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Types of common eczemas

Atopic eczema (aka infantile e., flexural e., atopic dermatitis) is an allergic disease believed to have a hereditary component, and often runs in families whose members also have hay fever and asthma. Itchy rash is particularly noticeable on head and scalp, neck, inside of elbows, behind knees, and buttocks. Experts are urging doctors to be more vigilant in weeding out cases that are, in actuality, irritant contact dermatitis. It is very common in developed countries, and rising.

Contact dermatitis is of two types: allergic (resulting from a delayed reaction to some allergen, such as poison ivy or nickel), and irritant (resulting from direct reaction to a detergent, such as sodium lauryl sulfate, for example). Some substances act both as allergen and irritant (wet cement, for example). Other substances cause a problem after sunlight exposure, bringing on phototoxic dermatitis. About three quarters of cases of contact eczema are of the irritant type, which is the most common occupational skin disease. Contact eczema is curable provided the offending substance can be avoided, and its traces removed from one’s environment.

Xerotic eczema (aka asteatotic e., e. craquele or craquelatum, winter itch, pruritus hiemalis) is dry skin that becomes so serious it turns into eczema. It worsens in dry winter weather, and limbs and trunk are most often affected. The itchy, tender skin resembles a dry, cracked, river bed. This disorder is very common among the older population. Ichthyosis is a related disorder.

Seborrhoeic dermatitis or Seborrheic dermatitis ("cradle cap" in infants) is a condition sometimes classified as a form of eczema which is closely related to dandruff. It causes dry or greasy peeling of the scalp, eyebrows, and face, and sometimes trunk. The condition is harmless except in severe cases of cradle cap. In newborns it causes a thick, yellow crusty scalp rash called cradle cap which seems related to lack of biotin, and is often curable.




Less common eczemas

Dyshidrosis (aka dyshidrotic e., pompholyx, vesicular palmoplantar dermatitis, housewife’s eczema) only occurs on palms, soles, and sides of fingers and toes. Tiny opaque bumps called vesicles, thickening, and cracks are accompanied by itching which gets worse at night. A common type of hand eczema, it worsens in warm weather.

Discoid eczema (aka nummular e., exudative e., microbial e.) is characterized by round spots of oozing or dry rash, with clear boundaries, often on lower legs. It is usually worse in winter. Cause is unknown, and the condition tends to come and go.

Venous eczema (aka gravitational e., stasis dermatitis, varicose e.) occurs in people with impaired circulation, varicose veins and edema, and is particularly common in the ankle area of people over 50. There is redness, scaling, darkening of the skin and itching. The disorder predisposes to leg ulcers.

Dermatitis herpetiformis (aka Duhring’s Disease) causes intensely itchy and typically symmetrical rash on arms, thighs, knees, and back. It is directly related to celiac disease and can often be put into remission with appropriate diet.

Neurodermatitis (aka lichen simplex chronicus, localized scratch dermatitis) is an itchy area of thickened, pigmented eczema patch that results from habitual rubbing and scratching. Usually there is only one spot. Often curable through behavior modification and anti-inflammatory medication. Prurigo nodularis is a related disorder showing multiple lumps.

Autoeczematization (aka id reaction, autosensitization) is an eczematous reaction to an infection with parasites, fungi, bacteria or viruses. It is completely curable with the clearance of the original infection that caused it. The appearance varies depending on the cause. It always occurs some distance away from the original infection. (L30.2)
There are also eczemas overlaid by viral infections (e. herpeticum, e. vaccinatum), and eczemas resulting from underlying disease (e.g. lymphoma). Eczemas originating from ingestion of medications, foods, and chemicals, have not yet been clearly systematized. Other rare eczematous disorders exist in addition to those listed here.



Side effects
Prolonged use of topical corticosteroids is thought to increase the risk of possible side effects, the most common of which is the skin becoming thin and fragile (atrophy).[6] Because of this, if used on the face or other delicate skin, only a low-strength steroid should be used. Additionally, high-strength steroids used over large areas, or under occlusion, may be significantly absorbed into the body, causing hypothalamic-pituitary-adrenal axis suppression (HPA axis suppression).[7] Finally by their immunosuppressive action they can, if used without antibiotics or antifungal drugs, lead to some skin infections (fungal or bacterial). Care must be taken to avoid the eyes, as topical corticosteroids applied to the eye can cause glaucoma [8] or cataracts.

Because of the risks associated with this type of drug, a steroid of an appropriate strength should be sparingly applied only to control an episode of eczema. Once the desired response has been achieved, it should be discontinued and replaced with emollients as maintenance therapy. Corticosteroids are generally considered safe to use in the short- to medium-term for controlling eczema, with no significant side effects differing from treatment with non-steroidal ointment.[9]

However, recent research has shown that topically applied corticosteroids did not significantly increase the risk of skin thinning, stretch marks or HPA axis suppression (and where such suppression did occur, it was mild and reversible where the corticosteroids were used for limited periods of time). Further, skin conditions are often under-treated because of fears of side effects. This has led some researchers to suggest that the usual dosage instructions should be changed from "Use sparingly" to "Apply enough to cover affected areas," and that specific dosage directions using "fingertip units" or FTU's be provided, along with photos to illustrate FTU's.[10]





Diet and nutrition

Recent studies provide hints that food allergy may trigger atopic dermatitis. For these people, identifying the allergens could lead to an avoidance diet to help minimize symptoms, although this approach is still in an experimental stage. [35]

Dietary elements that have been reported to trigger eczema include dairy products and coffee (both caffeinated and decaffeinated), soybean products, eggs, nuts, wheat and maize (sweet corn), though food allergies may vary from person to person.[citation needed] In certain individuals eczema is triggered by MSG (monosodium glutamate).[citation needed]

Recently German scientists discovered that a diet rich in Omega-3 may be able to reduce symptoms. [36] Vegetarian sources that are most beneficial are wheatgerm oil and Evening Primrose oil and animal sources include Cod-liver oil, although some individuals may be allergic to seafood.[citation needed]


Alternative therapies
Non-conventional medical approaches include traditional Chinese medicine and Western herbalism. There is a wide variety of treatments, each of which may vary from individual to individual as to efficacy or harm. Chinese medicine is known for successfully and permanently resolving eczema. In Chinese Medicine diagnosis, eczema is often a manifestation of underlying ill health. Treatment works by improving the overall health of the individual, therefore not only resolving the eczema but improving quality of life (energy level, digestion, disease resistance, etc.).[37] A recent study published in the British Journal of Dermatology describes improvements in quality of life and reduced need for topical corticosteroid application[38]. Another British trial was carried out in 47 children with extensive nonexudative atopic eczema, over an eight week treatment period. Active intervention comprised ten different plants traditionally used in Chinese medicine for eczema treatment. Of the 37 children analysed, for erythema scores there was a 51% decrease (95% CI 34.5 to 72.6) with active and a 6.1% decrease (95% CI -25.2 to 30.7) for placebo. For surface damage scores there was a 63.1% decrease (95 CI 34.5 to 72.6) with active and a 6.2% decrease (95% CI -25.2 to 30.7) with placebo. Both scores suggest a benefit with herbal remedy.[39]

It must be emphasized that Traditional Chinese Medicine is a licensed medical profession and must only be prescribed by physicians with proper education and board certification.[40]Patients should inform their doctor/allergist/dermatologist if they are pursuing one of these treatment routes.

Alleged remedies include:

Oatmeal is a common remedy to relieve itching, and can be applied topically as a cream or, as a colloid, in the bath. It is also part of many commercially available products intended for eczema treatment and for other skin conditions.
Sea water: According to the British Association of Dermatologists, there is considerable anecdotal evidence that salt water baths may help some children with atopic eczema.[41] One reason might be that seawater has antiseptic properties. The Dead sea is popular for alleviating skin problems including eczema.
Sulfur has been used for many years as a topical treatment in the alleviation of eczema, although this could be suppressive. It was fashionable in the Victorian and Edwardian eras. Recently sulfur has regained some popularity as a homeopathic alternative to steroids and coal tar. However, there is currently no scientific evidence for the claim that sulfur treatment relieves eczema.[42]
Probiotics are live microorganisms taken by mouth, such as the Lactobacillus bacteria found in yogurt. They are not effective for treating eczema, and have a small risk of adverse events such as infection.[43]
Other remedies lacking scientific evidence include chiropractic spinal manipulation[44] and Shea butter.[citation needed]
Patients can also wear clothing designed specifically to manage the itching, scratching and peeling associated with eczema.[45]



Behavioural approach
In the 1980s, Swedish dermatologist Peter Noren developed a behavioural approach to the treatment of long term atopic eczema. This approach has been further developed by dermatologist Richard Staughton and psychiatrist Christopher Bridgett at the Chelsea and Westminster Hospital in London.[46][47] Patients undergo a 6 week monitored program involving scratch habit reversal and self awareness of scratching levels. For long term eczema sufferers, scratching can become habitual. Sometimes scratching becomes a reflex, resulting in scratching without conscious awareness, rather than from the feeling of itchiness itself. The habit reversal program is done in conjunction with the standard applied emollient/corticosteroid treatments so that the skin can heal. It also reduces future scratching, as well as reduces the likelihood of further flareups. The behavioural approach can give an eczema sufferer some control over the degree of severity of eczema.



Home treatments

- Liver Flush
- Bowel Cleanse
- Diet & Nutrition
- Fittness


Dyshidrosis can be treated locally by braking early on the tiny vesicles with a small needle and disinfecting the scratch. It will reverse the eczemic inflammation and begin a scarring process, which stops the vesicle formation and the drying of the skin around the braked vesicle, and temporarily prevents the formation of new vesicles to the same area of the skin. When kept clean properly, the braked vesicles will first turn into scars, after which using dexpanthenol (vitamin B12) ointment heals the cracked and dry area of old vesicles.



Vulnerability to live vaccinia virus

In June, 2007, Science magazine reported that an American soldier who had been vaccinated for smallpox, a vaccine that contains live vaccinia virus, had transmitted vaccinia virus to his two-year-old son.[51]

The soldier and his son both had a history of eczema. The son rapidly came down with a rare side effect, eczema vaccinatum, which had been seen during the 1960s when children were routinely vaccinated against smallpox. The child developed a severe full-body pustular rash, his abdomen filled with fluid, and his kidneys nearly failed. Intense consultation with experts from the Centers for Disease Control and Prevention and a donation of an experimental antiviral drug by SIGA Technologies saved the child's life. Those with a family history of eczema are advised not to accept the smallpox vaccination, or anything else that contains live vaccinia virus.


[edit] References
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^ "neomycin and polymyxin b sulfates and bacitracin zinc with hydrocortisone acetate (Neomycin sulfate and Polymyxin B Sulfate, Bacitracin zinc and Hydrocortisone Acetate) ointment -- Warnings". U.S. Food and Drug Administration. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=1932#nlm34071-1.

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Also at Medscape
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Diseases of the skin and subcutaneous tissue (integumentary system) (L, 680-709)



Infections Bacterial skin disease Staphylococcus (Staphylococcal scalded skin syndrome, Impetigo, Boil, Carbuncle) · Strep (Impetigo) · Corynebacterium (Erythrasma)


Viral skin disease Wart · Molluscum contagiosum · Erythema infectiosum · Exanthema subitum · Herpes simplex (Herpetic whitlow)


General Cellulitis (Paronychia) · Acute lymphadenitis · Pilonidal cyst · Pimple (Pustule)


Bullous disorders acantholysis (Pemphigus, Transient acantholytic dermatosis) · Pemphigoid (Bullous, Cicatricial, Gestational) · Dermatitis herpetiformis

Inflammatory Dermatitis and eczema Atopic dermatitis · Seborrhoeic dermatitis (Dandruff, Cradle cap) · Contact dermatitis (Diaper rash, Urushiol-induced contact dermatitis) · Erythroderma · Lichen simplex chronicus/Prurigo nodularis · Itch (Pruritus ani) · Nummular dermatitis · Dyshidrosis · Pityriasis alba

Papulosquamous disorders Psoriasis (Psoriatic arthritis) · Parapsoriasis (Pityriasis lichenoides et varioliformis acuta, Pityriasis lichenoides chronica, Lymphomatoid papulosis) · other pityriasis (Pityriasis rosea, Pityriasis rubra pilaris) · other lichenoid (Lichen planus, Lichen nitidus)


Urticaria Dermatographic urticaria · Cold urticaria · Cholinergic urticaria


Erythema Erythema multiforme/drug eruptions: Stevens-Johnson syndrome · Toxic epidermal necrolysis · Erythema nodosum
Other erythema: Erythema annulare centrifugum · Erythema marginatum · Necrolytic migratory erythema · Erythema toxicum


Radiation-related disorders Sunburn · actinic rays (Actinic keratosis, Actinic cheilitis) · Polymorphous light eruption (Acne aestivalis) · Radiodermatitis · Erythema ab igne

Pigmentation disorder hypopigmentation (Albinism, Vitiligo) · hyperpigmentation (Melasma, Freckle, Café au lait spot, Lentigo/Liver spot, Acanthosis nigricans, Acral acanthotic anomaly)

Other skin keratosis/hyperkeratosis (Seborrheic keratosis, Callus) · other epidermal thickening (Ichthyosis acquisita, Palmoplantar keratoderma)
skin ulcer (Pyoderma gangrenosum, Bedsore)

Cutaneous Markers of Internal Malignancy (Florid cutaneous papillomatosis, acanthosis nigricans, sign of Leser-Trelat)

atrophic (Lichen sclerosus, Acrodermatitis chronica atrophicans)

necrobiosis (Granuloma annulare, Necrobiosis lipoidica) · other granuloma (Granuloma faciale, Pyogenic granuloma)

cutaneous vasculitis (Livedoid vasculitis, Erythema elevatum diutinum)

Connective tissues collagen disease: Keloid
localized connective tissue disorders: Lupus erythematosus (Discoid lupus erythematosus, Subacute cutaneous lupus erythematosus) · Scleroderma/Morphea · Linear scleroderma · Calcinosis cutis · Sclerodactyly · Ainhum

see also congenital, neoplasia


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