Content

Introduction

Introduction

Also known as dermatitis, eczema is the most common non-contagious skin disease.

It represents a particular mode of reaction of the skin with respect to various internal and external factors and is characterized by the presence of reliefs or vesicles, desquamation, itching and redness.

The size and the area in which the lesions appear on the skin are extremely varied as well as the causes that can determine them. There are many types of eczema but, broadly speaking, two main types can be distinguished:

  • eczema caused by external aggressive factors (exogenous)
  • eczema directly dependent on the body itself (endogenous)

In some cases the two factors may be present at the same time: for example, endogenous eczema can be aggravated by external factors such as direct skin contact with irritants (solvents, detergents).
Sometimes two or more forms of eczema can appear at the same time complicating the detection of the disease and the cure.

The intensity and duration of the disturbances can also vary: from a light and transient form to acute and / or chronic forms with a duration ranging from a few weeks to a few months or even years. Clearly, in the latter case the manifestation of eczema does not have a continuous trend, but alternates periods in which it is not present with others in which it appears again, often also according to the seasons. This is because changes in temperature and exposure to sunlight can act as exacerbating factors.

Depending on the prevalence of one disorder (symptom) over the other, the causes and the affected area different forms of eczema are distinguished, the main ones being:

  • atopic eczema, also known as Atopic dermatitis, is the most common form of eczema. It mainly affects children but can also appear in adolescents and adults with different characteristics according to age. It is often accompanied by allergic manifestations such as bronchial asthma and allergic rhinitis. Those affected are often sensitive to allergens (substances capable of triggering an "allergy) of food origin (milk, egg, etc.) or present in the air (pollen, dust, feathers, etc.). Genetic or hereditary factors are also involved. Generally the most affected parts of the body are: knees, elbows, neck, hands, face and scalp
  • contact eczema (or contact dermatitis), is a type of eczema that occurs when the body comes into contact with an irritant, usually of chemical origin. The most important sensitizing substances are made up of chromates, cobalt salts, formaldehyde, nickel and manganese, often present in detergents and solvents also in common use. It can be of allergic or irritative origin. It occurs in the area of ​​the skin that comes into contact with the triggering substance and, initially, remains confined to this area. Later, however, it can spread to other parts of the body
  • discoid eczema (or discoid dermatitis or nummular eczema), owes its name to the characteristic circular or oval shape of the patches that appear on the skin. The cause is unknown although it is often associated with dry skin. It mainly affects adults between the ages of 50 and 70. The patches can appear anywhere on the body but, in particular, occur on the forearms, back, hands, or feet. The face and scalp are generally excluded
  • seborrheic eczema (or seborrheic dermatitis), occurs with red and scaly patches, combined with itching, well delineated and localized on the sides of the nose, eyebrows, ears, scalp and back
  • dyshidrosic eczema (or dyshidrotic dermatitis or pompholix), is characterized by small itchy blisters located mainly on the palms of the hands or on the soles of the feet, often also between the fingers. The causes are not certain but are associated with excessive sweating and metal allergy
  • varicose eczema, generally affects the itchy legs and inflamed, scaly skin around areas with varicose veins. The main cause is the presence of varicose veins and poor blood circulation in the affected area
Symptoms

Symptoms

Given the great variety of eczema, the disorders (symptoms) they cause can also be very different. There are, however, some disorders that are always present that can combine with each other by varying in intensity and rapidity of onset.

The predominant disorder in all forms of eczema is itching combined with vesicles (small pads of the skin containing serous fluid) which over time, also due to their rubbing, tend to break. The rupture of the vesicles causes the liquid contained in them to escape and the formation of small crusts of a generally round shape. In the forms of eczema that appear suddenly and rapidly (acute) the scabs are usually larger.

In the phase preceding the healing, small scales appear which gradually diminish until they disappear (total healing). In some cases the healing process can be interrupted by a relapse (flare-up).

The different phases of eczema can not only alternate with each other but also be present simultaneously in different areas of the body.

Another often characteristic element of eczema is dry and red skin.

In summary, the main symptoms (symptoms) caused by eczema are:

  • itch
  • redness
  • appearance of vesicles
  • appearance of crusts
  • peeling

The itching can be of varying intensity, in some cases it can even be so intense and long-lasting that it interferes with the quality of life by causing insomnia, lack of appetite and nervousness.

Causes

Causes

The causes of eczema are often unknown, a wide variety of external and internal factors, acting individually or in combination, can cause it. In general, however, at birth there is already a sensitivity of the skin that predisposes it to the onset of the disease.

In cases of irritative and allergic contact eczema, the causes are to be found in the substances with which the body has come into contact. Very often this type of eczema depends on substances handled as part of one's work (people involved in construction, in the chemical and textile industry, painters, hairdressers, bakers and confectioners, etc.), so much so that it is often called "professional dermatitis "It can also happen that the triggering cause is associated, over time, with a sensitization of the skin, making the disease chronic.

Bacterial infections, mainly staphylococcal or streptococcal, or those caused by fungi are very frequent in the areas of excoriated skin and cause secretions on the eczematous lesions. The causes are attributable to the germs present. The so-called infectious eczemain fact, it is often a complication of other types of eczema.

Regarding eczema that develop from internal causes, it is more difficult to analyze its origin. In general, various genetic, immunological and environmental factors are involved, even stress seems to be a triggering factor.
Summarizing, the causes can be of type:

  • allergic
  • irritative
  • infectious
  • genetic
  • "From stress"

The condition tends to worsen with exposure to certain risk factors:

  • pollen
  • molds
  • dust mites
  • animals
  • certain foods (for allergic individuals)
  • some medications
  • cold, dry air
  • contact with irritating chemicals
  • direct skin contact with natural (wool) or synthetic raw fabrics
  • additives found in soaps and skin lotions
Diagnosis

Diagnosis

In most cases there are no specific tests to ascertain (diagnose) eczema. Usually it is the dermatologist who, analyzing the type of skin lesions and considering the general state of health of the person and the possible presence of family members with "eczema or with allergies, confirms the diagnosis. Based on the possible causes of the eczema, in fact, will require to undergo specific tests.

For allergic contact dermatitis, the patch test is currently the most used test to identify any sensitivity to certain substances. The test is performed on an outpatient basis, by applying on the skin, usually on the back, some patches in which the substances to be evaluated are present. The patch is removed 48-72 hours after application.

The evaluation of the test by the doctor is important to be able to identify the substance responsible for the disorders (allergen) and to distinguish between an irritant reaction and a real allergy. The result of the skin tests depends on the number and type of substances that are tested and on the analysis of the skin reaction.
It must also be considered that the body is exposed to an increasing number of allergens and, often, it is not a single substance but a set of them that causes the reaction. In any case, the patch test is able to provide information only on the state of awareness present at the time of its execution but cannot exclude that others may be verified later.

For atopic eczema, skin and blood tests can be performed to look for antibodies, IgE, specific for the responsible substance. The usefulness of the test, however, is currently under discussion, especially with regard to food.

Other methods consist of diets devoid of the suspected food and in so-called tests of controlled provocation which consist in the administration of foods believed to be responsible for eczema. The evaluation of other indicators (markers) present in the blood (receptors and interleukins involved in the activation of T lymphocytes and eosinophils) has also been proposed to determine the degree of activity and severity of the disease.

Therapy

Therapy

There is no cure for eczema but rather a series of therapies and treatments that help relieve discomfort, prevent new outbreaks and improve the general condition.

In cases where an external factor has been identified or suspected as the main cause of eczema, this must be eliminated immediately. In any case it is advisable to avoid the use of irritants and protect the skin by using emollient creams or lotions and tissues. appropriate.

The treatment is mainly local and aims to eliminate or, at least, alleviate the ailments. In cases of mild or moderate severity, cold or lukewarm compresses with saline solution, the use of creams based on zinc oxide and emollient creams or lotions that give immediate refreshment and relief may be sufficient.

In the most acute and severe forms, however, it is necessary to intervene with a pharmacological treatment, locally or general (systemic), based on cortisone and derivatives. It must be remembered, however, that their action is only for the control and management of disorders but is not curative, so the effect is limited in time and relapses can occur with the suspension of the treatment; moreover, cortisone drugs in general must be used when really necessary and for a limited time to avoid undesirable effects (side effects). Some immunosuppressants have been proposed as an alternative to steroids, such as tacrolimus and the cyclosporine, whose application must be carefully evaluated in terms of dose and duration. In any case, the use of cortisone and immunosuppressive drugs must always take place under strict medical supervision.

To limit the discomfort caused by itching, creams and lotions containing antihistamines for local use can be used. In addition, since eczema can also be aggravated by infections, in particular by staphylococcus, which occur as a result of skin lesions, antibiotics are also often prescribed both in cream for local use and by mouth.

Recently, in acute forms of eczema and especially in atopic dermatitis, phototherapy with exposure to ultraviolet rays has also been used with good success.

For the most severe forms, an innovative treatment, to be performed once a day, is the so-called "wet wrap therapy”Which consists in first carrying out a lukewarm bath with delicate detergents, then in covering the part with an emollient or cortisone-based cream and, finally, in“ wrapping it with damp gauze bandages. This therapy has the purpose of maintaining skin hydration, reducing, through the bandage, the loss of water through the skin and creating an occlusive barrier that prevents rubbing and favors the absorption of cortisone for local use.

In the event that the acute phase of eczema, after treatment, does not subside after 3-4 weeks, it is necessary to consider the possibility that:

  • sensitizing agents are still present
  • the person is intolerant or sensitized to the treatment carried out

There are also some general rules in the treatment of eczema that must be followed:

  • limit prolonged baths or showers with water that is too hot
  • use emollients daily to keep the skin constantly hydrated
  • avoid the use of soaps, perfumes and other possible irritants
  • avoid continuous rubbing of the injured part
  • avoid the use of irritating fabrics (raw wool, synthetics)
  • follow a correct diet
Prevention

Prevention

In general, the first real prevention is to try to keep the skin as healthy as possible and, therefore, able to defend itself from infections and irritations. This means having constant care of your skin and keeping it hydrated and nourished.

Specifically, there is no real prevention of eczema, but there are some precautions that can be followed after its appearance to reduce its disturbances, avoid relapses and unwanted effects.
To avoid drying and irritating the skin it is advisable:

  • use moisturizing and emollient creams daily
  • avoid harsh soaps and shampoos, especially those that contain sodium lauryl sulfate (SLS), a foaming agent that tends to cause dryness and irritation
  • avoid prolonged showers or baths and with very hot water
  • dry the skin carefully
  • maintain the right degree of humidity in the rooms
  • avoid sudden changes in temperature from hot to cold
  • prefer cotton fabrics if in direct contact with the skin

In the case of eczema caused by allergies or by contact with irritants, once the responsible substances have been identified, prevention consists in "avoiding direct contact with them, in being informed about the names commonly used to indicate them (including synonyms) products that most frequently contain them.
In particular, attention should be paid to:

  • body care products, such as perfumes, soaps, shampoos, lotions
  • metals that come into contact with the skin, such as buckles, zippers, earrings, bracelets and even cell phones
  • substances present in fabrics for clothing and linen (dyes, formaldehyde)
  • ingredients found in drugs

It is useful and necessary to learn to read the labels and ingredients (indicated with the INCI name: International Nomenclature of Cosmetic Ingredients) of the products to be used to verify the presence, or not, of substances to be avoided.

Living with

Living with

Since there is no definitive cure for most eczema, it is necessary to live with them in the best way and manage the present ailments appropriately, thus avoiding relapses. This is why it is important first of all to identify the risk factors and to know how to recognize the reactions of your body as ailments and treatments for eczema can differ greatly from individual to individual. The more you learn to familiarize yourself with eczema, the better you will be able to manage it.

A factor that should not be underestimated, often decisive for the quality of life, is the psychological impact of the disease. The psycho-physical well-being, in fact, can be limited by excessive itching that can cause sleep loss, nervousness and a sense of inadequacy towards others.

In addition to itching, acute skin manifestations, especially when they occur on the face or other visible parts of the body, can also have an impact on a person's psychological well-being and normal social life. In these cases, psychological support is recommended both to accept the disease and to reduce its skin manifestations. It is also important to talk about your discomfort with other people and to point out that it is not a contagious disease.

Bibliography

Bibliography

Mayo Clinic. Atopic dermatitis (eczema) (English)

NHS. Atopic eczema (English)

NHS. Contact dermatitis (English)

NHS. Discoid eczema (English)

National Eczema Society (English)

National Eczema Association (English)

Wollenberg A, Christen-Zäch S, Taieb A et al. ETFAD / EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children. Journal of the European Academy of Dermatology and Venereology. 2020; 34: 2717-2744 

EDF-Guidelines for Treatment of Atopic Eczema (Atopic Dermatitis) Developed by the Guideline Subcommittee "Atopic Eczema" of the European Dermatology Forum

In-depth link

In-depth link

Italian Society of Professional and Environmental Allergological Dermatology (SIDAPA)

Italian Association of Dermatology and Cosmetology (AIDECO)

Eczema Foundation

Guidelines for the diagnosis and treatment of allergies, by the Tuscany Region. 2011 (last update 2017)

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