Eczema is a skin condition that is characterized by skin inflammation that can occur at any age. It causes symptoms such as dryness, itching, swelling, blisters and redness of the skin, and most commonly affects children.
Although the cause is not yet known, it is believed that eczema, which is also known as atopic dermatitis, can be caused by factors such as allergies to substances or medications, changes in environmental temperature, or stress.
Treatment for eczema is guided by a dermatologist, who may prescribe ointments, creams, or oral medications containing corticosteroids, antihistamines and immunosuppressants, as well as phototherapy sessions.
Common symptoms
The main symptoms of eczema include:
- Dry skin;
- Skin peeling
- Intense itching
- Skin swelling
- Redness
- Blisters on the skin, which can rupture and release fluid
- Formation of wounds on the skin;
- Changes in skin color in affected areas, either lighter or darker than normal.
In chronic phases of eczema, the blisters begin to dry and form crusts, which can also increase the thickness of the skin in the area.
Symptoms in babies
In babies and young children, eczema is most commonly noted on the cheeks, outside of the elbows and knees. Babies with eczema may rub themselves against the bed or other objects to try to relieve the itching.
In older children, eczema often appears on the hands, feet, arms, and the backs of the knees.
Symptoms in black patients
Symptoms of eczema in black patients include thickening of the skin and red, brown, purple, gray or dark red plaques. Itching can also be more intense.
Confirming a diagnosis
An eczema diagnosis is confirmed by a dermatologist through an assessment of the symptoms and signs presented, as well as the health history and a physical examination.
The doctor may also recommend allergy tests to identify what specifically triggers eczema.
Possible causes
The causes of eczema are not yet well understood, however, factors that may increase the risk of this condition are:
- Family history of eczema dermatitis, allergies and asthma
- Extreme heat or cold
- Low air humidity
- Allergy to food, dust mites, mold, pollen, dust and animal dander
- Cleaning products, such as detergent and soap
- Clothes, belts, jewelry or some types of fabric, such as wool and jeans
- Medications, such as antibiotics, phenytoin, carbamazepine, and lamotrigine
- Cosmetic products such as makeup, perfume, shampoo, deodorant, soap and depilatory cream
Furthermore, eczema can also appear due to emotional factors (like stress, anxiety or depression) or due to hormonal changes during the menstrual cycle or pregnancy.
Eczema is a non-contagious inflammatory condition, meaning it is not transmitted from person to person.
Types of eczema
The types of eczema are characterized by their cause and the symptoms it presents with. They include:
1. Contact eczema
Contact eczema, or contact dermatitis, appears after contact with an irritating or allergenic object or material that leads to an exaggerated immune system response. The most common areas of contact eczema are the hands, face, neck and feet.
2. Nummular eczema
The cause of nummular eczema, also known as discoid eczema or nummular dermatitis, is not yet known. However, some factors that can cause this condition are atopic dermatitis, dry skin, allergies, frequent baths with hot water or emotional stress.
This type of eczema is characterized by the presence of coin-shaped pink, red or brown spots on the skin, as well as intense itching and burning.
3. Dyshidrotic eczema
Dyshidrotic eczema, or dyshidrosis, can be caused by skin allergies, atopic eczema, contact dermatitis, excessive moisture on the hands or feet, and increased physical or emotional stress.
Symptoms of this type of eczema include the appearance of small, fluid-filled blisters on the palms of the hands, the sides of the fingers, or the soles of the feet.
Dyshidrosis, or dyshidrotic eczema, is a skin condition that causes the formation of small, fluid-filled blisters, which often appear on the palms of the hands, sides of the fingers, or soles of the feet.
4. Eyelid eczema
Eyelid eczema is a condition caused by contact of the eyelids with an allergic substance.
Symptoms of eyelid eczema are redness, peeling, swelling, burning and itching of the eyelids.
5. Atopic eczema
Atopic eczema, or atopic dermatitis, is normally associated with asthma and rhinitis and symptoms, like intense itching, are usually noted on the face and in the folds of the arms and legs.
6. Stasis eczema
Stasis eczema, also known as stasis dermatitis, is an inflammation of the skin mainly caused by poor circulation in the legs. It leads to the accumulation of blood and fluids that leak from the veins and put pressure on the inner part of the skin.
The symptoms of this type of eczema are swelling, purple or brown skin, itching, pus-filled wounds and crusts on the legs and ankles.
7. Perianal eczema
Perianal eczema is characterized by redness, swelling, itching or changes in the skin around the anus, between the buttocks.
Some factors related to this type of eczema are advanced age, fecal incontinence, immobility, hyperhidrosis, obesity and poor anal hygiene, which alter the skin barrier in the anus and promote inflammation.
8. Asteatotic eczema
Asteatotic eczema is a type of eczema caused by loss of water from the skin due to a genetic predisposition and damage from environmental factors, such as low humidity or excessive bathing with strong soaps and detergents.
A person with this type of eczema may have diamond-shaped patches of skin, separated by red fissures on the skin.
9. Medication-related eczema
Medication-related eczema occurs when a person takes a medication that leads to the development of an allergic reaction, causing eczema to appear on the skin
Treatment options
Eczema treatment must be carried out by a dermatologist, and the use of ointments, oral medications and phototherapy may be recommended.
1. Ointment or cream
The dermatologist may prescribe creams or ointments containing corticosteroids, such as betamethasone or dexamethasone, to reduce inflammation and itching in the skin.
Others that contain antibiotics or calcineurin inhibitors, such as tacrolimus and pimecrolimus, may also be prescribed by the doctor to combat bacterial infection and decrease inflammation.
2. Oral medications
In some cases, your doctor may recommend the use of oral medications:
- Corticosteroids, such as prednisone or prednisolone
- Antihistamines, such as diphenhydramine or hydroxyzine
- Immunosuppressants, such as cyclosporine, azathioprine, mycophenolate or methotrexate
- Biological therapy, such as dupilumab in injection form
In some cases, your doctor may also recommend the use of oral antibiotics to prevent or treat bacterial skin infections.
3. Phototherapy
Phototherapy with ultraviolet A or B radiation (UVA or UVB) may be recommended by your doctor for moderate eczema that has not improved with other treatments, as it helps to reduce skin inflammation.
Phototherapy can be used together with an oral or topical medication, psoralen, which is referred to as PUVA therapy. This consists of taking or applying psoralen in the form of an ointment on the skin, and 2 hours later exposing the area that will be treated with ultraviolet radiation.
Daily care
Some daily care measures that help prevent flare-ups or worsening of symptoms include:
- Take short showers, for up to 5 minutes, with warm water
- Dry your skin after bathing with a soft, clean and dry towel, without rubbing the towel too hard on your skin
- Apply a neutral, fragrance-free moisturizer, as recommended by your doctor, daily after showering, while your skin is still damp
- Avoid scratching the affected skin
- Use neutral soaps and detergents to avoid skin irritation
- Avoid perfume or scented lotions on the skin
- Wear loose, cotton clothing, and avoid tight, rough fabrics
- Use a room humidifier when the weather is very dry or col
- Avoid very hot environments
It is important that these measures are done on an ongoing basis, even when symptoms of eczema resolve, as they can prevent dry skin and new flare-ups.