Eczema (or dermatitis) is a skin condition which results in dry, inflamed and sometimes weeping skin. There are many types of eczema but all have the same symptoms of itch, red spots, blisters, weeping or oozing in the acute stage and dryness, scaling, thickened rough skin in the chronic stage (i.e. when the condition has been long-standing).
There are 2 main types of eczema:
Atopic eczema is the commonest skin condition affecting children. It usually begins in infancy after 3 months of life or during childhood. It may, however, present at any age including adulthood. It is a very itchy condition and is usually chronic and relapsing. However, there is a tendency for it to improve with age and may even clear completely.
The exact cause is unknown but the tendency is inherited. People with atopic eczema tend to suffer from other atopic conditions like asthma or hay fever (allergic rhinitis). Family members may also suffer from these conditions. The term “atopy” refers to an inherited tendency to develop allergies or be hypersensitive to environmental factors. However, not every member of the family is affected by atopic disorders and eczema may not be manifested in every generation.
External factors such as contact with irritants and other factors such as skin barrier defects also play a role.
There are different patterns of location of the rash and the patterns change with age. In infancy, eczema usually presents on the cheeks and the baby may be fretful and rub his face against the pillow or the bedsheet. As the child grows older, the rash may be localized on the neck, elbows, knees, wrists and ankles. It appears dry, red and scaly. Eczema may affect any part of the body including ears and scalp.
The diagnosis of atopic eczema can be made clinically by an experienced dermatologist. The doctor will ask certain questions about the rash and do a physical examination. Usually, no laboratory or skin tests are required to make the diagnosis.
Atopic eczema is not caused by an allergy. However, a child with atopic eczema may suffer from other allergies which may make the skin condition more itchy. Common ones which may be relevant to people with atopic eczema are:
This type of eczema appears as circular patches on the arms and legs. It is often itchy and weepy in the acute or “wet” phase and dry and scaly in the chronic phase. Treatment includes the use of topical steroids. There is a tendency for the condition to run a relapsing course for many months.
This is another pattern of eczema which affects the hands predominantly. Small itchy blisters may appear recurrently on the palms, fingers and sometimes may involve the feet. The blisters dry and this is usually followed by cracks and scaling. If the eczema affects the nail folds, the nails become irregular and deformed as the cuticle is lost. Recurrence is common.
Hand eczema is made worse by irritants such as soaps and household detergents. If the condition is chronic and unresponsive to treatment, a skin test called patch test may be helpful to detect underlying contact allergy.
The most important part of managing hand eczema is to minimize contact with irritants such as detergents and excessive we work.
Your dermatologist may also prescribe topical corticosteroid creams to reduce inflammation.