Eczema

Eczema ranks among the most common skin conditions worldwide, affecting millions of people. This chronic inflammatory skin disorder creates itchy, red, and inflamed skin patches that can substantially disrupt daily comfort and quality of life.

People of all ages can develop eczema. About 10% to 20% of babies show signs of this condition. The good news is that half of the children with eczema either outgrow it or see major improvements as they get older. Symptoms usually appear as "flare-ups" that can last days or weeks.
Atopic dermatitis stands out as the most common type of eczema. 

This complete guide is about what eczema is, its symptoms, why it happens, its various types, and treatments that work. Knowledge about eczema helps people manage this condition better, whether they have it themselves or care for someone who does.

What is Eczema?

A group of inflammatory skin conditions known as eczema causes dry, itchy skin. Doctors often call it "the itch that rashes" because scratching irritated skin leads to visible inflammation. The skin's protective barrier becomes compromised, which makes it harder to retain moisture and block irritants.

Types of Eczema

Your doctor may tell you about seven different eczema types. These are:

• Atopic dermatitis: You may develop this common type during your childhood
• Contact dermatitis: Skin reactions occur from exposure to irritants or allergens
• Dyshidrotic eczema: Small, fluid-filled blisters appear on hands and feet
• Neurodermatitis: Repeated scratching creates intensely itchy patches
• Nummular or discoid eczema: Coin-shaped patches of irritated skin develop
• Seborrheic dermatitis: Oily areas like the scalp and face show symptoms
• Stasis dermatitis: Poor circulation in the lower legs triggers this type

Symptoms of Eczema

Intense itching, dryness, and redness stand out as key symptoms. People with darker skin might see purple, brown, or grey patches instead of redness. Eczema symptoms can vary based on severity:

• Scaly or crusty patches
• Blisters filled with fluid that may leak
• Skin that cracks or bleeds
• Chronic scratching leads to thickened, leathery areas

Eczema Causes 

Scientists haven't pinpointed the exact cause, but several factors play a role:

• Immune system dysfunction: The body overreacts to irritants and creates inflammation
• Genetic factors: Between 20-30% of patients have filaggrin gene mutations affecting their skin barrier
• Environmental triggers: Allergens, climate changes, and irritants can spark flare-ups

Risk of Eczema

A family history of allergies increases someone's risk. Other risk factors include:

• Urban living with high pollution exposure
• Living in colder regions far from the equator
• Being part of higher socioeconomic groups

Complications of Eczema

Eczema can lead to serious issues without proper care:

• Skin infections: Bacteria (especially Staphylococcus aureus), viruses, or fungi can infect the skin
• Sleep problems: Constant itching disrupts normal sleep patterns
• Mental health challenges: Chronic symptoms often trigger anxiety and depression
• Allergic conditions: The body becomes more prone to asthma and food allergies

Diagnosis

Doctors get into affected skin areas and ask about symptom patterns along with the patient's family history of allergic conditions. Several tests might help in cases that aren't clear:

• Patch testing identifies allergens that cause contact dermatitis
• Blood tests check immunoglobulin E (IgE) levels
• Skin biopsy confirms the diagnosis, though this happens rarely

Eczema Treatment

Eczema has no permanent cure, so treatment aims to manage symptoms:

• Daily moisturising requires thick, fragrance-free products
• Topical medications help during flare-ups:
  • Corticosteroid creams reduce inflammation
  • Calcineurin inhibitors provide relief
  • PDE4 inhibitors help patients
• Oral medications treat severe cases:
  • Antihistamines reduce itching
  • Corticosteroids tackle intense flares
• Advanced treatments address moderate-to-severe eczema:
  • Biologics offer relief
  • Phototherapy uses UV light
  • JAK inhibitors provide additional options

When to See a Doctor

Medical attention becomes necessary if:

• Eczema disrupts sleep or daily activities
• Symptoms continue despite home treatments
• Watch for signs of infection - your skin might get redder, warmer, swollen, or develop pus, and you might get a fever.

Prevention

Patients can prevent flares through these methods:

• Use gentle cleansers for skin cleaning
• Regular moisturising, especially after bathing prevents flares
• Staying away from known triggers helps
• Lukewarm baths work better than hot showers
• Soft, breathable fabrics protect skin
• Stress management plays a crucial role

FAQs

1. What is the main cause of eczema?

Several factors work together to cause eczema. People with eczema have an overactive immune system that triggers inflammation when they encounter certain triggers. Your genes play a vital role - if your family has a history of allergies or eczema, you face a higher risk. A weak skin barrier, often due to missing protein filaggrin, leads to really dry skin. Things in your environment like smoke, chemicals, big temperature changes, and stress can make symptoms worse.

2. What foods trigger eczema?

Milk, eggs, wheat, peanuts, tree nuts, fish, shellfish, and soy often trigger eczema. But everyone reacts differently to foods. Food reactions usually show up 6-24 hours after eating. Many kids with atopic dermatitis have food allergies.

3. How long does eczema last?

Most eczema flare-ups last about 15 days, but this can vary a lot. The condition moves through acute, subacute, and chronic phases. Good news for kids - the majority outgrow eczema by their teen years or early adulthood. Some people deal with it their whole lives, with symptoms coming and going. Adult eczema can be tougher to handle, and many adults first get symptoms later in life.

4. How to recover from eczema quickly?

Quick treatment helps cut down flare-up time. 

• Use thick, fragrance-free moisturisers daily to protect your skin barrier. 
• You can prevent new flares by staying away from your personal triggers. 
• Doctors often prescribe topical steroids to reduce inflammation and antihistamines to help with itching. 
• Tough cases might need immunomodulators or biologics. 
• Simple steps like keeping your skin cool, using gentle soaps, and wearing soft cotton clothes can bring relief.

5. When to worry about eczema?

Reach out to your doctor if:

• Eczema makes it hard for you to sleep or affects your daily routine.
• Watch for signs of an infection like a fever or skin that becomes red, warm, swollen, or starts oozing pus. 
• Kids with severe eczema might misbehave because they feel uncomfortable or struggle to sleep. 
• Also, contact your doctor if your symptoms worsen despite treatment.

6. How did I heal my eczema naturally?

Many people find relief by changing their diet and managing stress. Foods that fight inflammation, like salmon, herring, apples, berries, yoghurt, and kefir might help reduce symptoms. Taking vitamin D supplements has helped some patients. Natural moisturisers can keep your skin barrier working well. Remember that natural remedies work best when you use them along with regular treatments, not as a replacement.

Dr. Vivek Chaurasia

MBBS, MD (Internal Medicine)
CARE CHL Hospitals, Indore

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