Eczema

The term eczema is used to describe all kinds of red, blistering, oozing, scaly, brownish, thickened, and itching skin conditions.  Examples of eczema include dermatitis, allergic contact eczema, seborrheic eczema, and nummular eczema.

When the disease starts in infancy, it's sometimes called infantile eczema.  This itching, oozing, crusting condition tends to occur mainly on the face and scalp, although spots can appear elsewhere.  In attempts to relieve the itching, the child may rub their head and cheeks and other affected areas with a hand, a pillow, or anything within reach.  Parents should know that many babies improve before two years of age.  Proper treatment can be helpful, sometimes controlling the disease until time solves the problem.

Incidence; Causes and Development

The term atopic describes a group of allergic or associated diseases that often affect several members of a family.  These families may have allergies such as hay fever and asthma but also have skin eruptions called atopic dermatitis (AD).  While most people with AD have family members with similar problems, 20% may be the only one in their family bothered by this problem.  AD is very common in all parts of the world.  It affects about 10% of infants and 3% of the U.S. population overall.  The skin rash is very itchy and sometimes disfiguring.

The disease does not always follow the usual pattern.  It can appear on the palms or backs of the hands and fingers, or on the feet, where crusting, oozing, thickened areas may last for many years.

Emotional tension can provoke and aggravate itching in patients with AD and, according to a number of studies, AD patients show higher levels of anxiety, hostility and neurosis than matched controls.  Neurodermatitis is a form of atopic dermatitis characterized by a self-perpetuating scratch-itch cycle.  Although symptoms increase in times of stress, physiological changes in the nerve fibers are also present.

Signs and Symptoms

Symptoms can include: intense itching, blisters (vesicle formation) with oozing and crusting, skin redness or inflammation around the blisters, and rash.  In children under 2 years old, skin lesions begin on the cheeks in infants and may progress to the scalp, arms, trunk, and legs; they may also exhibit dry, leathery skin areas (lichenification), more or less pigment than their normal skin tone (normally found in the inner elbow or behind the knee).  It may spread to the neck, hands, feet, eyelids, or behind the knee.  Raw areas of the skin (excoriation) may arise from scratching and ear discharges or bleeding.

Amongst teens and young adults the eruptions typically occur on the elbow bends and backs of the knees, ankles and wrists, and on the face, neck and upper chest.  Although these are the most common sites, any body area may be affected.  An itching rash as described above, along with a family history of allergies, may indicate atopic dermatitis.

Diagnosis and Tests

Diagnosis is primarily based on the appearance of the skin and on personal and family history.  The health care provider should examine the lesions to rule out other possible causes.  A skin lesion biopsy may be performed, but is not always required to make the diagnosis.  This disease may result in an increased eosinophil count.

Treatment and Prevention

Proper, early and regular treatment by a dermatologist can bring relief and also may reduce the severity and duration of the disease.

The historic use of arctium lappa and other inulin-containing herbs for eczema has scientific validity.

Prognosis

The condition often improves during childhood, and almost always before age 25.  About 60% of patients have some degree of dermatitis and some suffer throughout life.

If the disease continues or occurs beyond infancy, the skin has fewer tendencies to be red, blistering, oozing and crusting.  Instead, the lesions become dry, red to brownish-gray, and the skin may be scaly and thickened.  An intense, almost unbearable itching can continue, becoming severe at night.  Some patients scratch at their skin until it bleeds and crusts.  When this occurs, the skin may become infected.