragged skin of nail folds, peri orbital darkening, lower eye lid folds, nipple eczema, pityriasis alba and generalized dryness of skin) help in diagnosing a patient with atopic eczema.

Nummular Eczema

Nummular eczema, also called nummular dermatitis or discoid eczema is a chronic, recurrent skin allergy, which is more common in middle aged people. It commonly develops on extremities rarely trunk can also be involved. It is called nummular because skin lesion is coin shaped. Itching can be of different severity.

Seborrheic Dermatitis

Seborrheic dermatitis is advanced and more severe stage of dandruff. It presents with red, greasy, scaly patches in areas of high density of sebaceous glands like scalp, eye brow, nasolabial folds, between eyebrows, behind ear, center of chest, upper back, underarms, groin and scrotum.
For more details about Dandruff and seborrheic dermatitis reat at –

Asteatotic Eczema

Asteatotic eczema usually occurs in elderly people with dry skin and involves most commonly lower extremities. It is more common in winters. Due to age related skin barrier impairment skin loses its water and causes dryness. Winters, warm water, heating, harsh detergents are common exacerbating factors. Rarely it can be associated with systemic problems like malnutrition, hypothyroidism and malignancy or side effect of some medicines like retinoids, diuretics and anti cancer medicines.
Asteatotic eczema typically presents as dry skin with superficial cracks in skin with scaling. It gives “dried river bed” appearance. Redness and itching may vary according to severity of disease. Lower limbs especially legs are most common site; upper limb can also be involved.

Stasis Eczema or venous eczema

Read more about it at : https://drkothiwalaskineva.com/medical-dermatology/varicose-eczema/

Dyshidrotic eczema

Dyshidrotic eczema or pompholyx also known as acute palmoplanter eczema characterized by severely itchy, fluid filled skin lesions on palms and soles. Among causes of hand eczema it accounts for 5 to 20% of cases. It is more common in young adults and affects male and female equally. Common risk factors are history of atopic dermatitis and exposure to contact allergen or irritants. Other factors associated with pompholyx are systemic exposure to contact allergen, id reaction (fungal infection), hyperhidrosis and smoking. It is more common in warm weather. It may be associated with stress.
It starts with episode of itching followed by sudden symmetric development of itchy fluid filled vesicles on palm, outer and upper aspect of fingers or soles. In 70-80% of patients only hands are involved. These vesicles are deeply seated and may joint with each other to form large skin lesion. They resolve with scaling. Frequent recurrence may result in chronic hand eczema characterized by thick scaly cracked skin lesions.

Pityriasis Alba

Pityriasis alba is a common skin problem that occurs mainly in children and adolescnets. It is also considered as one of manifestation of atopic eczema but it may develop in patients without atopic eczema. It is more noticeable in darker skin people. It typically presents with multiple asymptomatic hypopigmented spots that are round to oval in shape and mainly affects face, upper trunk and upper limbs. Slight redness and scaling can be present in lesions or precede development of hypopigmentation. The diagnosis is clinical but sometimes need to differentiate from other cause of hypopigmentation on face. It is self-limiting disease but sometimes it may take months to few years.

Eyelid Eczema

Eyelid eczema also known as periocular dermatitis or periorbital dermatitis, presents with a scaly, red or skin colored skin lesion on upper or lower or both eye lids with itching and burning sensation. Sometimes swelling can also be present. Eyelid dermatitis may be caused due to atopic eczema or seborrheic dermatitis or caused by contact with irritants or allergens. Common allergens are fragrance chemicals, gold jewelry with mineral based cosmetic or sunscreens and nail polish. Few topical eyedrops containing phenylephrine, gentamycin, neomycin and phenylephrine are common irritants causing eyelid eczema. Airborne contact dermatitis can also cause eyelid eczema due to exposure to irritant particles suspended in air.

Juvenile planter dermatitis

As name suggests juvenile plantar dermatosis (JPD) is a type of eczema that involves the soles and typically occurs in children aged 3 to 14 years, more often in those with an atopic diathesis (other allergic symptoms). Irritation from synthetic shoe materials, synthetic fabrics, friction, and sweating are thought to have a role in initiation and worsening of eczema.
JPD starts with dryness and itching on planter surface. Gradually skin becomes red, shiny and cracked. Sometimes deep fissures and scaling can also develop. The spaces between toes and upper aspect of feet are typically spared.
The diagnosis of JPD is usually clinical. If there is possibility of allergic contact dermatitis from leather or rubber shoes patch test can be done. Rarely KOH mount is required to rule out fungal infection.
JPD is a self-limiting condition and usually resolves spontaneously over a few years. As per severity of dermatitis oral and topical treatments are required. Avoidance of synthetic socks and shoes and frequent use of emollients are the mainstay of treatment.

Contact Dermatitis

Contact dermatitis means any dermatitis developing due to exposure of a substance to skin directly. It can be of two types: allergic or irritant contact dermatitis. Irritant contact dermatitis accounts for 80 percent of cases of contact dermatitis. In allergic contact dermatitis (ACD), an allergen induces an immune response, while in irritant contact dermatitis (ICD), the trigger substance itself directly damages the skin.

Allergic contact dermatitis

ACD usually presents an intensely itchy, eczematous eruption limited to the area of skin that comes in contact with the allergen.

Irritant contact dermatitis

It is the most common form of contact dermatitis in which contact of substances causes physical, mechanical, or chemical irritation of the skin. Common irritants include water and wet work, soaps and cleansers, bleach, solvents, acids and alkalis, plant parts, vegetables, paper, and dust or soil.
Acute ICD may present as redness, dryness, swelling, itching, burning sensation and pain. Severe ICD may cause vesicles or bullae formation with oozing. Chronic ICD characterized by thickening and fissuring in skin. Hands are the common sites for ICD and occur in food handlers, health care workers, mechanical industry workers, cleaners, and housekeepers.

Diagnosis

Dermatologist can diagnose most of eczema or dermatitis rash by clinically examining the age of patient, sites, pattern of involvement and skin lesions. Dermatologist can also identify common causes of contact dermatitis by detailed history of skin disease, occupation and daily living style of patient and clinical examination. Skin biopsy can be done to rule out possibility of close differentials. For contact dermatitis patch test can be done to identify allergen or irritant substance. Blood test for allergy doesn’t help much in identifying causative allergens for skin allergies.

Treatment

The management of dermatitis consists of identification of contact allergen, treatment of dry skin, skin inflammation and avoidance of causative factors.
Following measures can be taken for treatment of dry and sensitive skin:

• Avoid hot water for bath or facewash.
• Avoid harsh detergents/soap.
• Avoid fragrance full cosmetics.
• Use sufficient quantity of moisturizer and should be applied just after bath.
• Patients with hand eczema should avoid harsh detergents or soap for hand wash.
• After finishing work like kitchen, cement work, other occupational activities, and patient should wash hands with clean water and apply moisturizer.
• Cotton clothes should be preferred.

Treatment of skin inflammation in dermatitis or eczema

Topical medicines: the most important topical medicine is suitable moisturizer. Topical corticosteroids, calcineurin inhibitors and other keratolytic preparations can be used to combat skin inflammation according to site and severity of skin allergy.
Oral or injectable medicines: Oral steroids, methotrexate, azathioprine, cyclosporine are immunosuppressive or immunomodulators medicines which can be used for treatment of dermatitis or eczema according to acute or chronic nature of disease. Other oral medicines for itching in form of antihistaminic, for dry and scaly skin Vit D supplements and for superadded infection antibiotics can be used as per disease appearance. Sometimes biological therapies can be used for recalcitrant atopic dermatitis.

Phototherapy

Narrowband ultraviolet rays B (NBUVB) therapy is beneficial in cases of moderate to severe atopic dermatitis. Phototherapy helps in reducing burden of oral medicines also by maintaining the response achieved by oral medicines.

Avoidance of triggers and causative factors

Dermatologist suggests avoidance of certain things to control recurrence and also suggest some tips to avoid contact with known allergens. These tips are useful for preventing recurrence and fresh episodes of eczema.

FAQs

Can you get rid of eczema?

A. There is no permanent cure of eczema. There are treatments for managing sign and symptoms for long time. For achieving long symptom free period you should visit dermatologist as soon as possible once you observe symptoms.

How long does eczema last?

A. It depends on type and duration of eczema. Moderate to Severe episodes can be managed in 2-3 weeks with medicines but complete clearance of skin lesions and symptoms may take time of 8-12 weeks. Dermatologist usually doesn’t stop medicines abruptly so you should follow dermatologist even after clearance of symptoms.

Is Eczema a sign of a weak immune system?

Usually eczema develops due to autoimmunity but it can develop in patients with normal immune system.

Can you suddenly get eczema?

Eczema can develop suddenly and at any age during childhood, adolescence, or adulthood and it can range from mild to severe. Eczema is not contagious.

What should you not eat if you have eczema?

Avoidance of food or dietary restriction depends on clinical history correlation that can be identified by detailed history, skin prick test and patch test.

Why should I visit Dr Kothiwala’s SkinEva Clinic for Eczema Treatment in Jaipur?

• Dr Sunil Kothiwala is best and qualified dermatologist trained from AIIMS and has experience of 10 years in treating eczema.
• Clinic is equipped with all diagnostic methods for eczema.
• Précised and protocol based personalized treatment depending on patient and eczema type and severity.