eczema

Definition eczema

Eczema is an eczema that occurs in infants as a cradle cap and in later life mainly affects the elbow, popliteal and neck.
An eczema is an acute or chronic disease of the epidermis (so-called epidermis) with extensive skin lesions that are not clearly distinguishable from the healthy skin. It is an inflammation.

The reasons

The causes of atopic dermatitis are not fully understood yet. There seems to be connections between the very complex disease process and the individual processes with genetic factors, changes in the body's defense system and environmental influences. Even a psychosomatic component does not seem to be the cause of atopic dermatitis.

Genetic factors seem to make people more responsive to certain influences than others. However, the exact scientific evidence for this theory is still missing.
The predisposition is inherited on several genes. However, the onset and the existence of the disease is also dependent on many external (exogenous) factors and internal (endogenous) modulation factors. Exogenous factors include food allergens, and endogenous factors include infections and mental factors.

A skin barrier defect is always at the onset of atopic dermatitis. This may be due to local inflammation or a primary defect in the function of certain skin cells. This cell defect increases the release of messenger substances that attract inflammatory cells. A complex immunological process is initiated, which corresponds to an allergic reaction. In addition, the barrier function of the skin is further disturbed, as the body's defense causes further skin defects. Another theory of the cause of atopic dermatitis suspected behind the disease, a kind of autoimmune disease in which the body's defense system is directed against the skin's own cells.

Another cause could be a colonization of the skin and the mucous membrane by micro-organisms. It has been found that on the skin and in the paranasal sinuses of people with atopic dermatitis often prevails an excessive colonization with bacteria of the species Staphylococcus aureus . These bacteria penetrate into the skin through the already existing skin defects and produce enterotoxins. Enterotoxins are toxic proteins against which the body's own immune system forms antibodies. In this way the inflammatory reaction of atopic dermatitis is intensified. Similar enhancement reactions are conceivable in fungi such as Pityrosporum ovale or Candida albicans as well as in various viruses.

The pathogenesis

In the disease of atopic dermatitis several disorders play a role.
Allergen contact leads to an inflammatory reaction in which immunoglobulins and messenger substances, so-called cytokines, play a major role. The itching is triggered mainly by the subsequent release of histamine from certain cells.
Biochemical disorders include, for example, the decreased sebum secretion from the sebaceous glands of the skin. This results in dry skin with reduced barrier function. Therefore, there is a loss of water, reduced skin protection coat with easier penetration of foreign substances and increased itching.

All these disorders have a certain genetic disposition, so we are given the tendency to eczema on our genes.

The symptoms

The skin symptoms are usually symmetrical and the dry skin is often accompanied by severe itching, which leads to a desire for scratching in the patients. However, this aggravates the situation by causing weeping eczema. Depending on the age of the patient, different symptoms occur.

In case of atopic dermatitis in infancy, pyogenic inflammatory eczema, especially in the face and head are typical ("cradle cap"). In 50% of the babies there is a spontaneous regression.
In childhood, there is often a coarsening of the field skin (skin of the hand and foot inner surfaces), a deep, weeping abrasion and dry skin. All these symptoms occur in children especially in the popliteal, elbow, skin and ankle joints, as well as the neck. In adolescence and adulthood, there are chronic enlargements of the pelvic skin with nodules, especially on the face, neck, flexors of the arms and legs, and on the backs of the hands and feet.

Wide features of the atopic dermatitis patients are a double eyelid fold (Dennie Morgan fold) and a paradoxical vascular reaction: in the patients who suffer from atopic dermatitis, scratching does not result in red but white traces (white dermatographism ).

There are also so-called minimal variants of atopic dermatitis known. It is possible, for example, that atopic eczema occurs only on the earlobe, on the eyelids and on the tips of the fingers and toes.

The itching

The itching is at the forefront of atopic dermatitis. Although the sites of predilection, that is, the location of the rash, differ between the different age groups, the itching of the skin is always one of them. This can occur even if the skin is only dry and not red. Partially, the itching is so severe that the skin is scratched bloody. Especially at night, when those affected can no longer deliberately suppress the scratching stimulus, it often leads to severe scratching attacks, which worsens the skin condition and retards the healing of the skin areas.

In addition, the itching can promote skin infections, as it is easier for bacteria to penetrate into scratched skin. Therefore, treatment of itching is very important.

The localization

Eczema on the face

The face is especially affected in babies of eczema. As the skin becomes more susceptible to allergens as a result of atopic dermatitis, the face is especially affected in infancy, puberty and adulthood when facial skin reacts to, for example, cosmetics, other care products or clothing.

The treatment of eczema on the face is possible. In general, care should be taken that the skin, which is generally dry in those affected, is cared for daily with moisturizers. In this case, creams can be used, which additionally bind moisture (hydrophilic creams) and creams that reduce the water loss of the skin (moisturizing creams). In the treatment of eczema on the face with cortisone-containing ointments, special care should be taken because the skin on the face is already thinner than on the rest of the body and cortisone makes the skin thinner (atrophied). Therefore, only low-effective cortisone ointments containing, for example, hydrocortisone are to be applied to the face. In order to treat the eczema optimally, consultation with a dermatologist should be consulted.

Eczema on the eyes

The neurodermatitis in the eyes is especially in puberty typical, but can also occur in any other age. This leads to red eyelids. The skin is very dry and can also shed. Since the atopic dermatitis is an inflammatory reaction of the skin, the eyelids are often swollen due to the skin disease. If no other skin areas are affected, the eye reaction must be strictly differentiated from an allergic reaction. Normally, however, other body regions are found, such as elbow bows or backs of the hands, which are also affected by atopic dermatitis.

In addition, the itching, which is also found on the eyelids, is distressing. Especially at night sufferers scratch the skin sore. Since the risk of skin infections is greatly increased, it is essential to have treatment. The care of the eyelids is a little more difficult, because it should be ensured that the care products do not get in the eye and the skin reaction does not increase.
In the acute inflammatory thrust, the use of cortisone-containing creams is usually unavoidable. Since the skin on the eye is very sensitive and thin, only low-effective creams prescribed by the dermatologist should be used.

Atopic dermatitis of the scalp

The scalp is primarily infested with infants. Atopic dermatitis is also referred to as cradle cap in this case. There are itching nodules and blisters. The skin is dry and flaky. In the later course, other parts of the body are typically affected. In rare cases, however, the scalp may also be affected during puberty or adulthood. Again, it comes to a strong itching and reddened, dry skin.
The eczema on the head is triggered especially when the sensitive skin reacts to, for example, shampoos, hair dye products or the fabric of a cap. Even too frequent hair washing can dry out the scalp and provoke atopic dermatitis. The triggers should be avoided in any case to reduce further thrusts.

Rashes and scaly skin on the head are all in all, however, signs of another skin disease: psoriasis. To get the right diagnosis, a dermatologist should be consulted if skin rashes and dry skin on the scalp occur. Basically, shampoos should be used that do not irritate the scalp, so do not contain fragrances or preservatives. In addition, shampoos should be used to moisturise the scalp, with products that contain urea (urea), which additionally binds water.

Eczema on the hand

Atopic dermatitis often occurs on the back of the hand and on the fingers. This is especially noticeable when it gets cold outside and dries out the already dry skin even further. Therefore, it is important to pay attention to sufficient moisturizing care, especially during the winter months. In addition, certain occupational groups of eczema on the hands are particularly affected. These are mainly occupations that deal with skin-irritating substances.
These include hairdressers, for example, whose frequent contact with water, shampoos and hair dyes can irritate the hands. Here then often the interdental spaces are strongly affected. The rash can then occur on the palms. Nursing and healing professions, in which disinfectants are used, are more frequently affected by eczema on the hands.

The eczema on the hands is also shown by a red, itchy rash. Scratching can make the skin sore and wet. Therapy is possible during acute inflammation, especially with cortisone creams. Since often a change of occupation is not simply possible or wanted, it can be attempted to wear gloves when working with skin-irritating substances - such as in the hairdressing profession - in mild atopic dermatitis. Care should be taken, however, that under the gloves - often made of latex or nitrile gloves - cotton gloves are pulled because the material also a skin reaction can be triggered.

  • Eczema of the hand.
  • Eczema on the finger and fingernails

Eczema in the elbow

The elbow is a special predilection site (spot where eczema is particularly common) in atopic dermatitis. Skin rash is particularly common in childhood, adolescence and adulthood. The rash is red, interspersed with small nodules and itches usually strong. Especially when heat or sweat occurs in the elbow, the itching may increase.

To prevent atopic dermatitis care should be taken not to wear scratchy clothing. In acute episodes, it is usually possible only with the help of a cortisone cream to reduce the inflammation. Since the atopic dermatitis is provoked by dry skin, it should also be avoided to shower several times a day. After showering, it is necessary to take care of the skin with moisturizing lotions that are suitable for sensitive and allergy-prone skin. Lotions which contain urea, which additionally binds water, are particularly suitable for this purpose. If the itching is particularly severe, creams containing polidocanol can be used. These stun the skin superficially and remove the itching. During the night, cotton gloves can be worn to prevent the skin from being scratched with sharp nails, thus preventing inflammation or delaying healing.

Eczema in the genital area

Atopic dermatitis is not common. This is mainly due to the reaction of the skin to allergens, such as the wrong shower gel. The shaving of pubic hair can provoke the onset of atopic dermatitis.

Since the use of cortisone creams in the genital area is to be treated with particular care, it is essential to consult a dermatologist. Cortisone easily enters the body in this area and can therefore cause particularly strong side effects.

Eczema in the baby

Atopic dermatitis is often the first time between the third and sixth month of life. 60% of the diseases manifest within the first year of life. In the baby the atopic dermatitis begins as a so-called milk scab. The name comes from the fact that the skin has a similarity to burnt milk. It shows itching nodules, blisters, crusts and scales.

The rash is mainly in the face, on the head and the extensor sides of the arms and legs. This contrasts sharply with the elderly sufferers, who are particularly affected by the flexors of the arms and legs. Partially, other skin areas on the trunk are affected. In the baby, the diaper region is usually not affected by the rash.

It is important to treat the baby's skin as there is an increased risk of bacterial skin diseases on the affected skin. To prevent eczema in the baby, the babies should be breastfed for four to six months. The baby's diet with hypoallergenic baby food is also recommended.

The diagnosis

There are several different criteria for the diagnosis. The leading symptoms, the most important and common symptoms, are dry skin and itching.

The main criteria include:

  • itching
  • dry skin
  • Typical appearance (eczema, coarsening of the field skin, nodules)
  • Typical localization (child: face, outer sides of arms and legs, adolescent: bending of elbows, knees)
  • Occurrence of eczema in the family or already in the patient himself
  • Chronic and / or repeated course

Also, the history (medical history), ie the questioning of the patient to his health, his environment, etc., should be collected conscientiously. Here are many clues to the emergence to be found.
Blood tests are examined for the amount of immunoglobulins, in particular of the IgE type. However, IgE may be elevated in allergies. An increase thus provides no proof of the existence of atopic dermatitis.

The treatment

The treatment of atopic dermatitis is adapted to the course of the disease and the severity of the symptoms. It can be used as a guide to a step pattern, which must be adjusted individually.

The first stage of the therapy is for dry skin and consists of a basic skin care that stabilizes the barrier function of the skin and makes the skin less sensitive to irritation and allergens. In addition, provocation factors that increase atopic dermatitis should be largely avoided.
If mild eczema occurs, external agents may be used as the second stage of therapy. Frequently used ointment additives are, for example, evening primrose oil, St. John's wort extract, dexpanthenol or zinc. Also antiseptic agents can provide relief in atopic dermatitis, especially when it comes to excessive colonization of the skin with bacteria or fungi. Since atopic eczema is often associated with severe itching, the second treatment stage also includes the treatment of itching, which can happen, for example, with tanning preparations. Even so-called antihistamines can reduce itching.

If more severe inflammatory symptoms occur, ointments with anti-inflammatory agents are used, but most commonly with the drug group of glucocorticoids (cortisone). The glucocorticoids act against itching, inflammation of the skin and relieve severe atopic dermatitis flare-ups. Depending on the nature and severity of the symptoms, different agents are used. For the second stage of neurodermatitis therapy, weak or moderate glucocorticoid drugs are sufficient.
In severe episodes, severe glucocorticoids may be externally applied in the third stage when moderate eczema occurs. Irradiation with high-dose UV light can have anti-inflammatory effects on the affected skin and allow temporary healing.

Prolonged or severe eczema may require systemic therapy (Level 4) in addition to the treatment options already mentioned. In these cases, internal use of cortisone may be considered. The most severe form of atopic dermatitis is cyclosporin A. Cyclosporin A often causes atopic dermatitis to be very rapid, but it also has severe side effects, which is why it is not generally recommended. Cyclosporin A, for example, can lead to increases in blood pressure, kidney damage or gum proliferation and may favor the occurrence of malignant tumors.

  • Treatment of atopic dermatitis
  • photodynamic therapy

cortisone

Cortisone is used in atopic dermatitis, especially in the acute inflammatory phase. Above all, the cortisone is applied directly to the skin by means of cream. It so relieves the inflammation and also helps against the itching. Most of the itch disappears within a few hours, the redness usually goes back within a few days.

Since cortisone makes the skin thinner, which is also called atrophy of the skin, cortisone should not be used too often. It can also lead to wound healing disorders, as cortisone lowers the immune system. In severe skin involvement, a cortisone therapy in tablet form is possible. However, this can lead to severe side effects such as high blood pressure, water retention or osteoporosis. The application should therefore be made only in consultation with a doctor.

Various creams

An atopic dermatitis disease is associated with a very dry skin. It makes sense to treat this dry skin with a gentle skin care cream. For this, ointments, creams and lotions can be used, which offer a high proportion of fat and moisture. This daily basic care should be used regularly to stabilize the barrier function of the skin. In addition, the sensitivity of the skin to allergens and irritations should be reduced by skincare.
The composition of eczema creams depends on the current condition of the skin. As a rule, oil-in-water emulsions are used; for very dry skin, water-in-oil emulsions can also be used. e

Since a skin affected by atopic dermatitis has a very low concentration of urea, urea-containing creams can help to reduce the characteristic dryness of the skin. However, the use of urea on the skin can lead to further irritation or painful burning when applying even irritated or cracked skin.

Many other additives in creams for eczema to improve the moisturizing ability or the healing process of the skin. Thus, specific active ingredients such as evening primrose oil, St. John's Wort extract, zinc or dexpanthenol are added to the creams to nourish the skin. The Multilind ® healing ointment, which contains zinc oxide as active ingredient, can be used, for example, as a care product for atopic dermatitis.

A cream for atopic dermatitis may also contain antiseptic agents. If the skin is overly populated with bacteria or fungi, for example, triclosan, chlorhexidine or antibiotics may be used externally. An additional treatment with diluted chlorine bleach (sodium hypochlorite solution) can also improve the condition of the skin when it is colonized with the bacterium Staphylococcus aureus .
When the rash is wet, tanning creams are available. These have a drying, antipruritic and slightly anti-inflammatory effect. Stronger relapses of atopic dermatitis are treated with cream containing immunosuppressants, mostly cortisone. Cortisone-containing creams can be used in different concentrations and ointment bases. For mild symptoms or on the face, hydrocortisone creams are often sufficient. Since cortisone has many side effects, the indication for the use of cortisone-containing creams should be personalized by a specialist.

home remedies

There are many different home remedies that can be used in atopic dermatitis. Since not all home remedies have the same effect on every person affected, sufferers must individually test what helps and what does not. On the one hand, home remedies are used to increase the moisture of the skin. On the other hand, home remedies can be used in the acute episode of inflammation and itching to delay the use of cortisone.

For example, Aloe Vera gel can relieve itching through its cooling and soothing properties. Water-diluted apple cider vinegar (ratio 9: 1) can also be applied to the skin. Apple cider vinegar has an anti-inflammatory effect and can also be effective against redness and itching. Yogurt or cottage cheese applied to the skin, have a cooling and thus itching effect. The yoghurt or cottage cheese is simply washed off after it has dried. St. John's wort oil can also soothe the skin affected by atopic dermatitis.

Hyaluronic acid gel can be applied to provide the dry skin with more moisture. Also, coconut oil is a home remedy that can reduce the symptoms of acute rash. In addition, it moisturizes. However, the oil should not be applied directly to the skin, but first mixed with a skin-friendly base cream (ratio base cream to coconut oil 9: 1). If this mixture is stored in the refrigerator, it can also reduce the itching in acute inflammations due to the cooling effect.

What role does the psyche play in atopic dermatitis?

Atopic dermatitis is not a neurological or mental illness. However, an emotional burden can provoke the onset of atopic dermatitis. These include stress, anger, grief or even nervousness. So many sufferers also report that atopic dermatitis gets worse when they are not feeling well.

However, since sufferers often suffer from the salient symptoms - especially when the facial rash occurs - it is often a vicious circle, as this emotional burden can exacerbate eczema. Also, one should take the suffering of neurodermatitis patients seriously, as it may result in further mental stress and also the withdrawal from social life.

What is an eczema thrust?

A push indicates the period in which the symptoms of a chronic illness occur. The symptoms may worsen or show on previously healthy skin. In atopic dermatitis, certain triggers are often involved in the onset of thrust.

The thrust can - with proper treatment - be restrained again. How long a thrust lasts depends also on the treatment of the affected skin.

What are the triggers for a boost?

The triggers of a push in atopic dermatitis are very diverse and sometimes very unspecific. For example, dust exposure can provoke the rash within a very short time. Also heat accumulation, for example during the sport, when the skin gets too warm and starts to sweat, can trigger the neurodermatitis. In the winter months, the skin dries out due to cold weather. Since the skin of neurodermatitis is already dry anyway, it comes through the additional drying of the skin to the onset of the rash.

Emotional stress such as stress or grief can also cause a boost. Partly the symptoms worsen even with infections. Skin irritations, for example through skin-irritating substances such as creams or scratchy clothing, can also lead to skin rashes.

Many other stimuli can cause the onset of atopic dermatitis, so it should be individually determined what makes the neurodermatitis worse and these factors are avoided.

Is eczema contagious?

Eczema is not contagious. Although the cause of atopic dermatitis is not yet clear, genetic predisposition is suspected. This means that, first, the eczema is heritable and often further skin disease can be found within the family. Inherited is a predisposition to the increased formation of antibodies that are involved in inflammatory reactions and allergies: the so-called IgE antibodies.

Furthermore, those affected are suspected of having a skin barrier that causes water to leak from the inside out, causing the skin to dry out and become more susceptible to environmental stress.

Can you cure atopic dermatitis?

Atopic dermatitis is a chronic disease that is not curable. If the first symptoms occur in infancy, it may be hoped that the symptoms will decline during puberty and adulthood. Only in a few cases does it come to a strong expression of atopic dermatitis in adulthood. Spontaneous regressions are possible at any time, ie in every age group.


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