Atopic Eczema (Dermatitis) is an inflamed condition of the skin which is characterized with the appearance of flares or rashes on the skin surface from time to time [1]. Atopic eczema proves to be the most common type of eczema. The prevalence of this type of eczema is quite high, and it is estimated that 1 in every 20 people may develop atopic eczema.

Atopic eczema is a difficult condition to manage as it often involves extreme irritation and an urge to scratch the itch. If not taken care of, sever itching may lead to a rupture in the surface of the skin and presents a high risk of infection. As such, atopic dermatitis is often inked to infection by the simplex herpes virus, the staphylococcus aurues bacteria and certain types of fungi.

Atopic eczema is considered to be a chronic form of eczema and the flares or the rashes appear, subside over a course of time and then reappear sometime later in life. Atopic eczema is also found to be more common in children of a younger age and infants, although the condition may prove to be developed by anybody at any age. Unfortunately, the disease has no complete cure and managing the signs and symptoms of the condition and reducing the inflammation of the skin are the best possible treatment measures.

Atopic eczema is not considered to be a life-threatening or a serious condition, although it may prove to be quite uncomfortable and may prove to hinder an individual from performing normal everyday activities such as causing difficulties in sleep.

It has also been observed that out of the infants and children who encounter atopic eczema early on in life, most of them go on to develop other allergies including seasonal allergies such as hay fever or asthma.

Management of eczema can be quite effective and the symptoms can be easily controlled by following simple home remedies and lifestyle measures. Only when the symptoms cannot be effective controlled does one require medication or other professional forms of treatment. However, most of the complications associated with atopic eczema are caused due to excessive scratching and this must always be avoided.

Causes of Atopic Eczema

Even though atopic eczema proves to be a fairly widespread disorder and it has been a disease that has been around for quite some time now, the exact cause behind the development of the condition remains largely unknown despite studies and research being actively carried out. While experts continue to debate on the possible exact causes of the condition, it is generally agreed upon that atopic eczema is always associated with some allergic or atopic condition similar to that of hay fever or asthma, just as the word atopic itself suggests association with allergy.

Genetic factors cause the skin surface to behave in a manner contrary to normal when exposed to specific environmental factors [2]. It is believed that any defect in the natural oily or lipid based skin barrier can lead to the development of atopic eczema. Excessive dryness or loss of moisture from the skin may also allow the allergic germs to enter in the body through skin, leading to skin infections and complications.

The flare ups or rashes associated with atopic eczema may be triggered through contact with certain allergic agents or irritants such as dust, wool, nylon, pollen, dander, certain metals or even chemical solvents as found in soaps, shampoos and detergents. Extreme hot or extreme cold weather conditions may also lead to dryness and sensitivity of the skin surface and further on prove to cause eczema.

A defect in the surface of the skin may also be caused due to a dysfunction in the immune system of the body. This may lead to a blocking of the sweat glands on the surface of the body, proving to be more irritable and sensitive. The skin barrier then proves to perform its function ineffectively and may soon prove to be infected and may go on to develop eczema if continually exposed to harsh irritants or environmental factors.

Atopic eczema may be caused by one or a combination of all of the above. While there is still active research being carried out in trying to determine the exact cause behind the condition, most schools of thought carry out research in one or the other of the mentioned areas.

Symptoms of Atopic Eczema

The signs and symptoms of atopic eczema may vary from one individual to another and may also be dependent on the particular location of the body. However, the condition may be characterized by some common signs and symptoms which are almost always associated with conditions of atopic eczema. These signs and symptoms include the following:

  • The condition is almost always characterized by a dryness of the skin surface.
  • One may notice redness and inflammation in some areas of the skin. The most commonly affected areas of the body include the creases or folds in skin, especially the backs of the knees, the front of the elbows and the wrists and also around the neck. Besides these areas, atopic eczema may also occur in other regions of the body as well. Infants and young babies who develop conditions of atopic eczema mostly show the appearance of rashes and inflammation on the face.
  • The inflammation of the skin surface is always accompanied with sever itching leading to a strong urge to scratch. Scratching may create thickened patches on the skin and may also prove to rupture the skin surface, causing the condition to feel even more irritable. Scratching also results in the skin becoming cracked, leathery and dry in addition to being thickened.
  • Sometimes there may also be the presence of blisters and the skin lesions may become weepy and filled with pus. This is usually a result of scratching and associated infection of the sensitive area.
  • Inflamed areas of skin may also become secondarily infected in some cases. Infection by the staphylococcus aurues bacteria and simplex herpes virus, as also some certain types of fungi are commonly reported to be associated infections with atopic eczema.

While atopic eczema may occur in any age group including the infants, children, pregnant females and others, it is reported to be more commonly diagnosed in younger children and infants [3]. Atopic eczema flare ups can range from mild to very severe and the chances of recurrence of flare ups are quite high with the condition.

There are some factors which prove to worsen the signs and symptoms of atopic eczema. These include the following:

  • Taking long baths, especially with hot water, leads to a dehydration of the skin surface and can prove to be harmful with atopic eczema conditions
  • Taking up a lot of stress proves to weaken the immunological function of the body and this leads to an individual being more prone to infection
  • Excessive sweating can cause the skin surface to become even more sensitive and rashes become extremely uncomfortable
  • Irritants such as wool, pollen, dust, mites, or even smoke can prove to worsen the signs and symptoms of atopic eczema
  • Certain food groups, including soybeans, wheat, fish, eggs and dairy products may prove to contain allergens and can affect eczema sufferers adversely

Diagnosis of Atopic Eczema

Atopic eczema can be managed effectively only if it is diagnosed appropriately. For the proper diagnosis, distinguishing the type of eczema is of utmost importance [4]. This can be done by considering a proper history of the signs and symptoms as well as the diet in case of allergies of the patient.

Diagnosis of eczema also includes careful examination of the skin. While in most conditions, a clinical examination is all that is required for diagnosing the disease, in some cases a skin biopsy may be required, wherein, a small incised portion of the skin is taken and sent to the laboratory for microscopic examination and testing.

The allergy triggered atopic eczema is usually diagnosed by means of a patch test. This test serves the purpose of identifying the allergen that proves to trigger the rash. The suspected allergen is exposed to the skin by means of a small puncture in the surface and in case any redness or swelling occurs, this test is confirmed to be positive.

Prevention of Atopic Eczema

Atopic eczema may not be a serious disorder, but it is definitely associated with some very nasty complications and also the development of other allergies. By itself, atopic eczema can be frustrating to deal with, given that it involves a lot of embarrassment while also hindering the regular activities of affected individuals. Atopic eczema does not have a definite cure and as such, prevention of the disease is the best way to avoid having to deal with the condition.

Atopic eczema can be avoided by avoiding contact with triggering factors or irritants. The following measures are recommended to be adopted in order to prevent the occurrence of atopic eczema:

  • Avoid contact with harsh irritants such as detergents, soaps, dust, pollens, chemical solvents etc.
  • Wear gloves and cover yourself while going out in the sun
  • Use moisturizers and other lubricants to avoid dryness of skin at least twice daily
  • Prefer wearing light cotton clothes over synthetic or woolen fabrics
  • Use mild soaps and most preferably soaps with glycerin or moisturizers
  • Avoid contact with people with viral infections like herpes simplex
  • Ensure to take shorter baths and showers and dry the skin thoroughly by gently tapping the skin and never rubbing the skin too vigorously

Treatment of Atopic Eczema

Unfortunately, the chronic condition of atopic eczema cannot be completely cured and management of the signs and the symptoms of the condition are considered to be the best methods of treatment of the disease. That being said, the signs and symptoms of atopic eczema can be easily controlled with the help of simple home remedies and lifestyle measures. In cases of severe eczema, medication can be used but usually it is not required.

Some of the common remedies, lifestyle measures as well as medications that are used for the treatment of the conditions of atopic eczema include the following:

  • Using moisturizers or greasy emollients: One should apply medicated moisturizers that contain no perfume or other allergic agents over the flared patches. It may prevent itchiness and keeps the skin moist. It is recommended to apply moisturizers to the skin at least twice daily.
  • Application of corticosteroids: Corticosteroid creams or ointments may be applied to the rashes immediately after a bath under your doctor’s prescription and direction. While there are over the counter corticosteroid drugs available, many people prove to be allergic to them and as such, they should only be used under licensed medical recommendation.
  • Use of anti-histamines: Anti-histamines such as hydroxyzine are recommended to reduce itching. While they may prove to have the side effect of causing drowsiness, they can prove to be great in helping eczema sufferers sleep better.
  • Immunomodulators drugs: Immunomodulators drugs such as pimecrolimus and tacrolimus are newer drugs to be introduced to the market which reduce itching in case of a severe rash. These drugs work by modulating the immune system of the body and helps prevent the exaggerated response to an allergen. However, these drugs should only be taken under doctor’s prescription.
  • Calcineurin inhibitor creams can help in repairing the surface of the skin in case of cracks and lesions. However, these may have possible side effects and should only be used in case other medications are not working out.
  • Wet dressings which contain medication may also be applied to affected areas to provide relief.

Eczema may prove to be a difficult and embarrassing condition to deal with, added to the fact that it proves to be very irritating with all the scratching and itching [5]. However, simple measures can greatly help in alleviating the signs and symptoms of the disease and can allow sufferers to enjoy a higher quality of life. With active medial research being carried out for the disorder, the world awaits with bated breath to see a complete cure for this chronic condition.

References


[1] Atopic eczema/dermatitis syndrome and Malassezia, Scheynius A,Johansson C, Buentke E ;127(3):161-169-  2002- DOI: 1159/000053860, http://europepmc.org/abstract/med/11979041


[2] Management of Patients with Atopic Dermatitis: The Role of Emollient Therapy, Catherine Mack Correa and Judith Nebus; 2012: 836931- 2012 Sep 13 DOI: 10.1155/2012/836931http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3449106/


[3] Clinical Validation of a New Triplex Real-Time Polymerase Chain Reaction Assay for the Detection and Discrimination of Herpes simplex Virus Types 1 and 2, Heide Reil, Ariane Bartlime, Jana Drerup; 10(4): 361–367- 2008 Jul- DOI:  10.2353/jmoldx.2008.070104http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2438206/


[4] Epidemiological Change of Atopic Dermatitis and Food Allergy in School-Aged Children in Korea between 1995 and 2000, Jae-Won Oh, Bok-Yang Pyun, Ji-Tae Choung; 19(5): 716–723- 2004 Oct 30-  DOI:  10.3346/jkms.2004.19.5.716http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816337/


[5] Analysis of circulating γδ+ T cells in children affected by IgE-associated and non-IgE-associated allergic atopic eczema/dermatitis syndrome, C Cairo, E Arabito, F Landi; 141(1): 116–121-  2005 Jul- DOI:10.1111/j.1365-2249.2005.02813.xhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1809419/