In this article
	Summary
	What is eczema?
	What causes eczema?
	What are the symptoms?
	Prevalence
	Course
	Risk factors
	When to see a doctor
	Diagnosis
	Treatment
	Prevention

Summary

• Eczema is also called dermatitis.
• Eczema is not contagious.
• Some forms of eczema tend to run in families with a history of allergies.
• Symptoms may last from two weeks to many years.
• Treatment is usually effective and may lead to long periods of remission.

What is eczema?

Eczema is an inflammatory skin response. It is chronic and has flare-ups and remissions. There are various types of eczema: some caused by allergies or irritating chemicals, others the result of other medical conditions such as varicose veins. In the early states the condition is characterised by dry, red, itchy skin. An acute attack may produce crusty scales or blisters.

Eczema in children is often associated with asthma and hay fever.

What causes eczema?

• Atopic eczema (atopic dermatitis) occurs in people who have an inherited predisposition to allergies such as allergic asthma, hay fever or food allergies. Babies from two to 18 months may have eczema on the face, neck and groin. In older children, teenagers and adults, it affects mainly the skin of the hand

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  s and feet and in the folds of the elbows and knees. Some children may outgrow the condition by the age of two years.
• Contact dermatitis occurs after contact with a substance to which the patient has become allergic.
• Irritant contact dermatitis may be caused by prolonged contact with mild irritants such as soap, detergent, bubble bath, sweat, saliva, urine (in nappy rash) or even water. Irritant contact dermatitis is not immunologically initiated. Anyone can develop it, if subjected to an irritant enough.
• Allergic contact dermatitis is caused by an allergy to a specific metal of chemical, for example nickel and chemicals in perfumes, skin creams and lotions, cosmetics, shampoos, shoes and clothing. Contact with some animals, plants, flowers, herbs, fruits and vegetables may cause a reaction in some people.
• Hand eczema, a chronic eczema occurring only on the hands, is related to atopic eczema in allergic people, but can also be caused by repeated hand washing or exposure to strong detergents. It may also be caused by an allergy to latex rubber.
• Nummular (discoid) eczema, a type of eczema that occurs mainly in middle age, may be related to atopic dermatitis and (less often) to contact dermatitis. A dry environment, very hot showers, stress and other skin disorders may cause nummular eczema.
• Asteatotic eczema, occurring mainly in the elderly, is caused by dry skin and dry conditions, for example when they spend more time in an indoors environment with low humidity during winter. It usually leads to fine cracks in the skin, starting on the legs.
• Stasis dermatitis is the result of poor blood circulation in the lower legs. It affects people suffering from varicose veins or other conditions that cause poor blood circulation. It may lead to ulcers on the lower legs.
• Seborrhoeic dermatitis is a scaly skin condition that occurs when the sebaceous glands produce too much oil (sebum). It is aggravated by stress and is common in Aids patients.

What are the symptoms?

Generally the symptoms of eczema include patches of itching red, brown or normally coloured, raised skin, and tiny bumps or blisters that may ooze fluid. The itching may become very severe.

If untreated, the skin may become thick, scaly and dry, with areas of hair loss and pigment changes in dark-skinned people. In babies it is usually found on the face or groin, in children on the inside of the elbow or back of the knee and in adults on the hands, feet, ankles and groin.

• In atopic eczema the affected skin looks wet or crusted. The patches are very itchy and irritated. Scratching increases the risk of infection from bacteria. In babies the symptoms appear on the face, neck or groin, in children on the inside of the elbow or back of the knee and in adults on the hands, back of the neck, ankles and feet.
• Contact dermatitis has the following symptoms when caused by an irritant: mild redness to severe blistering or even ulceration of the skin. When the cause is an allergic reaction, skin redness, fine red bumps or blisters and severe itching are the result. When caused by an allergy to plants, the reaction is quite severe with bumps and blisters, and a pattern of lines or streaks can be seen on the skin where there has been contact.
• Hand eczema caused by irritants has symptoms of dry, cracked skin, with or without redness. Other forms of hand eczema may be itchy red bumps and blisters. The skin under a ring often shows the first symptoms.
• Nummular eczema, which begins with small areas of irritation, later turns into red, round, crusted, scaly patches. The patches usually occur on the legs, buttocks, hands and arms of older people.
• In asteatotic eczema, the patient feels a stinging in areas of redness and dry skin. Tiny bumps may also occur.
• Stasis dermatitis initially presents as a mild redness and itching of the legs and the skin around the ankles. The legs may already be slightly puffy or very swollen due to poor blood circulation. If redness and tenderness develop suddenly, it might indicate a secondary bacterial infection, which needs immediate medical attention.
• People with seborrhoeic dermatitis have greasy, yellowish scales on the scalp and eyebrows, behind the ears and around the nose. In infants it is called "cradle cap" if it occurs on the scalp.

Prevalence

Accurate South African statistics are unknown, but between three and 10% of Americans suffer from atopic eczema. In 70% of the sufferers the condition runs in the family. It is common among infants, who may outgrow it before their second birthday.

Course

Symptoms may clear up after a week or two or may persist for years, resulting in a chronic condition. Contact dermatitis, for example, may heal within a week after removing the irritant, whereas stasis dermatitis caused by varicose veins may persist for many years. The response to treatment may also vary from person to person.

Risk factors

• Children with asthma and hay fever (atopy)
• People with a family history of allergies
• Men of 55 years and older (nummular eczema)
• The elderly (asteatotic eczema) with dry skins
• People with Aids (seborrhoeic dermatitis)
• Alcohol consumption

When to see a doctor

• If someone with a family history of eczema or asthma develops an unexplained rash
• If home treatment does not have the desired effect after a week
• If a yellowish to light brown crust, or pus-filled or oozing blisters, develop over existing patches of eczema, possibly indicating an infection
• If the skin is painfully dry
• If you have been exposed to a person with a viral skin disease (such as cold sores, genital warts or genital herpes) while you are having a flare-up of eczema
• If numerous small, pus-filled blisters develop, possibly indicating a rare but serious complication called eczema herpeticum, which is caused by the herpes simplex II virus

Diagnosis

Eczema can usually be diagnosed by the doctor’s observation of the affected area. Your doctor will take your personal and family history of allergies and enquire about your exposure to potential allergens. If an allergy is suspected, patch testing with various allergenic chemicals may be ordered to determine the source. Sometimes a skin scraping will be taken for microscopic analysis.

A radioallergosorbent test (Rast) may also be done to identify possible allergens. There is not a definite correlation between the RAST tests and eczema.

Treatment

The main purpose of treatment is to identify and eliminate the causative factors as far as possible and to relieve the symptoms.

Home

• Wear loose clothing, preferably cotton.
• Soak in a medicated bath to remove crusted skin. Use starch, colloidal oatmeal or bath oil in the water to help soothe irritated nerve endings and reduce the risk of bacterial infection.
• After a bath, apply petroleum jelly or simple moisturising cream or emolient to help conserve the skin’s natural moisture. Topical coal-tar products may also be used for short periods of time but they are messy and smelly. Coal-tar products may not be used during pregnancy. A coal-tar-based shampoo may be used for seborrhoeic dermatitis. Some studies have suggested that coal-tar products may be carcinogenic.
• You can relieve the dry sores of nummular dermatitis by soaking in salt water, followed by an application of corticosteroid cream and emolient.
• In the case of stasis dermatitis you should wear support stockings and rest frequently.
• In extreme cases of eczema, especially in children, an effective method of returning moisture to the skin is a wet body wrap. The person sleeps in wet sleepwear covered with dry clothes or a nylon tracksuit. The face can be covered with wet gauze covered with an elastic bandage. The hands and feet can be covered with a pair of wet socks under a pair of dry ones. The person’s room must be kept warm.

Medication

• Moisturising creams and ointments are essential.
• Steroid-based cortisone creams are used to help reduce itching, but not if the skin is broken or infected.
• Avoid overuse of cortisone creams, because they may lead to premature ageing and atrophy of the supporting layers of the skin.
• Antihistamine taken orally may be used to help control itching and to sedate the patient if the eczema is associated with an allergy.
• In severe cases, a doctor may prescribe an oral corticosteroid.
• Severe cases of seborrhoeic dermatitis may need corticosteroid injections.
• The doctor will prescribe an antibiotic to treat secondary infection.
• Stasis dermatitis may need treatment with tar or zinc paste, which must be left on the sores and must be bandaged by a trained professional for up to two weeks.

Other

• In some cases, treatment with ultraviolet light is an option.
• Patients may need programmes that promote stress management and lifestyle changes.

Prevention

• Prevent dry skin by using moisturising creams and ointments.
• Prevent eczema flare-ups by avoiding exposure to temperature extremes, dry air, harsh soaps and bubble baths.
• Use cotton blankets and clothing and avoid wool and synthetic fabrics, which are more irritating.
• Pat yourself dry after a shower or bath so that a thin layer of moisture remains on the skin. Apply a moisturising cream or lotion.
• Use a room humidifier during the winter to add moisture to a room.
• Avoid contact with irritating chemicals, animals, plants, jewellery or any other substance that could trigger a skin allergy. Wash the skin with soap and water immediately after contact with an irritant.
• People with varicose veins should wear compression stockings and should elevate their legs as much as possible to prevent stasis dermatitis if they have to sit for long periods of time.
• Prevent eczema in a baby by protecting the infant from potential allergens such as tobacco smoke, pet hair, mites and moulds. The baby should feed exclusively on mother’s milk for the first three months and should not be given eggs or fish until the age of one year.

Reviewed by Prof H. Jordaan, Dermatology Department, University of Stellenbosch.