Eczema

What is eczema?

Eczema (commonly misspelled exema, exzema, eckzema) is an inflammatory skin condition (a type of dermatitis) .It is related to atopy (which also causes asthma and hay fever) and to allergy.

What are the types of eczema?

There are many different types, however the most common are:

1. Atopic eczema: It comes in attacks and sometimes coexists with asthma or allergic rhinitis.
   
2. Contact dermatitis: This must be distinguished from other types because it might be curable if the allergen is identified and removed (for example the rubber in gloves, the metals in jewelry, cleaning products etc).
   
3. Xerotic eczema or dry eczema: It is characterized by a severe dryness of the skin, which then progresses to flaky excoriating skin.
   
   
   
   This type is the one usually seen in elderly people.

How to diagnose eczema and identify the allergen?

Identifying the allergen is done by the allergist by:

1. Determination of IgE levels and eosinophilia in blood, which proves there is an allergy.
   
2. A “radioallergosorbent” test   is done by adding samples of different allergens to the blood and checking which one reacts with the blood.
   
3. A “skin patch” test is performed by applying different allergens to the skin and observing which one causes an allergic reaction on the skin.

How to prevent eczema attacks?

1. Once an allergen is identified, it must be removed from the patient’s surroundings. Non-allergenic material should be used instead of allergenic material (like plastic gloves in cases of latex allergy)
   
2. The next important step is to care for the skin and protect it from drying:
        a.
   
   
   
   Definitely not to use detergents, use only soaps that are rich in fat, and non-scented. Even that soap should be used scarcely.
        b.
   
   
   
   Not using towels or sponges to dry the skin because they might injure the fragile, already dry skin.
        c. Emollient ointments and moisturizers.

Treatment of eczema:

1. Use of moisturizers and emollients.
   
2. Steroids are effective in controlling the symptoms although they cannot completely cure eczema.
   
   
   
   The drugs prescribed by the doctor vary from mild steroids like Hydrocortisone to heavy duty steroids like Clobetasol. 
   Precaution: steroids themselves cause the skin to atrophy with excessive use; also if used in large quantities they might get into the system and cause many issues like osteoporosis (brittle bones). Steroids should only be used as directed by the treating doctor.
   
3. Light treatment or treatment with UV light.
   
   
   
   The problem is the risk of developing skin cancers. If the light treatment alone is not effective, an ointment like Psoralen might be added.
   
   
   
   This same combination is used to treat Psoriasis.
   
4. Drugs that modify the immune system like Tacrolimus: The benefit is to decrease dependence on steroids. However there is a risk of interfering with immunity to the extent where cancers might occur. This is controversial, and many doctors recommend the use of these drugs, since eczema itself might theoretically increase the risk of cancer.

When to consult the doctor?

Eczema is a chronic, debilitating disease. Patients should be always in contact with a dermatologist. Sometimes counseling is advised to deal with the psychological burden of the disease (the disfigurement, the itching attacks, the stigma of itchy rashes etc)