eczema

definition

By definition, eczema is a non-infectious, inflammatory skin condition that affects only the uppermost layer of skin (epidermis) and possibly the uppermost layers of the dermis, which are directly under the epidermis and interlocked with it.

Since eczema is not caused by pathogens, it is also not contagious. With a prevalence of between 3 and 20%, eczema is the most common skin disease.
It is believed that almost every person in his or her life has eczema at least once. In addition, eczema is by far the most common occupational disease.

introduction

The term " eczema " (also called skin rash, dermatitis, itching or falsely dermatitis) is a collective name for a variety of non-infectious, inflammatory diseases that affect the uppermost layer of skin.

There are many different causes that can lead to eczema, and depending on that, they can look quite different. However, a symptom course in phases is typical, whereby the acute phase is characterized by an inflamed, itchy and reddened skin.

Reliable treatment options are available for most forms of eczema, but they should be used as early as possible to avoid complications.

Causes of eczema

There are a variety of causes of eczema. In principle one differentiates between

  • endogenous (if the disease is triggered by internal factors) and
  • exogenous (if the eczema is caused by external influences) eczema.

In addition, you still differentiate between

  • acute
  • chronic eczema

and may also classify by localization (for example, hand-foot eczema).

Roughly, you can classify most eczema in three subgroups:

1. Atopic eczema
2. Contact dermatitis and
3. the seborrhoeic eczema

1. "Atopic eczema" is another term for atopic dermatitis. This is the classic representative of endogenous eczema, as atopic dermatitis is caused by various inherited factors. Here is a predisposition to allergies in general, so that the atopic eczema often occurs together with hay fever or asthma.

2. In contact dermatitis one differentiates between one again

  • allergic and
  • a toxic form.

Allergic contact dermatitis occurs when there is an allergy to a substance that comes in contact with the skin. A common example of this is nickel, other options are latex or ingredients of perfumes, creams, hair dyes.

This allergy is a type 4 allergy, which means it's a late reaction.
First, the skin must first be "sensitized" to the allergen, which is why it does not actually react until repeated contact with the substance.

Then it can take hours to days to come to a contact with the causative material to symptoms. This often makes identifying the cause more difficult.

Toxic contact dermatitis occurs when the skin has contact with harmful substances, usually chemicals, over a long period of time. This group includes, for example, acids, alkalis, detergents, solvents and detergents.

3. Seborrhoeic dermatitis is the result of increased production of sebum and a defective composition of this substance.

In addition, there are several other causes that can trigger eczema, such as UV radiation, medication, overproduction of sweat, etc.

The main risk factor for eczema in general is dry skin. Individuals who often wash their skin or stay in living rooms with dry air are more likely to develop eczema. With them, namely the acid mantle of the skin is disturbed and therefore more susceptible to external influences. Long-term UV radiation can also increase the risk of developing eczema, as it also permanently damages the skin.

Illustration causes of eczema

Figure facial eczema: causes (AE) and alternative treatment (FH)

facial eczema
(Allergic-inflammatory
conditional skin irritation)

  1. erythema
  2. swelling
  3. blistering
  4. pimple
  5. psoriasis
    Causes:
    A - Contact allergies -
    Metallic substances -
    Nikelallergie (Earrings,
    A necklace)
    B - Types of cosmetics -
    Skin creams, powders, lotions
    C - Stress -
    Mental stress,
    eczema
    (Disease of the skin)
    or psoriasis
    D - Pregnancy -
    atopic pregnancy dermatosis
    (Atopic dermatitis, hay fever,
    Bronchial asthma)
    E - Toddler -
    eczema
    (Disease of the skin),
    Milk scab (in infancy)
    Alternative treatment:
    F - Aromatherapy -
    Oils with intense scents
    (Lavender, lemon balm, thyme,
    Peppermint)
    G - Chemical substances,
    herbal substances
    (Chamomile, sage leaves,
    Marigold)
    H - bath therapy,
    Face wraps, steam baths,
    Regions by the sea
    with salty air

Symptoms of eczema

Although the eczema may differ significantly in their origin, and thus in their characteristic appearance and localization, they all have in common that they take a phase-wise course.

First of all, every eczema is in the acute phase. At this time, the acute inflammatory reaction of the skin predominates. This means that the affected skin area is reddened, itchy and often swelling due to water retention.

Sometimes, in addition to these typical changes, there are also scales, vesicles, or nodules, some of which also secrete fluid ("wet"). Over time, the bubbles dry out, causing crusts to form. Dander can also occur now. Especially if the eczema affects the scalp, dandruff is sometimes the only symptom.

Chronic eczema occurs when it repeatedly occurs in the same place or never heals properly. In this chronic stage, eczema is more characterized by thickening and scaling of the skin and a coarsening of the skin structure ( lichenification ).
Often one finds this condition in allergic eczema, which often also show discoloration in the neck or torn ear lobes (due to dry skin).
Please also read our article Rash on the neck

In addition, chronic eczema can lead to itching scratches and inflammatory nodules. At the same time, there may also be skin areas that are still in acute eczema.

Depending on the cause of an eczema, there are certain places where it occurs preferentially:

  • Atopic eczema is often noticeable in the flexion folds (for example, in the elbows or the back of the knees) or on the scalp (especially in babies as "cradle cap").
  • Contact dermatitis occurs where the allergenic agent came in contact with the skin. Since the classic representative of this group is nickel and many jewelry contain nickel, allergic contact dermatitis is often seen on the ears, wrists or around the neck - just where jewelery is worn. Light-induced eczema is found mainly on skin areas that are often exposed to the sun.

Diagnosis of eczema

The diagnosis of eczema can usually be made by a dermatologist on the basis of clinical appearance without an eye gaze diagnosis.

Nevertheless, further examinations or tests may be necessary to find out the cause of the eczema. If the medical history ( anamnesis ) provides an indication of allergy, an allergy test (depending on the type of allergy, a prick or epicutaneous test) can help.

Since often a number of triggers or risk factors come together and some of them are not directly linked to eczema by a patient (for example, by wearing jewelry or taking medication several days ago), it is often not easy to do so Reason to find eczema.

The therapy of eczema

Especially creams and ointments are used.

The treatment of eczema depends firstly on its stage and secondly on its cause. Generally, eczema is usually treated locally externally with the help of certain creams or ointments.

The worsening the eczema, the more water should contain the remedy used. On very dry skin, on the other hand, fatty ointments are used. In an acute episode ointments are usually used that contain a form of anti-inflammatory cortisone.

Antihistamines, which can generally be used in allergic eczema, can help against the itching. If an atopic eczema is present, it may be useful to take additional drugs that have an effect on the immune system and / or have a hyposensitization performed.

If local therapy is not effective, most of the medicines mentioned also have the option of taking them in the form of tablets (which gives them a systemic effect). Of course, if definite triggers of eczema have been identified, such as nickel, latex or certain medications, these substances must, of course, be avoided as consistently as possible.

Ointments for eczema

In addition to the avoidance of triggering substances or cosmetics, the therapy of eczema consists of the application of ointments. It is important that the condition of the ointment is adjusted to the skin condition.
For example, in oozing eczema an ointment with a high water content is chosen, whereas in the case of crusting and dandruff a greasy consistency is important for the care of the skin.

The ointments are particularly effective when applied in the form of envelopes. Prescription drugs such as cortisone ( a glucocorticoid ) have anti-inflammatory and local immunosuppressive effects. If the affected, open skin site as a complication infected with bacteria, so an antibiotic-containing or antiseptic ointment is applied.

Course of an eczema

In principle, eczema is treatable and therefore usually no cause for concern. However, this assumes that the cause of the eczema has been correctly identified. If this does not happen, there is a high probability that eczema will become chronic or recurrent.

In addition, eczema in case of poor treatment can be a portal of entry for pathogens and thereby secondary to an infection ( superinfection ). It is therefore important to provide adequate eczema, regardless of the cause, to avoid consequential damage.

Prophylaxis for eczema

Because there are so many different causes of eczema, there are also a number of preventative measures that are often designed to prevent a specific type of eczema. Generally, however, you can make sure to avoid dry skin, if you want to prevent eczema:

  • Do not wash the skin too often
  • Too long in the water
  • Moisten room air
  • use special, moisturizing care products
  • avoid any irritant substances (or wear gloves)
  • avoid excessive solar radiation (especially, of course, if sun-sensitive eczema is present!)

With clothes one should make sure that one grabs to skin-friendly materials such as cotton or silk and washes them before the first wearing.

In addition, of course, it goes without saying that, once you have been suffering from eczema, you are doing a so-called secondary prophylaxis, by preventing further relapses. For this purpose, it is essential to consistently avoid the triggering substance, eg nickel.

Eczema by location of occurrence

Eczema on the face

Eczema occur in addition to other parts of the body on the face.
In the facial area, eczema occurs mainly on the cheeks or around the nose.
It is important to distinguish acute from chronic facial eczema.

  • Acute eczema on the face is usually triggered by certain substances that cause an allergic skin reaction. Typical of this are the sequential occurrence of redness, itching and blistering.
  • In chronic facial eczema, on the other hand, the symptoms of redness, swelling and blistering occur simultaneously, and activation of the immune system happens differently.

Potential triggers of eczema on the face are all sorts of foreign chemical and natural substances. Mostly, the person's skin has never been in contact with it before. Cosmetics such as skin creams, powders or make-up are often the cause of most people's faces. In this case, it remains only to sell off the corresponding product in case of suspicion immediately.
Since they often use a lot more cosmetics, women are more likely to suffer from facial eczema. Likewise, children are more often affected, whereas older people are less likely to suffer from facial eczema, which is related to the decreased activity of their immune system.

In addition to discontinuation of the triggering product may be necessary depending on the severity of further treatment. In the acute stage with redness and strong itching, especially cortisone-containing ointments are used. Especially in the face, however, the right dosage and duration of use are of great importance. In later stages with oozing blisters, moist pads made from moisturizing lotions or soothing ingredients such as chamomile or black tea should be used.

Eczema in the ear

Also in the ear can occur eczema.
This can affect both the external auditory canal, as well as the inside or the outside of the auricle.

The symptoms are typical of eczema on other parts of the body. These include itching, redness and swelling and blistering. One differentiates a weeping eczema from a dry one, as well as the acute eczema from a chronic one.
If the eczema occurs on the earlobe or the pierced auricle, a nickel allergy may be the trigger. In this case, it is recommended to remove the plug immediately and switch to nickel-free jewelry.
On the other hand, if the eczema is located further inside or reaches right into the ear canal, it is advisable to consult a specialist in Otorhinolaryngology.

Eczema on the eyelid

Eczema on the eye, especially on the eyelid ( lids ), are less common than other parts of the body, but are not uncommon.
The causes of lupine eczema are manifold.

One differentiates a chronic from an acute form of Lidekzems. This can be distinguished from the dehydration eczema, which is characterized by regular lines in the epidermis.
It is more common in the elderly and has a lack of fluid of the skin as a cause. Triggers of acute Lidekzems are often contact allergies, but also can not cause allergic, plant-related skin diseases. Since the skin around the eye is the thinnest skin of our body, with only a slight allergy tendency, some substances can only cause eczema at this point, even if other parts of the body have far more contact with the corresponding substance.

By involuntary eye rubbing theoretically all substances come into question with which our hands come into contact. Most commonly, however, are cosmetics, body care and cleaning products that are well tolerated on the rest of the body, but can cause eczema on the lid. Also, contact lenses or the contact lens fluid can trigger such eczema.
For treatment, of course, the triggering agent, if known, should be avoided. Furthermore, it is recommended to use cosmetics and ointments that are labeled as non-allergenic and unscented. The use of cortisol in the eye is critical. If it can not be avoided, the period of use should be limited to a few days. In addition, nourishing ointments and envelopes of chamomile or black tea can provide relief.

Eczema at the corner of the eye

Eczema can also occur at the corner of the eye. Causes can be allergic reactions, but also viruses such as herpes zoster. Depending on the cause, treatment may include various ointments that may contain antibiotics or anti-virus medicines. Read more under: Rash on the corner of the eye

Eczema on the buttocks / anal eczema

An eczema on the butt, ie an anal eczema, is an inflammation of the skin of the anus and / or the surrounding skin ( perianal region ). The course of the disease can be acute, subacute (a little bit creeping ) or chronic. Anal eczema always occurs as a result of other dermatological or microbial diseases or as part of other diseases of the rectum or anus.
For example, cumulative toxic eczema, which is characterized by a weeping, strongly itchy anal region, occurs mainly in hemorrhoidal or intestinal parasites.

The most important treatment step is thus the recognition and therapy of the underlying disease. In contrast, contact allergic eczema is triggered by allergens, which are found in toilet paper or skin care products, for example. The products should be avoided in the future, for the care should be used only water and pure olive oil or Vaseline to avoid further irritation by potential allergens. Temporarily, the skin can be treated with local glucocorticoids.
A slightly lower proportion of anal eczema is characterized by atopic dermatitis, better known as atopic dermatitis.

  • Eczema on the buttocks
    and
  • anal eczema

The eczema of the baby

The most common form of eczema in babies is atopic ( Greek for locale ) eczema, better known as eczema.
However, this term is misleading insofar as it implies that there is an inflammation of the nerves. In Germany, up to 15% of children develop eczema, up to 60% of them in their first age.
Thus, atopic dermatitis is the most common skin disease in children. The genesis is a multifactorial cause, whereby genetic predisposition, immunological changes and environmental influences such as the child's diet (eg cow's milk is suspected as a trigger) seem to play a role.

The atopic eczema manifests itself mainly by a very dry, sensitive skin, especially the face and neck, as well as arm and squat are affected. The most distressing for the babies, however, is often very intense itching, which causes the children to scratch the diseased skin permanently.
In infants, the so-called milk scab on the scalp may be an early form of atopic dermatitis. The disease usually runs in spurts and can take from harmless to severe very different shapes and dimensions. Accordingly, the treatment needs to be adjusted.

Eczema according to its form of expression

Asteatotic eczema

Astetatotic eczema is also known as so-called exsiccation eczema or dehydration eczema.
It is an eczema that occurs due to a decreased fat content of the skin.

So-called lipids (fats) protect the skin from dehydration and are therefore very important for a healthy skin barrier.
The absence of lipids therefore results in inflammation of the skin.

Asteatotic eczema is a chronic eczema that is particularly prevalent in the elderly

  • wrong or exaggerated body care or
  • as an undesirable side effect when taking medication occurs.

Above all, medicines, such as isotrentinoin, bevacizumab or indinavir, promote dehydration of the skin.
The eczema usually occurs from the age of 60 and often worsens in winter.
Affected are especially the extensor sides of the arms, the shins and the trunk.

The asteatotic eczema resembles a "dry riverbed" with

  • deep tears in the skin,
  • Scalings and
  • superficial bleeding due to scratching by the person affected.

Astetatic eczema is treated by oiling the skin and using cortisone ointments on the affected area to control the inflammation.

Atopic eczema

Atopic eczema is commonly referred to as atopic dermatitis.

It is a chronic inflammatory skin disease that usually occurs in childhood and is associated with a disruption of the skin barrier.
It is estimated that more than 13% of children in Germany - at least temporarily - suffer from atopic eczema.
Until early adulthood, about two-thirds of the children originally affected are symptom-free again.
In adulthood, about 2 to 3% appear to be affected by atopic dermatitis.

Typical of atopic eczema is

  • a very dry skin that is prone to severe itching and eczema.
    The eczema are found in adults and adolescents, especially in the flexor, on the neck, the back of the hand and the skin folds.
    In infancy, however, the localization differs slightly and the eczema is found primarily as a so-called cradle cap on the scalp and also on the extensor sides of the arms and legs, as well as on the face.
  • Characteristic of the itchy eczema is the tendency to reddening and crusting.
  • Skin scratching causes cracks and, in the case of a lengthy course, hyperpigmentation, which causes the skin to appear darker.

There are other typical changes associated with atopic eczema, which are also called stigmata of atopy. These changes include:

  • a deep hairline,
  • a double lower lid crease - so-called Dennie Morgan sign -
  • a thinning of the lateral eyebrow (hertoghe sign) and
  • a fading of the skin when pressure is applied to it (white dermographism).

Atopic dermatitis usually occurs in combination with allergies.
These are mainly food allergies.

The therapy of atopic dermatitis includes a step therapy, which is adapted to the severity of the eczema.

  • Everyone affected receives a basic care with moisturizing and water-binding creams to strengthen the skin barrier.
  • Furthermore, trigger factors of the eczema, such as special foods or scratching garments, should be avoided.
  • In the second stage of the therapy topical cortisone creams, disinfecting lotions and tablets that inhibit itching (Antipruriginosa) and topical calcineurin inhibitors are used.
    The latter are medications that regulate the immune system.
  • Even a light therapy comes in this stage of therapy in question.
  • The ultimate measure may be a systemic immunoregulatory therapy with tablets or injections.
    Commonly used drugs include cyclosporine, azathioprine, MMF and oral cortisone.
  • For some time, newer drugs exist, which are referred to as so-called biologics.
    These are only approved for severe forms of atopic dermatitis.

Find out more about this: treatment of atopic dermatitis

Dyshidrotic eczema

Dyshidrotic eczema is an eczema that affects the palms and soles and usually occurs in batches.

Characteristic of the dishydrotische eczema is the appearance of about 0.1 cm large bubbles with a clear content.

The dishydrotische eczema may be in the context of various underlying diseases, such as

  • an atopic eczema,
  • a psoriasis palmoplantaris or
  • a mycosis occur.
  • It may also be due to allergic contact dermatitis or
  • occur as a drug side effect.

Furthermore, the cause is often unclear, then one speaks of an idiopathic dyshidrotic eczema.

The eczema occurs mostly in the warm season.
The small, clear blisters, which are characteristic for the eczema, usually appear suddenly and grouped on the side parts of the fingers and palms - analogously also on the feet.
The blisters itch very much.

In an amalgamation of the bubbles to larger bubbles one speaks of a Pompholyx.
In this case a bacterial or mycotic (fungal) infection of the eczema can occur as a complication.

The dyshidrotic eczema is associated with

  • local cortisone preparations,
  • Light therapy and
  • Care of affected areas treated.

In case of a more severe infestation, however, cortisone tablets are taken for therapy.

Allergic contact dermatitis

Allergic contact dermatitis is the result of contact of the skin with a triggering allergen.

A typical allergen that many people react to is nickel, for example.
Therefore, jewelry is almost always produced nickel-free today.

Other common allergens include fragrances, Perubalm, chromium and cobalt.

Allergic contact dermatitis is one of the common diseases in Germany.
Typically occurs after about 24 to 48 hours of contact with the allergen

  • mostly blurred limited, red plaque on,
  • that itches strongly and
  • rises above the skin level.

When a very serious reaction arises

  • big bubbles that
  • burst open and leave crusts and erosions.

If the allergen repeatedly comes into contact with the skin, chronic eczema develops, which is characterized by a scaly plaque formation with crusts and erosions as well as a coarsening of the skin appearance.

The therapy of allergic contact dermatitis includes above all the avoidance of the allergen, as well as local cortisone preparations.

Irritative contact dermatitis

Irritant contact dermatitis is often referred to as toxic contact dermatitis.

It is a direct damage to the skin by an external cause, such as contact with an acid.
In more than 90% of the cases the hands are affected, less often the feet.

One differentiates thereby

  • acute from
  • chronic irritant contact dermatitis.

Acute dermatitis is caused by direct contact with a sufficient dose of the causative agent.
Chronic irritant contact dermatitis is a creeping consequence of constant contact with a substance that has low toxicity.
These can be, for example, household cleaning products.

Over a longer period of time, the skin barrier is damaged.
Typically, it is a sharply limited eczema, which occurs only at the point where the skin had contact with the toxic substance.
The appearance of the eczema includes

  • flaking,
  • redness,
  • crusts
  • Tears and
  • a blistering.

The therapy consists in a strict avoidance of the triggering cause, as well as a local treatment with cortisonhaltigen ointments.
If an occupational disease is suspected, a professional medical procedure must be initiated and appropriate safety precautions taken at the workplace.

Nummular eczema

The nummular eczema characteristically shows refractory, coin-shaped, scaly plaques, which sometimes itch very much.

The plaques are found all over the body and can occur as a concomitant of congestive dermatitis.
The exact cause of the nummular eczema is unclear.

It discusses a connection to diseases such as atopic dermatitis, psoriasis or chronic microbial colonization of the skin.

Men are more frequently affected than women, with eczema on their lower legs and, more rarely, thighs, back and palms.

There is no uniformly effective therapy for nummular contact dermatitis.
Therapy may include oral antibiotics and local cortisone preparations.
In severe forms of eczema additional light therapies and internal cortisone therapy come into question.

Seborrheic dermatitis

Seborrhoeic dermatitis affects mainly men between the ages of 40 and 60 and is more common in HIV and Parkinson's patients.

The cause is an interaction of excessive sebum production of the skin and an over-colonization with the yeast fungus Malassezia furfur.
The eczema improves with sunlight and worsens due to stress.
Typically, it occurs in places with increased sebum production, such as:

  • the hairy scalp,
  • the front and rear welding channel,
  • the cheeks,
  • behind the ears and
  • the nose and mouth region.

The eczema shows coin-shaped, reddened foci with a yellow-greasy scaling.
In part, a strong itching occurs - especially in an attack of the scalp.

Seborrheic dermatitis is often a gaze diagnosis.
In very young patients with severe seborrhoeic eczema, HIV diagnosis should be performed as seborrhoeic dermatitis is more common in HIV.

The therapy includes the use of creams or shampoos containing the antifungal agent ketoconazole, as well as outdoor and sun stays.
With a very high spread local cortisone preparations can be used.

In most cases symptom-free intervals can be achieved.
Healing of the eczema is not possible, however, so that there is always a spread of skin lesions.

As a special form exists the seborrheic infant eczema, which is also known as head gneiss.
The eczema mainly affects the scalp and occurs immediately after birth.
It disappears by itself after a few months.
The seborrheic infant eczema must not be confused with the milk scab, which usually occurs after the third month of life and is accompanied by itching.

Disseminated eczema

The disseminated eczema is one of the extremely rare manifestations of eczema.
Women of this form are even more rarely affected than men.

In disseminated eczema, various affected skin areas occur mainly on the arms and legs.
In most cases, the symptoms occur again and again after treatment.

What is Eczema and How Is it Treated? (December 2019).


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