Eczema – the truth (Part 2 of 2)

  • Articles
  • 19 November 2022
  • Marista

Eczema is a common chronic or recurrent inflammatory skin disease and affects 15-20% of children and 1-3% of adults worldwide. Although common, it is often misunderstood. In this 2-part article, we will give you all the information you need to understand and treat eczema a little better.

In Part 1 we will discuss:

  • What eczema is,
  • General symptoms, and
  • Complications

In Part 2 we will discuss:

  • Types of eczema,
  • Triggers, and
  • Treatments

Part 2

Types of Eczema

  1. Atopic dermatitis

Atopic dermatitis is the most common form of eczema. It usually starts in childhood, and often gets milder or goes away by adulthood. Atopic dermatitis is part of what healthcare professionals call the atopic triad. “Triad” means three. The other two diseases in the triad are asthma and hay fever. Many people with atopic dermatitis have all three conditions. 

Symptoms

  • The rash often forms in the creases of your elbows or knees.
  • The skin in areas where the rash appears may turn lighter or darker or get thicker.
  • Small bumps may appear and leak fluid if you scratch them.
  • Babies will often get the rash on their scalp and cheeks.
  • Your skin can get infected if you scratch it.

Causes

Atopic dermatitis happens when your skin’s natural barrier against the elements is weakened. This means your skin is less able to protect you from irritants and allergens. Atopic dermatitis is likely caused by a combination of factors, such as:

  • genes
  • dry skin
  • an immune system problem
  • triggers in the environment

2. Contact dermatitis

If you have red, irritated skin, thick scaly region that’s caused by a reaction to substances you touch, you may have contact dermatitis. It comes in two types: Allergic contact dermatitis is an immune system reaction to an irritant, like latex or metal. Irritant contact dermatitis starts when a chemical or other substance irritates your skin.

Symptoms

  • You skin itches, turns red, is hyperpigmented or pink, magenta, burns, and stings.
  • Itchy bumps called hives may appear on your skin.
  • Fluid-filled blisters can form that may ooze and crust over.
  • Over time, the skin may thicken and feel scaly or leathery.

Causes

Contact dermatitis happens when you touch a substance that irritates your skin or causes an allergic reaction. The most common causes are:

  • detergents
  • bleach
  • jewelry
  • latex
  • nickel
  • paint
  • poison ivy and other poisonous plants
  • skin care products, including makeup
  • soaps and perfumes
  • solvents
  • tobacco smoke

3. Dyshidrotic eczema

Dyshidrotic eczema causes small blisters to form on your hands and feet. It’s more common in women than men.

Symptoms

  • Fluid-filled blisters form on your fingers, toes, palms, and the soles of your feet.
  • These blisters may itch or hurt.
  • Your skin can scale, crack, and flake.

Causes

  • Dyshidrotic eczema can be caused by:
  • allergies
  • damp hands and feet
  • exposure to substances, such as nickel, cobalt, or chromium salt
  • stress
  • smoking tobacco products

4. Hand eczema

Eczema that only affects your hands is called hand eczema. You may get this type if you work a job, like hairdressing or cleaning, where you regularly use chemicals that irritate the skin.

Symptoms

  • Your hands get red, hyperpigmented, itchy, and dry.
  • They may form cracks or blisters.

Causes

Hand eczema is triggered by exposure to chemicals. People are more likely to get this form if they work in jobs that expose them to irritants, such as:

  • cleaning
  • hairdressing
  • healthcare
  • laundry or dry cleaning

5. Neurodermatitis

Neurodermatitis is similar to atopic dermatitis. It causes thick, scaly patches to appear on your skin.

Symptoms

  • Thick, scaly patches form on your arms, legs, back of your neck, scalp, bottoms of your feet, backs of your hands, or genitals.
  • The patches can be very itchy, especially when you’re relaxed or asleep.
  • The patches can bleed and get infected if you scratch them.

Causes

Neurodermatitis usually starts in people who have other types of eczema or psoriasis. Doctors don’t know exactly what causes it, but stress can be a trigger.

6. Nummular eczema

This type of eczema causes round, coin-shaped spots to form on your skin. The word “nummular” means coin in Latin. Nummular eczema looks very different from other types of eczema, and it can itch a lot.

Symptoms

  • Round, coin-shaped spots form on your skin.
  • The spots may itch or become scaly.

Causes

Nummular eczema can be triggered by a reaction to an insect bite or an allergic reaction to metals or chemicals. Dry skin can also cause it. You’re more likely to get this form if you have another type of eczema, such as atopic dermatitis.

7. Stasis dermatitis

Stasis dermatitis happens when fluid leaks out of weakened veins into your skin. This fluid causes:

  • swelling
  • redness in lighter skin tones
  • brown, purple, gray or ashen color in darker skin tones
  • itching
  • pain

Symptoms

  • The lower part of your legs may swell, especially during the day when you’ve been walking.
  • Your legs may ache or feel heavy.
  • You’ll likely also have varicose veins, which are thick, ropey damaged veins in your legs.
  • The skin over those varicose veins will be dry and itchy.
  • You may develop open sores on your lower legs and on the tops of your feet.

Causes

Stasis dermatitis happens in people who have blood flow problems in their lower legs. If the valves that normally push blood up through your legs toward your heart malfunction, blood can pool in your legs. Your legs can swell up and varicose veins can form.

 Identifying which one you or your loved one suffers from, can be difficult, time-consuming and costly at times. If the eczema is severe, painful, affecting your ability to do daily tasks, or leaves the skin broken and not healing, I suggest a visit to a professional (doctor, dermatologist) immediately.

Triggers & aggravators

Although it isn’t always easy to completely avoid these triggers or aggravators, it will go a long way in helping to lessen the severity or frequency of outbreaks.

  • Heat; such as thick layers of clothes, hot heaters, hot cars, classrooms, hot baths, thick blankets, woollen underlays or electric blankets and hot water bottles
  • Prickly/rough material for example wool, sandpits, clothing tags
  • Irritation; avoid products that contain plants, perfumes and foods
  • SLS – commercial washing powders, bubble baths, most body washes & shower gels
  • Fabric softeners
  • Stress
  • Food Allergies & sensitivities
  • Glycerin

Although glycerin is truly a wonderful moisturizer, with amazing properties, it should be avoided in the treatment of eczema. Basically all the articles advocate for the use of glycerin in treating eczema, but our experience have been that once it is eliminated, the skin reacts better and heals quicker. Any exposure to products that contain glycerin, aggravates the eczema again.

Treatments

There is no cure for eczema.

 But it can be managed.

Everyday solutions

Treatment of atopic dermatitis may start with regular moisturizing and other self-care habits:

  • Regular moisturiser, 
  • Daily cool bath (30-32 degrees C
  • Consider Vitamin D 

 If these don’t help, your health care provider might suggest medicated creams that control itching and help repair skin. These are sometimes combined with other treatments.

Atopic dermatitis can be persistent. You may need to try various treatments over months or years to control it. And even if treatment is successful, symptoms may return (flare).

Our Skin Restoring Eczema Cream is designed as an effective daily moisturizer, that also helps to relieve and ease the symptoms of eczema.

Medications

  • Topical steroids and anti-inflammatory creams 
  • Drugs to fight infection. 
  • Pills that control inflammation. 
  • Tar creams are used when the skin is lichenified (thickening of the skin) or for discoid eczema.
  • Cool compressing for immediate relief of itch 

Wet a cloth with water and plain bath oil (example chux or rediwipe). Apply to wet cloth to itchy areas for 5 -10 minutes, then apply a moisturiser post compressing. These are also the wet dressing for the face, and are best applied while awake and when feeding. Another option is using a thermal water spray to the itchy area. Age dependant the children should be encouraged to learn this technique rather than scratching. 

Treatments for severe eczema. 

Therapies

  • Wet dressings. An effective, intensive treatment for severe eczema involves applying a corticosteroid ointment and sealing in the medication with a wrap of wet gauze topped with a layer of dry gauze. Sometimes this is done in a hospital for people with widespread lesions because it’s labor intensive and requires nursing expertise. Or ask your health care provider about learning how to use this technique at home safely.
  • Light therapy. This treatment is used for people who either don’t get better with topical treatments or rapidly flare again after treatment. The simplest form of light therapy (phototherapy) involves exposing the affected area to controlled amounts of natural sunlight. Other forms use artificial ultraviolet A (UVA) and narrow band ultraviolet B (UVB) alone or with drugs.
  • Though effective, long-term light therapy has harmful effects, including premature skin aging, changes in skin color (hyperpigmentation) and an increased risk of skin cancer. For these reasons, phototherapy is less commonly used in young children and is not given to infants. Talk with your health care provider about the pros and cons of light therapy.
  • Counselling. If you’re embarrassed or frustrated by your skin condition, it can help to talk with a therapist or other counsellor.
  • Relaxation, behaviour modification and biofeedback. These approaches may help people who scratch out of habit.

Baby eczema

Treatment for eczema in babies (infantile eczema) includes:

  • Identifying and avoiding skin irritants
  • Avoiding extreme temperatures
  • Giving your baby a short bath in warm water and applying a cream or ointment while the skin is still damp

Infected eczema

Secondary infection of eczema is a common complication as the skin is not intact and thus more vulnerable to infection. Infection can make eczema worse and more difficult to treat. A common causative bacterium is Staphylococcus aureus which is commonly found on eczema skin. 

Infection should be suspected if there is crusting, weeping, erythema, cracks, frank pus or multiple excoriations and increased soreness and itching which may suggest bacterial infection. 

Secondary viral infection caused by herpes simplex virus (HSV) is characterized by a sudden onset of grouped, small white or clear fluid filled vesicles, satellite or “punch out” lesions, pustules, and erosions. It is often tender, painful and itchy. Other viruses that may cause the eczema to flare are molluscum contagiosum and coxsackie A6 virus (hand foot and mouth disease).

Secondary infection should be treated by a doctor. Do not try to treat it at home, as the complications from secondary infections caused by infected eczema can be life-threatening.

However, there is no such thing as instant and/or lasting relief. The skin has been damaged and is constantly damaged when it itches and is scratched. It can be aggravated by playing outside, dirt, water, soaps, sun, etc. So to expect any cream or treatment to help overnight is farfetched, and to expect it to work all the time, is too. As the skin changes with age, with hormonal interference, other health conditions, it’s reaction towards medications and creams will change as well. Which means that a cream that has worked for a couple of years, suddenly stops working. There will be times when it looks better and the itching stops and you almost think you beat it, and then it will flare up again. That’s eczema.

References:

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