The image above shows two examples of eczema. The top image shows the dry and scaly form of eczema. The bottom image shows inflamed and weeping eczema.
Eczema classification is actually rather difficult. It can be described by location, by the physical appearance or by probable cause. The term eczema is broadly applied to a range of persistent skin conditions. These include dryness and recurring skin rashes that are characterized by one or more of these symptoms: redness, skin oedema (swelling), itching and dryness, crusting, flaking, blistering, cracking, oozing, or bleeding. Areas of temporary skin discolouration may appear and are sometimes due to healed injuries. Scratching open a healing lesion may result in scarring and may enlarge the rash. The image given here shows two typical forms of eczema. In the first (uppermost) we have dry and scaly skin. The second type has inflamed and weeping skin. |
Eczema Classification
In general, eczema is classified into two types: common and less common, with distinct sub-divisions within these classifications.
Common types of Eczema
Less common types of Eczema
Diagnosis of eczema is based mostly on history and physical examination. However, in uncertain cases, skin biopsy may be useful.
Prevention of Eczema
Those with eczema should not get the smallpox vaccination due to risk of developing eczema vaccinatum, a potentially severe and sometimes fatal complication
There is currently no cure for eczema. Instead, treatments aim at controling the underlying symptoms by reducing the level of inflammation and by reducing itching.
Corticosteroids are often the most typical medication prescribed. They are often highly-effective in controlling and suppressing symptoms. For mild eczema, a weak steroid such as hydrocortisone may be used, while in more severe cases a higher-potency steroid (e.g. clobetasol propionate) may be prescribed.
Unfortunately, corticosteroids have severe side-effects on prolonged use. The most common of these is the skin becoming thin and fragile. As a result, 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
Newer agents are topical immunosuppressants (eg pimecrolimus and tacrolimus). They often give a dramatic in the condition of sufferers, however there is some concern about a possible increased risk of lymph node or skin cancer from use of these products. But the relief induced often far-outweighs potential risks.
If the eczema is severe and unresponsive to other treatments then immunosuppressant drugs may be 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.
During a severe flare-up of eczema, the associated itch may become almost debilitating. Indeed, a severe itch can cause considerable damage to the skin due to its being constantly scratched. This damage causes further itching with means more scratching. As a result anti-itch and anti-histamine drugs may be prescribed. Often antihistamines that cause drowsiness such as promethazine and diphenhydramine are prescribed as these help with night-time sleep. Capsaicin (the 'heat' compound in chillies) may also be applied to the skin as a counter-irritant. Hydrocortisone applied to the skin aids in temporary itch relief. Temporary relief can also be attained by cooling the skin with water or by applying an ice pack.
Moisturizers help ameliorate the associated dryness of the skin in eczema. Indeed, 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. Soaps and harsh detergents should not be used on affected skin because they can strip natural skin oils and lead to excessive dryness. When choosing an emollient (a moisturizing agent) 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.
Light therapy using ultraviolet light can also help control eczema.
Recent research also suggests that food allergies may be a factor in triggering atopic dermatitis. For people where this is a case, identifying the triggering allergens and eliminating them from the diet can helm minimize and ameliorate the symptoms.
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