Eczema
Encyclopedia
Eczema is a form of dermatitis
, or inflammation
of the epidermis (the outer layer of the skin). In England, an estimated 5.7 million or about one in every nine people have been diagnosed with the disease by a clinician at some point in their lives.
The term eczema is broadly applied to a range of persistent skin conditions. These include dryness and recurring skin rash
es that are characterized by one or more of these symptom
s: redness, skin edema
(swelling), itching and dryness, crusting, flaking, blistering, cracking, oozing, or bleeding. Areas of temporary skin discoloration may appear and are sometimes due to healed injuries
. Scratching open a healing lesion
may result in scarring and may enlarge the rash.
The word 'eczema' comes from Greek words, that mean 'to boil over'. Dermatitis comes from the Greek word for skin – and both terms refer to exactly the same skin condition. In some languages, dermatitis
and eczema are synonymous, while in other languages dermatitis implies an acute condition
and "eczema" a chronic
one. The two conditions are often classified together.
The term eczema refers to a set of clinical characteristics. Classification of the underlying diseases has been haphazard and unsystematic, with many synonym
s used to describe the same condition. A type of eczema may be described by location (e.g., hand eczema), by specific appearance (eczema craquele
or discoid), or by possible cause (varicose eczema). Further adding to the confusion, many sources use the term eczema for the most common type of eczema (atopic dermatitis
) interchangeably.
The European Academy of Allergology and Clinical Immunology (EAACI) published a position paper in 2001 which simplifies the nomenclature of allergy-related diseases including atopic and allergic contact eczemas. Non-allergic eczemas are not affected by this proposal.
The classification below is ordered by incidence frequency.
The hygiene hypothesis
postulates that the cause of asthma
, eczema, and other allergic diseases is an unusually clean environment. It is supported by epidemiologic studies for asthma. The hypothesis states that exposure to bacteria and other immune system modulators is important during development, and missing out on this exposure increases risk for asthma and allergy.
While it has been suggested that eczema may sometimes be an allergic reaction to the excrement from house dust mite
s, with up to 5% of people showing antibodies to the mites, the overall role this plays awaits further corroboration.
Researchers have compared the prevalence of eczema in people who also suffer from celiac
disease to eczema prevalence in control subjects, and they've found that eczema occurs about three times more frequently in celiac disease patients and about two times more frequently in relatives of celiac patients, potentially indicating a genetic
link between the two conditions.
, a potentially severe and sometimes fatal complication.
) may be used. In severe cases, oral or injectable corticosteroids may be used. While these usually bring about rapid improvements, they have greater side effects.
Prolonged use of topical corticosteroids is thought to increase the risk of side effects, the most common of which is the skin becoming thin and fragile (atrophy
).
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).
Finally by their immunosuppressive action they can, if used without antibiotic
s or antifungal drug
s, lead to some skin infections (fungal or bacteria
l). Care must be taken to avoid the eyes, as topical corticosteroids applied to the eye can cause glaucoma
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.
Some recent research claims 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. However, caution must always be used as long-term use, prolonged widespread coverage, or use with occlusion, can create side effects that are permanent and resistant to treatment.
s like pimecrolimus
(Elidel and Douglan) and tacrolimus
(Protopic) were developed after topical corticosteroids had come into widespread use. These newer agents effectively suppress the immune system in the affected area, and appear to yield better results in some populations.
The U.S. Food and Drug Administration
has issued a public health advisory about the possible risk of lymph node or skin cancer from use of these products, but many professional medical organizations disagree with the FDA's findings;
drugs are sometimes prescribed. These dampen the immune system and can result in dramatic improvements to the patient's eczema. However, immunosuppressants can cause side effects on the body. As such, patients must undergo regular blood tests and be closely monitored by a doctor. In the UK, the most commonly used immunosuppressants for eczema are ciclosporin
, azathioprine
and methotrexate
. These drugs were generally designed for other medical conditions but have been found to be effective against eczema.
, may reduce the itch during a flare up of eczema, and the reduced scratching in turn reduces damage and irritation to the skin (the "itch cycle"). However, in some cases, significant benefit may be due to the sedative side effects of these drugs, rather than their specific antihistamine effect. Thus sedating antihistamines such as promethazine (Phenergan) or diphenhydramine (Benadryl) may be more effective at preventing night time scratching than the newer, nonsedating antihistamines.
Capsaicin
applied to the skin acts as a counter irritant (see gate control theory of nerve signal transmission).
Hydrocortisone applied to the skin aids in temporary itch relief.
Temporary yet significant and fast-acting relief can be found by cooling the skin via water (swimming, cool water bath or wet washcloth), air (direct output of an air conditioning
vent), or careful use of an ice pack
(wrapped in soft smooth cloth, e.g., pillow case, to protect skin from damage).
of the skin. Moisturizing is one of the most important self-care treatments for eczema. Keeping the affected area moistened can promote skin healing and relief of symptoms. Soap
s and harsh detergents should not be used on affected skin because they can strip natural skin oils and lead to excessive dryness.
Moistening agents are called emollients. In general, it is best to match thicker ointments to the driest, flakiest skin. Light emollients may not have any effect on severely dry skin. Moisturizing gloves (gloves which keep emollients in contact with skin on the hands) can be worn while sleeping. Generally, twice-daily applications of emollients work best. Ointments, with less water content, stay on the skin longer and need fewer applications, but they can be greasy and inconvenient. Steroids may also be mixed in with ointments.
For unbroken skin, direct application of waterproof tape with or without an emollient or prescription ointment can improve moisture levels and skin integrity which allows the skin to heal. This treatment regimen can also help prevent the skin from cracking, as well as put a stop to the itch cycle. The end result is reduced lichenification (the roughening of skin from repeated scratching). Taping works best on skin away from joints.
There is a disagreement whether baths are desirable or a necessary evil. For example, the Mayo Clinic
advises against daily baths to avoid skin drying. On the other hand,
the American Academy of Dermatology
claims "it is a common misconception that bathing dries the skin and should be kept to a bare minimum" and recommends bathing to hydrate skin. They even suggest up to 3 short baths a day for people with severe eczema. According to them, a moisturizer should be applied within 3 minutes to trap the moisture from bath in the skin.
U.S. National Eczema Association
and the Eczema Society of Canada make similar recommendations.
Anecdotal evidence suggested that soft water could have therapeutic effects for people with eczema currently using hard water. However, a trial involving 336 children with eczema showed no objective difference in outcomes between the children whose homes were fitted with a water softener and those without.
Recently, ceramide
s, which are the major lipid constituent of the stratum corneum
, have been used in the treatment of eczema. They are often one of the ingredients of modern moisturizers. These lipids were also successfully produced synthetically in the laboratory
.
However, detergents are so ubiquitous in modern environments in items like tissues, and so persistent on surfaces, "safe" soaps are necessary to remove them from the skin in order to control eczema. Although most eczema recommendations use the terms "detergents" and "soaps" interchangeably, and tell eczema sufferers to avoid both, detergent
s and soap
s are not the same and are not equally problematic to eczema sufferers. Detergents, often made from petrochemicals, increase the permeability of skin membranes in a way that soaps and water alone do not. Sodium lauryl sulfate, the most common household detergent, has been shown to amplify the allergenicity of other substances ("increase antigen penetration").
Unfortunately there is no one agreed-upon best kind of skin cleanser for eczema sufferers. Different clinical tests, sponsored by different personal product companies, unsurprisingly tout various brands as the most skin-friendly based on specific properties of various products and different underlying assumptions as to what really determines skin friendliness. The terms "hypoallergenic" and "doctor tested" are not regulated, and no research has been done showing that products labeled "hypoallergenic" are in fact less problematic than any others. It may be best to avoid soaps and detergent cleansers altogether, except for the armpits, groin and perianal areas, and use cheap bland emollients in the bath or shower.
light can help control eczema. UVA is mostly used, but UVB and Narrow Band UVB are also used. Overexposure to ultraviolet light carries its own risks, particularly potential skin cancer
from exposure.
When light therapy alone is found to be ineffective, the treatment is performed with the application (or ingestion) of a substance called psoralen
. This PUVA
(Psoralen + UVA) combination therapy is termed photo-chemotherapy. Psoralens make the skin more sensitive to UV light, thus allowing lower doses of UVA to be used. However, the increased sensitivity to UV light also puts the patient at greater risk for skin cancer.
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.
Dietary elements that have been reported to trigger eczema include dairy
products, coffee
(both caffeinated and decaffeinated), soybean
products, eggs
, nuts
, wheat
and maize
(sweet corn), though food allergies may vary from person to person.
However, in 2009, researchers at National Jewish Medical and Research Center
found that eczema patients were especially prone to misdiagnosis of food allergies.
A study led by researchers at the University of California, San Diego School of Medicine suggests that use of oral vitamin D3 supplements bolsters production of a protective chemical normally found in the skin, and may help prevent skin infections that are a common result of atopic dermatitis
, the most common form of eczema. It can be noted that the production of vitamin D3 is catalyzed by UV radiation and may influence histocompatibility
expression, correlating with both the seasonality of eczema and its relation to the immune system.
A diet rich in omega-3 (and low in omega-6) polyunsaturated fatty acids may be able to reduce symptoms.
Patients can also wear clothing designed specifically to manage the itching, scratching and peeling associated with eczema.
Christopher Bridgett at the Chelsea and Westminster Hospital
in London.
Patients undergo a six-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.
or genetic engineering
might help.
Damage from the enzymatic
activity of allergens is usually prevented by the body's own protease inhibitor
s, such as, LEKTI, produced from the gene SPINK5
. Mutations in this gene are known to cause Netherton’s syndrome, which is a congenital erythroderma
. These patients nearly always develop atopic disease, including hay fever, food allergy, urticaria and asthma. Such evidence supports the hypothesis that skin damage from allergens may be the cause of eczema, and may provide a venue for further treatment.
Another study identified a gene that the researchers believe to be the cause of inherited eczema and some related disorders. The gene produces the protein filaggrin
, the lack of which causes dry skin and impaired skin barrier function.
A recent study indicated that two specific chemicals found in the blood are connected to the itching sensations associated with eczema. The chemicals are Brain-derived neurotrophic factor
(BDNF) and Substance P
.
Eczema has increased dramatically in England
as a study showed a 42% rise in diagnosis of the condition between 2001 and 2005, by which time it was estimated to affect 5.7 million adults and children. A paper in the Journal of the Royal Society of Medicine says Eczema is thought to be a trigger for other allergic conditions
. GP
records show over 9 million patients were used by researchers to assess how many people have the skin disorder.
Dermatitis
-Etymology:Dermatitis derives from Greek derma "skin" + -itis "inflammation" and genetic disorder.-Terminology:There are several different types of dermatitis. The different kinds usually have in common an allergic reaction to specific allergens. The term may describe eczema, which is also called...
, or inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
of the epidermis (the outer layer of the skin). In England, an estimated 5.7 million or about one in every nine people have been diagnosed with the disease by a clinician at some point in their lives.
The term eczema is broadly applied to a range of persistent skin conditions. These include dryness and recurring skin rash
Rash
A rash is a change of the skin which affects its color, appearance or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell and may be painful. The causes, and...
es that are characterized by one or more of these symptom
Symptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
s: redness, skin edema
Edema
Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
(swelling), itching and dryness, crusting, flaking, blistering, cracking, oozing, or bleeding. Areas of temporary skin discoloration may appear and are sometimes due to healed injuries
Injury
-By cause:*Traumatic injury, a body wound or shock produced by sudden physical injury, as from violence or accident*Other injuries from external physical causes, such as radiation injury, burn injury or frostbite*Injury from infection...
. Scratching open a healing lesion
Lesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
may result in scarring and may enlarge the rash.
The word 'eczema' comes from Greek words, that mean 'to boil over'. Dermatitis comes from the Greek word for skin – and both terms refer to exactly the same skin condition. In some languages, dermatitis
Dermatitis
-Etymology:Dermatitis derives from Greek derma "skin" + -itis "inflammation" and genetic disorder.-Terminology:There are several different types of dermatitis. The different kinds usually have in common an allergic reaction to specific allergens. The term may describe eczema, which is also called...
and eczema are synonymous, while in other languages dermatitis implies an acute condition
Acute (medicine)
In medicine, an acute disease is a disease with either or both of:# a rapid onset, as in acute infection# a short course ....
and "eczema" a chronic
Chronic (medicine)
A chronic disease is a disease or other human health condition that is persistent or long-lasting in nature. The term chronic is usually applied when the course of the disease lasts for more than three months. Common chronic diseases include asthma, cancer, diabetes and HIV/AIDS.In medicine, the...
one. The two conditions are often classified together.
Classification
Synonym
Synonyms are different words with almost identical or similar meanings. Words that are synonyms are said to be synonymous, and the state of being a synonym is called synonymy. The word comes from Ancient Greek syn and onoma . The words car and automobile are synonyms...
s used to describe the same condition. A type of eczema may be described by location (e.g., hand eczema), by specific appearance (eczema craquele
Craquelure
In art, craquelure is the fine pattern of dense "cracking" formed on the surface of paintings, in particular due to the aging of paints. It is often used to determine the age of paintings and to detect art forgery, as craquelure is a hard-to-forge signature of authenticity.-Authentic:Authentic...
or discoid), or by possible cause (varicose eczema). Further adding to the confusion, many sources use the term eczema for the most common type of eczema (atopic dermatitis
Atopic dermatitis
Atopic dermatitis is an inflammatory, chronically relapsing, non-contagious and pruritic skin disorder...
) interchangeably.
The European Academy of Allergology and Clinical Immunology (EAACI) published a position paper in 2001 which simplifies the nomenclature of allergy-related diseases including atopic and allergic contact eczemas. Non-allergic eczemas are not affected by this proposal.
The classification below is ordered by incidence frequency.
Common
- 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 asthmaAsthmaAsthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
. Itchy rashRashA rash is a change of the skin which affects its color, appearance or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell and may be painful. The causes, and...
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. (L20) - Contact dermatitisContact dermatitisContact dermatitis is a term for a skin reaction resulting from exposure to allergens or irritants . Phototoxic dermatitis occurs when the allergen or irritant is activated by sunlight....
is of two types: allergic (resulting from a delayed reaction to some allergenAllergenAn allergen is any substance that can cause an allergy. In technical terms, an allergen is a non-parasitic antigen capable of stimulating a type-I hypersensitivity reaction in atopic individuals....
, such as poison ivyPoison ivyToxicodendron radicans, better known as poison ivy , is a poisonous North American plant that is well known for its production of urushiol, a clear liquid compound found within the sap of the plant that causes an itching rash in most people who touch it...
or nickelNickelNickel is a chemical element with the chemical symbol Ni and atomic number 28. It is a silvery-white lustrous metal with a slight golden tinge. Nickel belongs to the transition metals and is hard and ductile...
), 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. (L23; L24; L56.1; L56.0) - Xerotic eczemaXerotic eczemaXerotic eczema is a form of eczema that is characterized by changes that occur when skin becomes abnormally dry, itchy, and cracked...
(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. IchthyosisIchthyosisIchthyosis is a heterogeneous family of at least 28, generalized, mostly genetic skin disorders. All types of ichthyosis have dry, thickened, scaly or flaky skin...
is a related disorder. (L30.8A; L85.0) - Seborrhoeic dermatitisSeborrhoeic dermatitisSeborrhoeic dermatitis is an inflammatory skin disorder affecting the scalp, face, and torso. Typically, seborrheic dermatitis presents with scaly, flaky, itchy, and red skin. It particularly affects the sebaceous-gland-rich areas of skin...
or Seborrheic dermatitis ("cradle capCradle capCradle cap is a yellowish, patchy, greasy, scaly and crusty skin rash that occurs on the scalp of recently born babies. It is usually not itchy, and does not bother the baby. Cradle cap most commonly begins sometime in the first 3 months...
" in infants) is a condition sometimes classified as a form of eczema that is closely related to dandruffDandruffDandruff is the shedding of dead skin cells from the scalp . Dandruff is sometimes caused by frequent exposure to extreme heat and cold. As it is normal for skin cells to die and flake off, a small amount of flaking is normal and common; about 487,000 cells/cm2 get released normally after...
. 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 biotinBiotinBiotin, also known as Vitamin H or Coenzyme R, is a water-soluble B-complex vitamin discovered by Bateman in 1916. It is composed of a ureido ring fused with a tetrahydrothiophene ring. A valeric acid substituent is attached to one of the carbon atoms of the tetrahydrothiophene ring...
and is often curable. (L21; L21.0)
Less common
- DyshidrosisDyshidrosisDyshidrosis is a skin condition that is characterized by small blisters on the hands or feet...
(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. (L30.1) - Discoid eczemaNummular dermatitisNummular dermatitis is one of the many forms of dermatitis. Also known as discoid dermatitis, it is characterized by round or oval-shaped itchy lesions...
(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. (L30.0) - Venous eczemaStasis dermatitisStasis dermatitis refers to the skin changes that occur in the leg as a result of "stasis" or blood pooling from insufficient venous return; the alternative name of varicose eczema comes from a common cause of this being varicose veins.Insufficient venous...
(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 ulcersVenous ulcerVenous ulcers are wounds that are thought to occur due to improper functioning of venous valves, usually of the legs. They are the major cause of chronic wounds, occurring in 70% to 90% of chronic wound cases...
. (I83.1) - Dermatitis herpetiformisDermatitis herpetiformisDermatitis herpetiformis , or Duhring's disease,Freedberg, et al. . Fitzpatrick's Dermatology in General Medicine. . McGraw-Hill. ISBN 0-07-138076-0. is a chronic blistering skin condition, characterised by blisters filled with a watery fluid...
(aka Duhring’s Disease) causes intensely itchy and typically symmetrical rash on arms, thighs, knees, and back. It is directly related to celiac disease, can often be put into remission with appropriate diet, and tends to get worse at night. (L13.0) - Neurodermatitis (aka lichen simplex chronicusLichen simplex chronicusLichen simplex chronicus is a skin disorder characterized by chronic itching and scratching. The constant scratching causes thick, leathery, brownish skin.- Causes :...
, localized scratch dermatitis) is an itchy area of thickened, pigmented eczema patch that results from habitualHabit (psychology)Habits are routines of behavior that are repeated regularly and tend to occur subconsciously. Habitual behavior often goes unnoticed in persons exhibiting it, because a person does not need to engage in self-analysis when undertaking routine tasks...
rubbing and scratching. Usually there is only one spot. Often curable through behavior modification and anti-inflammatory medication. Prurigo nodularisPrurigo nodularisPrurigo nodularis is a skin disease characterised by pruritic nodules which usually appear on the arms or legs. Patients often present with multiple excoriated lesions caused by scratching...
is a related disorder showing multiple lumps. (L28.0; L28.1) - AutoeczematizationAutoeczematizationAutoeczematization refers to the development of widespread dermatitis or dermatitis distant from a local inflammatory focus....
(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. herpeticumEczema herpeticumEczema herpeticum is a rare but severe disseminated herpes infection that generally occurs at sites of skin damage produced by, for example, atopic dermatitis, burns, or eczema...
, e. vaccinatumEczema vaccinatumEczema vaccinatum is a rare severe adverse reaction to smallpox vaccination.It is characterized by serious local or disseminated, umbilicated, vesicular, crusting skin rashes in the face, neck, chest, abdomen, upper limbs and hands, caused by widespread infection of the skin in people with previous...
), and eczemas resulting from underlying disease (e.g. lymphomaLymphomaLymphoma is a cancer in the lymphatic cells of the immune system. Typically, lymphomas present as a solid tumor of lymphoid cells. Treatment might involve chemotherapy and in some cases radiotherapy and/or bone marrow transplantation, and can be curable depending on the histology, type, and stage...
). 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.
Cause
The cause of eczema is unknown but is presumed to be a combination of genetic and environmental factors.The hygiene hypothesis
Hygiene hypothesis
In medicine, the Hygiene Hypothesis states that a lack of early childhood exposure to infectious agents, symbiotic microorganisms , and parasites increases susceptibility to allergic diseases by suppressing natural development of the immune system...
postulates that the cause of asthma
Asthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
, eczema, and other allergic diseases is an unusually clean environment. It is supported by epidemiologic studies for asthma. The hypothesis states that exposure to bacteria and other immune system modulators is important during development, and missing out on this exposure increases risk for asthma and allergy.
While it has been suggested that eczema may sometimes be an allergic reaction to the excrement from house dust mite
House dust mite
The house dust mite is a cosmopolitan guest in human habitation. Dust mites feed on organic detritus such as flakes of shed human skin and flourish in the stable environment of dwellings. House dust mites are a common cause of asthma and allergic symptoms worldwide...
s, with up to 5% of people showing antibodies to the mites, the overall role this plays awaits further corroboration.
Researchers have compared the prevalence of eczema in people who also suffer from celiac
Celiac
Celiac may refer to:* Coeliac disease* Celiac artery* Celiac lymph nodes* Celiac plexus...
disease to eczema prevalence in control subjects, and they've found that eczema occurs about three times more frequently in celiac disease patients and about two times more frequently in relatives of celiac patients, potentially indicating a genetic
Genetic
Genetic may refer to:*Genetics, in biology, the science of genes, heredity, and the variation of organisms**Genetic, used as an adjective, refers to heredity of traits**Gene, a unit of heredity in the genome of an organism...
link between the two conditions.
Diagnosis
Diagnosis of eczema is based mostly on history and physical examination. However, in uncertain cases, skin biopsy may be useful.Prevention
Those with eczema should not get the smallpox vaccination due to risk of developing eczema vaccinatumEczema vaccinatum
Eczema vaccinatum is a rare severe adverse reaction to smallpox vaccination.It is characterized by serious local or disseminated, umbilicated, vesicular, crusting skin rashes in the face, neck, chest, abdomen, upper limbs and hands, caused by widespread infection of the skin in people with previous...
, a potentially severe and sometimes fatal complication.
Treatment
There is no known cure for eczema; therefore, treatments aim to control the symptoms by reducing inflammation and relieving itching. Also, Hemp oil has been shown to relieve the symptoms of eczema (atopic dermatitis).Corticosteroids
Corticosteroids are highly effective in controlling or suppressing symptoms in most cases. For mild-moderate eczema a weak steroid may be used (e.g. hydrocortisone), while in more severe cases a higher-potency steroid (e.g. clobetasol propionateClobetasol propionate
Clobetasol propionate is a corticosteroid used to treat various skin disorders including eczema and psoriasis. It is also highly effective for contact dermatitis caused by exposure to poison ivy/oak. Clobetasol belongs to US Class I of the corticosteroids, making it one of the most potent...
) may be used. In severe cases, oral or injectable corticosteroids may be used. While these usually bring about rapid improvements, they have greater side effects.
Side effects
Prolonged use of topical corticosteroids is thought to increase the risk of side effects, the most common of which is the skin becoming thin and fragile (atrophy
Atrophy
Atrophy is the partial or complete wasting away of a part of the body. Causes of atrophy include mutations , poor nourishment, poor circulation, loss of hormonal support, loss of nerve supply to the target organ, disuse or lack of exercise or disease intrinsic to the tissue itself...
).
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
Occlusive dressing
An occlusive dressing is an air- and water-tight trauma dressing used in first aid. These dressings are generally made with a waxy coating so as to provide a total seal, and as a result do not have the absorbent properties of gauze pads...
, may be significantly absorbed into the body, causing hypothalamic-pituitary-adrenal axis
Hypothalamic-pituitary-adrenal axis
The hypothalamic-pituitary-adrenal axis , also known as thelimbic-hypothalamic-pituitary-adrenal axis and, occasionally, as the hypothalamic-pituitary-adrenal-gonadotropic axis, is a complex set of direct influences and feedback interactions among the hypothalamus, the pituitary gland ,...
suppression (HPA axis suppression).
Finally by their immunosuppressive action they can, if used without antibiotic
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
s or antifungal drug
Antifungal drug
An antifungal medication is a medication used to treat fungal infections such as athlete's foot, ringworm, candidiasis , serious systemic infections such as cryptococcal meningitis, and others...
s, lead to some skin infections (fungal or bacteria
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
l). Care must be taken to avoid the eyes, as topical corticosteroids applied to the eye can cause glaucoma
Glaucoma
Glaucoma is an eye disorder in which the optic nerve suffers damage, permanently damaging vision in the affected eye and progressing to complete blindness if untreated. It is often, but not always, associated with increased pressure of the fluid in the eye...
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.
Some recent research claims 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. However, caution must always be used as long-term use, prolonged widespread coverage, or use with occlusion, can create side effects that are permanent and resistant to treatment.
Topical immunosuppressants
Topical immunosuppressantImmunosuppressant
An immunosuppressant is any substance that performs immunosuppression of the immune system. They may be either exogenous, as immunosuppressive drugs, or endogenous, as ,e. g., testosterone...
s like pimecrolimus
Pimecrolimus
Pimecrolimus is an immunomodulating agent used in the treatment of atopic dermatitis . It is currently available as a topical cream, once marketed by Novartis under the trade name Elidel.-Pharmacology:Pimecrolimus is an ascomycin macrolactam derivative...
(Elidel and Douglan) and tacrolimus
Tacrolimus
Tacrolimus is an immunosuppressive drug that is mainly used after allogeneic organ transplant to reduce the activity of the patient's immune system and so lower the risk of organ rejection...
(Protopic) were developed after topical corticosteroids had come into widespread use. These newer agents effectively suppress the immune system in the affected area, and appear to yield better results in some populations.
The U.S. Food and Drug Administration
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
has issued a public health advisory about the possible risk of lymph node or skin cancer from use of these products, but many professional medical organizations disagree with the FDA's findings;
- The postulation is that the immune system may help remove some pre-cancerous abnormal cells which is prevented by these drugs. However, any chronic inflammatory condition such as eczema, by the very nature of increased metabolism and cell replication, has a tiny associated risk of cancer (see Bowen's diseaseBowen's diseaseBowen's disease is a neoplastic skin disease, it can be considered as an early stage or intraepidermal form of squamous cell carcinoma. It was named after Mark Bowen...
). - Current practice by UK dermatologists is not to consider this a significant real concern and they are increasingly recommending the use of these new drugs. The dramatic improvement on the condition can significantly improve the quality of life of sufferers (and families kept awake by the distress of affected children). The major debate, in the UK, has been about the cost of such newer treatments and, given only finite NHSNational Health ServiceThe National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
resources, when they are most appropriate to use. - In addition to cancer risk, there are other potential side effects with this class of drugs. Adverse reactions including severe flushing,headaches, flu-like syndrome, photosensitive reactivity and possible drug interactions with a variety of medications, alcohol and grapefruit.
Oral and parenteral immunosuppressants
When eczema is severe and does not respond to other forms of treatment, immunosuppressantImmunosuppressant
An immunosuppressant is any substance that performs immunosuppression of the immune system. They may be either exogenous, as immunosuppressive drugs, or endogenous, as ,e. g., testosterone...
drugs are sometimes prescribed. These dampen the immune system and can result in dramatic improvements to the patient's eczema. However, immunosuppressants can cause side effects on the body. As such, patients must undergo regular blood tests and be closely monitored by a doctor. In the UK, the most commonly used immunosuppressants for eczema are ciclosporin
Ciclosporin
Ciclosporin , cyclosporine , cyclosporin , or cyclosporin A is an immunosuppressant drug widely used in post-allogeneic organ transplant to reduce the activity of the immune system, and therefore the risk of organ rejection...
, azathioprine
Azathioprine
Azathioprine is a purine analogue immunosuppressive drug. It is used to prevent organ rejection following organ transplantation and to treat a vast array of autoimmune diseases, including rheumatoid arthritis, pemphigus, inflammatory bowel disease , multiple sclerosis, autoimmune hepatitis, atopic...
and methotrexate
Methotrexate
Methotrexate , abbreviated MTX and formerly known as amethopterin, is an antimetabolite and antifolate drug. It is used in treatment of cancer, autoimmune diseases, ectopic pregnancy, and for the induction of medical abortions. It acts by inhibiting the metabolism of folic acid. Methotrexate...
. These drugs were generally designed for other medical conditions but have been found to be effective against eczema.
Itch relief
Anti-itch drugs, often antihistamineAntihistamine
An H1 antagonist is a histamine antagonist of the H1 receptor that serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions...
, may reduce the itch during a flare up of eczema, and the reduced scratching in turn reduces damage and irritation to the skin (the "itch cycle"). However, in some cases, significant benefit may be due to the sedative side effects of these drugs, rather than their specific antihistamine effect. Thus sedating antihistamines such as promethazine (Phenergan) or diphenhydramine (Benadryl) may be more effective at preventing night time scratching than the newer, nonsedating antihistamines.
Capsaicin
Capsaicin
Capsaicin 2CHCH=CH4CONHCH2C6H3-4--3- ) is the active component of chili peppers, which are plants belonging to the genus Capsicum. It is an irritant for mammals, including humans, and produces a sensation of burning in any tissue with which it comes into contact...
applied to the skin acts as a counter irritant (see gate control theory of nerve signal transmission).
Hydrocortisone applied to the skin aids in temporary itch relief.
Temporary yet significant and fast-acting relief can be found by cooling the skin via water (swimming, cool water bath or wet washcloth), air (direct output of an air conditioning
Air conditioning
An air conditioner is a home appliance, system, or mechanism designed to dehumidify and extract heat from an area. The cooling is done using a simple refrigeration cycle...
vent), or careful use of an ice pack
Ice pack
An ice pack or gel pack is a plastic sac of ice, refrigerant gel or liquid, or, in an emergency, even frozen vegetables. The refrigerant, usually non-toxic, can absorb a considerable amount of heat, since its enthalpy of fusion is high...
(wrapped in soft smooth cloth, e.g., pillow case, to protect skin from damage).
Moisturizers
Eczema can be exacerbated by drynessDryness (medical)
Dryness is a medical condition in which there is local or more generalized decrease in normal lubrication of the skin or mucous membranes.Examples of local dryness include dry mouth, dry eyes, dry skin and vaginal dryness. These often have specific causes and treatments...
of the skin. Moisturizing is one of the most important self-care treatments for eczema. Keeping the affected area moistened can promote skin healing and relief of symptoms. Soap
Soap
In chemistry, soap is a salt of a fatty acid.IUPAC. "" Compendium of Chemical Terminology, 2nd ed. . Compiled by A. D. McNaught and A. Wilkinson. Blackwell Scientific Publications, Oxford . XML on-line corrected version: created by M. Nic, J. Jirat, B. Kosata; updates compiled by A. Jenkins. ISBN...
s and harsh detergents should not be used on affected skin because they can strip natural skin oils and lead to excessive dryness.
Moistening agents are called emollients. In general, it is best to match thicker ointments to the driest, flakiest skin. Light emollients may not have any effect on severely dry skin. Moisturizing gloves (gloves which keep emollients in contact with skin on the hands) can be worn while sleeping. Generally, twice-daily applications of emollients work best. Ointments, with less water content, stay on the skin longer and need fewer applications, but they can be greasy and inconvenient. Steroids may also be mixed in with ointments.
For unbroken skin, direct application of waterproof tape with or without an emollient or prescription ointment can improve moisture levels and skin integrity which allows the skin to heal. This treatment regimen can also help prevent the skin from cracking, as well as put a stop to the itch cycle. The end result is reduced lichenification (the roughening of skin from repeated scratching). Taping works best on skin away from joints.
There is a disagreement whether baths are desirable or a necessary evil. For example, the Mayo Clinic
Mayo Clinic
Mayo Clinic is a not-for-profit medical practice and medical research group specializing in treating difficult patients . Patients are referred to Mayo Clinic from across the U.S. and the world, and it is known for innovative and effective treatments. Mayo Clinic is known for being at the top of...
advises against daily baths to avoid skin drying. On the other hand,
the American Academy of Dermatology
American Academy of Dermatology
The American Academy of Dermatology is the largest organization of dermatologists in the world. It was founded in 1938 and represents 17,000 dermatologists in the United States, Canada, and around the world. The Academy grants Fellowships and Associate Memberships, as well as Fellowships for...
claims "it is a common misconception that bathing dries the skin and should be kept to a bare minimum" and recommends bathing to hydrate skin. They even suggest up to 3 short baths a day for people with severe eczema. According to them, a moisturizer should be applied within 3 minutes to trap the moisture from bath in the skin.
U.S. National Eczema Association
and the Eczema Society of Canada make similar recommendations.
Anecdotal evidence suggested that soft water could have therapeutic effects for people with eczema currently using hard water. However, a trial involving 336 children with eczema showed no objective difference in outcomes between the children whose homes were fitted with a water softener and those without.
Recently, ceramide
Ceramide
Ceramides are a family of lipid molecules. A ceramide is composed of sphingosine and a fatty acid. Ceramides are found in high concentrations within the cell membrane of cells. They are one of the component lipids that make up sphingomyelin, one of the major lipids in the lipid bilayer...
s, which are the major lipid constituent of the stratum corneum
Stratum corneum
The stratum corneum is the outermost layer of the epidermis, consisting of dead cells that lack nuclei and organelles. The purpose of the stratum corneum is to form a barrier to protect underlying tissue from infection, dehydration, chemicals and mechanical stress...
, have been used in the treatment of eczema. They are often one of the ingredients of modern moisturizers. These lipids were also successfully produced synthetically in the laboratory
Laboratory
A laboratory is a facility that provides controlled conditions in which scientific research, experiments, and measurement may be performed. The title of laboratory is also used for certain other facilities where the processes or equipment used are similar to those in scientific laboratories...
.
However, detergents are so ubiquitous in modern environments in items like tissues, and so persistent on surfaces, "safe" soaps are necessary to remove them from the skin in order to control eczema. Although most eczema recommendations use the terms "detergents" and "soaps" interchangeably, and tell eczema sufferers to avoid both, detergent
Detergent
A detergent is a surfactant or a mixture of surfactants with "cleaning properties in dilute solutions." In common usage, "detergent" refers to alkylbenzenesulfonates, a family of compounds that are similar to soap but are less affected by hard water...
s and soap
Soap
In chemistry, soap is a salt of a fatty acid.IUPAC. "" Compendium of Chemical Terminology, 2nd ed. . Compiled by A. D. McNaught and A. Wilkinson. Blackwell Scientific Publications, Oxford . XML on-line corrected version: created by M. Nic, J. Jirat, B. Kosata; updates compiled by A. Jenkins. ISBN...
s are not the same and are not equally problematic to eczema sufferers. Detergents, often made from petrochemicals, increase the permeability of skin membranes in a way that soaps and water alone do not. Sodium lauryl sulfate, the most common household detergent, has been shown to amplify the allergenicity of other substances ("increase antigen penetration").
Unfortunately there is no one agreed-upon best kind of skin cleanser for eczema sufferers. Different clinical tests, sponsored by different personal product companies, unsurprisingly tout various brands as the most skin-friendly based on specific properties of various products and different underlying assumptions as to what really determines skin friendliness. The terms "hypoallergenic" and "doctor tested" are not regulated, and no research has been done showing that products labeled "hypoallergenic" are in fact less problematic than any others. It may be best to avoid soaps and detergent cleansers altogether, except for the armpits, groin and perianal areas, and use cheap bland emollients in the bath or shower.
Lifestyle
Various measures may reduce the amount of mite antigens, in particular swapping carpets for hard surfaces. However it is not clear whether such measures actually help with eczema. A controlled study suggested that a number of environmental factors such as air exchange rates, relative humidity and room temperature (but not the level of house dust mites) might have an effect on the condition.Light therapy
Light therapy (or deep penetrating light therapy) using ultravioletUltraviolet
Ultraviolet light is electromagnetic radiation with a wavelength shorter than that of visible light, but longer than X-rays, in the range 10 nm to 400 nm, and energies from 3 eV to 124 eV...
light can help control eczema. UVA is mostly used, but UVB and Narrow Band UVB are also used. Overexposure to ultraviolet light carries its own risks, particularly potential skin cancer
Skin cancer
Skin neoplasms are skin growths with differing causes and varying degrees of malignancy. The three most common malignant skin cancers are basal cell cancer, squamous cell cancer, and melanoma, each of which is named after the type of skin cell from which it arises...
from exposure.
When light therapy alone is found to be ineffective, the treatment is performed with the application (or ingestion) of a substance called psoralen
Psoralen
Psoralen is the parent compound in a family of natural products known as furocoumarins. It is structurally related to coumarin by the addition of a fused furan ring, and may be considered as a derivative of umbelliferone...
. This PUVA
PUVA
PUVA is a psoralen + UVA treatment for eczema, psoriasis, graft-versus-host disease and vitiligo, and mycosis fungoides. The psoralen is applied or taken orally to sensitize the skin, then the skin is exposed to UVA. Long term use has been associated with higher rates of skin cancer.Psoralens are...
(Psoralen + UVA) combination therapy is termed photo-chemotherapy. Psoralens make the skin more sensitive to UV light, thus allowing lower doses of UVA to be used. However, the increased sensitivity to UV light also puts the patient at greater risk for skin cancer.
Diet
Recent studies provide hints that food allergyFood allergy
A food allergy is an adverse immune response to a food protein. They are distinct from other adverse responses to food, such as food intolerance, pharmacological reactions, and toxin-mediated reactions....
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.
Dietary elements that have been reported to trigger eczema include dairy
Dairy
A dairy is a business enterprise established for the harvesting of animal milk—mostly from cows or goats, but also from buffalo, sheep, horses or camels —for human consumption. A dairy is typically located on a dedicated dairy farm or section of a multi-purpose farm that is concerned...
products, coffee
Coffee
Coffee is a brewed beverage with a dark,init brooo acidic flavor prepared from the roasted seeds of the coffee plant, colloquially called coffee beans. The beans are found in coffee cherries, which grow on trees cultivated in over 70 countries, primarily in equatorial Latin America, Southeast Asia,...
(both caffeinated and decaffeinated), soybean
Soybean
The soybean or soya bean is a species of legume native to East Asia, widely grown for its edible bean which has numerous uses...
products, eggs
Egg (food)
Eggs are laid by females of many different species, including birds, reptiles, amphibians, and fish, and have probably been eaten by mankind for millennia. Bird and reptile eggs consist of a protective eggshell, albumen , and vitellus , contained within various thin membranes...
, nuts
Nut (fruit)
A nut is a hard-shelled fruit of some plants having an indehiscent seed. While a wide variety of dried seeds and fruits are called nuts in English, only a certain number of them are considered by biologists to be true nuts...
, wheat
Wheat
Wheat is a cereal grain, originally from the Levant region of the Near East, but now cultivated worldwide. In 2007 world production of wheat was 607 million tons, making it the third most-produced cereal after maize and rice...
and maize
Maize
Maize known in many English-speaking countries as corn or mielie/mealie, is a grain domesticated by indigenous peoples in Mesoamerica in prehistoric times. The leafy stalk produces ears which contain seeds called kernels. Though technically a grain, maize kernels are used in cooking as a vegetable...
(sweet corn), though food allergies may vary from person to person.
However, in 2009, researchers at National Jewish Medical and Research Center
National Jewish Medical and Research Center
National Jewish Health is a research institute located in Denver, Colorado specializing in respiratory, immune and allergic research and treatment. It was founded in 1899 to treat tuberculosis, and is today considered one of the world's best medical research and treatment centers...
found that eczema patients were especially prone to misdiagnosis of food allergies.
A study led by researchers at the University of California, San Diego School of Medicine suggests that use of oral vitamin D3 supplements bolsters production of a protective chemical normally found in the skin, and may help prevent skin infections that are a common result of atopic dermatitis
Atopic dermatitis
Atopic dermatitis is an inflammatory, chronically relapsing, non-contagious and pruritic skin disorder...
, the most common form of eczema. It can be noted that the production of vitamin D3 is catalyzed by UV radiation and may influence histocompatibility
Histocompatibility
Histocompatibility is the property of having the same, or mostly the same, alleles of a set of genes called the major histocompatibility complex. These genes are expressed in most tissues as antigens, to which the immune system makes antibodies...
expression, correlating with both the seasonality of eczema and its relation to the immune system.
A diet rich in omega-3 (and low in omega-6) polyunsaturated fatty acids may be able to reduce symptoms.
Alternative therapies
A number of alternative therapies are used for eczema including:- Sea water: there is some anecdotal evidence that salt water baths may help some children with atopic eczema. One reason might be that seawater has antiseptic properties. The Dead seaDead SeaThe Dead Sea , also called the Salt Sea, is a salt lake bordering Jordan to the east and Israel and the West Bank to the west. Its surface and shores are below sea level, the lowest elevation on the Earth's surface. The Dead Sea is deep, the deepest hypersaline lake in the world...
is popular for alleviating skin problems including eczema. The benefit of this treatment must be weighed against the extreme discomfort and burning sensations suffered as the salt water contacts raw skin. - SulfurSulfurSulfur or sulphur is the chemical element with atomic number 16. In the periodic table it is represented by the symbol S. It is an abundant, multivalent non-metal. Under normal conditions, sulfur atoms form cyclic octatomic molecules with chemical formula S8. Elemental sulfur is a bright yellow...
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. However, there is currently no scientific evidence for the claim that sulfur treatment relieves eczema. - Probiotics are live microorganisms taken orally, such as the LactobacillusLactobacillusLactobacillus is a genus of Gram-positive facultative anaerobic or microaerophilic rod-shaped bacteria. They are a major part of the lactic acid bacteria group, named as such because most of its members convert lactose and other sugars to lactic acid. They are common and usually benign...
bacteria found in yogurt. They are not effective for treating eczema in older populations, but some research points to some strains of beneficial microorganisms having the ability to prevent the triad of allergies, eczema and asthma, although in rare cases they have a very small risk of infection in those with poor immune system response. - Traditional Chinese medicine: According to American Academy of DermatologyAmerican Academy of DermatologyThe American Academy of Dermatology is the largest organization of dermatologists in the world. It was founded in 1938 and represents 17,000 dermatologists in the United States, Canada, and around the world. The Academy grants Fellowships and Associate Memberships, as well as Fellowships for...
, while certain blends of Chinese herbal medicines have been proven effective in controlling eczema, they have also proven toxic with severe consequences. In Chinese Medicine diagnosis, eczema is often considered a manifestation of underlying ill health. Treatment aims to improve the overall health of the individual, therefore not only resolving the eczema but improving quality of life (energy level, digestion, disease resistance, etc.). A recent study published in the British Journal of Dermatology describes improvements in quality of life and reduced need for topical corticosteroid application. Another British trial with ten different plants traditionally used in Chinese medicine for eczema treatment suggest a benefit with herbal remedy, but reviewers noted that the blinding was not maintained, leaving the results invalid. - Other remedies lacking scientific evidence include chiropracticChiropracticChiropractic is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. It is generally categorized as complementary and alternative medicine...
spinal manipulation and acupuncture.
Patients can also wear clothing designed specifically to manage the itching, scratching and peeling associated with eczema.
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 psychiatristPsychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
Christopher Bridgett at the Chelsea and Westminster Hospital
Chelsea and Westminster Hospital
Chelsea and Westminster Hospital is a public hospital located on Fulham Road, in the Chelsea area of London, England. It is managed by the Chelsea and Westminster Hospital NHS Foundation Trust, and opened in May 1993.-History:...
in London.
Patients undergo a six-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.
Epidemiology
The lifetime clinician-recorded prevalence of eczema has been seen to peak in infancy, with female predominance of eczema presentations occurring during the reproductive period of 15–49 years. Although little data on the trend of eczema prevalence over time exists prior to the Second World War (1939–45), the prevalence of eczema has been found to have increased substantially in the latter half of the 20th Century, with eczema in school-aged children being found to increase between the late 1940s and 2000. A review of epidemiological data in the UK has also found an inexorable rise in the prevalence of eczema over time. Further recent increases in the incidence and lifetime prevalence of eczema in England have also been reported, such that an estimated 5,773,700 or about one in every nine people have been diagnosed with the disease by a clinician at some point in their lives.Research
Other than direct treatments of the symptoms, no cure is presently known for most types of dermatitis; even cortisone treatments and immunomodulation may often have only minor effects on what may be a complex problem. As the condition is often related to family history of allergies (and thus heredity), it is probable that gene therapyGene therapy
Gene therapy is the insertion, alteration, or removal of genes within an individual's cells and biological tissues to treat disease. It is a technique for correcting defective genes that are responsible for disease development...
or genetic engineering
Genetic engineering
Genetic engineering, also called genetic modification, is the direct human manipulation of an organism's genome using modern DNA technology. It involves the introduction of foreign DNA or synthetic genes into the organism of interest...
might help.
Damage from the enzymatic
Enzyme
Enzymes are proteins that catalyze chemical reactions. In enzymatic reactions, the molecules at the beginning of the process, called substrates, are converted into different molecules, called products. Almost all chemical reactions in a biological cell need enzymes in order to occur at rates...
activity of allergens is usually prevented by the body's own protease inhibitor
Protease inhibitor
Protease inhibitor can refer to:* Protease inhibitor : a class of medication that inhibits viral protease* Protease inhibitor : molecules that inhibit proteases...
s, such as, LEKTI, produced from the gene SPINK5
SPINK5
Lympho-epithelial Kazal-type-related inhibitor also known as serine protease inhibitor Kazal-type 5 is a protein that in humans is encoded by the SPINK5 gene.- Structure and function :...
. Mutations in this gene are known to cause Netherton’s syndrome, which is a congenital erythroderma
Erythroderma
Erythroderma is an inflammatory skin disease with erythema and scaling that affects nearly the entire cutaneous surface....
. These patients nearly always develop atopic disease, including hay fever, food allergy, urticaria and asthma. Such evidence supports the hypothesis that skin damage from allergens may be the cause of eczema, and may provide a venue for further treatment.
Another study identified a gene that the researchers believe to be the cause of inherited eczema and some related disorders. The gene produces the protein filaggrin
Filaggrin
Filaggrin is a filament-associated protein that binds to keratin fibers in epithelial cells.-Profilaggrin:Filaggrin monomers are tandemly clustered into a large, 350kDa protein precursor known as profilaggrin. In the epidermis, these structures are present in the keratohyalin granules in cells of...
, the lack of which causes dry skin and impaired skin barrier function.
A recent study indicated that two specific chemicals found in the blood are connected to the itching sensations associated with eczema. The chemicals are Brain-derived neurotrophic factor
Brain-derived neurotrophic factor
Brain-derived neurotrophic factor, also known as BDNF, is a protein that, in humans, is encoded by the BDNF gene. BDNF is a member of the "neurotrophin" family of growth factors, which are related to the canonical "Nerve Growth Factor", NGF...
(BDNF) and Substance P
Substance P
In the field of neuroscience, substance P is a neuropeptide: an undecapeptide that functions as a neurotransmitter and as a neuromodulator. It belongs to the tachykinin neuropeptide family. Substance P and its closely related neuropeptide neurokinin A are produced from a polyprotein precursor...
.
Eczema has increased dramatically in England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
as a study showed a 42% rise in diagnosis of the condition between 2001 and 2005, by which time it was estimated to affect 5.7 million adults and children. A paper in the Journal of the Royal Society of Medicine says Eczema is thought to be a trigger for other allergic conditions
Allergy
An Allergy is a hypersensitivity disorder of the immune system. Allergic reactions occur when a person's immune system reacts to normally harmless substances in the environment. A substance that causes a reaction is called an allergen. These reactions are acquired, predictable, and rapid...
. GP
General practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...
records show over 9 million patients were used by researchers to assess how many people have the skin disorder.
External links
- MedlinePlus: Dermatitis
- Mayo Clinic: Dermatitis and Eczema - Overview, Treatment, Causes, Prevention, Self-Care
- National Eczema Society (UK)
- National Eczema Association (US)
- Eczema Zones, resource for people with eczema