What is Eczema?
Eczema is a non-infectious inflammatory condition of the skin. Its primary lesion is a vesicle, and it occurs in three stages:
- Acute stage: Ill-defined erythematous patches, papulovesicular eruption with exudation of serum.
- Sub-acute stage: Erythema and scaling.
- Chronic stage: Dryness and lichenification (thick, leathery, and hyperpigmented skin).
Types of Eczema
Eczema represents a reaction pattern to a variety of stimuli.
- Endogenous eczema:
- Atopic dermatitis
- Discoid eczema
- Pityriasis alba
- Stasis dermatitis
- Exogenous eczema:
- Contact dermatitis
- Irritant contact dermatitis
- Allergic contact dermatitis
Contact Dermatitis: This occurs when the skin reacts to exogenous agents, such as chemicals, plants, metals, etc.
Irritant Contact Dermatitis:
- Irritants, either physical or chemical, cause dermatitis by directly damaging the skin barrier function.
- The most important irritants include acids, alkalis (e.g., cement, organic solvents, and detergents).
- Irritant causes more cases of contact dermatitis than allergens, although the clinical appearances are often similar.
Allergic Contact Dermatitis (Sensitization Dermatitis):
- An example of a hypersensitivity reaction.
- Diagnosed by patch testing.
Common allergens:
- Chemicals (e.g., dyes, nickel, cement, detergents, etc.)
- Cosmetics (e.g., lipsticks, nail polish, hair dyes, eyeliners, depilators, etc.)
- Locally applied drugs (e.g., neomycin and sulfonamides)
- Textiles (e.g., nylon, wool, rubber, etc.)
Atopic Dermatitis:
- Chronic pruritic inflammation of the skin, often associated with a personal or family history of allergy (e.g., asthma, allergic rhinitis, or conjunctivitis).
- Uncontrollable scratching is prominent, and the course is remittent.
Causes:
- Genetic factors
- Environmental factors (e.g., pollution, microbes)
- Immune dysregulation
Infantile phase:
- Lesions most frequently start on the face.
- Erythematous, discrete, or confluent edematous papules.
- Papules are intensely itchy and may become exudative and crusted.
- Secondary infection and enlargement of lymph nodes are common.
Childhood phase:
- Sites most commonly involved are the flexures of elbows and knees, sides of the neck, wrists, hands, and ankles.
- Erythematous, edematous papules tend to be replaced by lichenification.
- Vesiculation may occur, often in discoid patches.
Adulthood phase (Neurodermatitis):
- Lesions consist of lichenified plaques.
- Sites most commonly affected are the outer arms, upper back, and shin of the tibia.
Discoid Eczema:
- Circular or oval, coin-shaped lesions with a demarcated edge.
- Lesions are usually bilateral and symmetrical.
- More common in adults on the extensor aspects of limbs.
Varicose Eczema (Stasis Eczema):
- There is increased venous pressure in the lower limbs (e.g., varicose veins).
- It presents on the lower legs as erythematous, scaly, oozing areas surrounded by small slate-blue macules resulting from hemosiderin deposits.
- Ulceration around one of the malleoli often complicates the condition.
Seborrheic Dermatitis:
- Scaly erythematous dermatitis associated with seborrhea, abnormal sebum composition, and lipophilic yeast (Malassezia).
- symptoms:
- Infantile type: From 2 weeks to 10 months. Greasy yellowish scales on erythematous areas, usually on the scalp (cradle cap), diaper area, and intertriginous folds.
- Adult type: Diffuse or localized scaly erythematous patches involving hairy areas and body flexures (e.g., nasolabial folds, eyebrows, retroauricular areas).
Infective Eczematous Dermatitis:
It affects areas of skin around a discharging focus (e.g., discharging ear or nose). The lesion is characterized by erythematous patches with exudation and crusting.
Dyshidrotic Eczema (Pompholyx): Etiology:
- Occurs more commonly in individuals who perspire heavily.
- Dyshidrotic eczema may develop as an allergic reaction to a distant focus of infection (e.g., tinea pedis).
Symptoms of Dyshidrotic Eczema:
- An acute or subacute vesicular eruption, usually starting on the sides of the fingers and toes and extending to the soles through deep-seated vesicles.
- The vesicles tend to dry up in two weeks, with desquamation of the skin.
- Itching is very severe in dyshidrotic eczema that other types.
Pityriasis Alba:
Chronic eczema of unknown origin, though it is mostly related to environmental factors. It usually occurs in children and sometimes manifests as atopic dermatitis.
- Lesions appear as rounded or oval patches or erythematous plaques with fine lamellar or branny whitish scaling. They later subside, leaving areas of scaling and hypopigmentation.
- The most common site is the face.
- The course is highly variable, and recurrent crops of new lesions may develop at intervals.
Diagnosis and Treatment of Eczema:
Eczema is typically diagnosed by a primary care doctor who may refer you to a dermatologist for a more specialized evaluation and treatment plan.
The diagnosis typically involves a skin examination and a discussion of your family history and symptoms, including how severe they are.
Your doctor may also ask you to track any triggers you’ve noticed, such as certain foods, pets, or cleaning products.
You may also be ordered to undergo skin and/or blood allergy tests, as identifying these triggers can help both diagnosis and treatment.
In severe cases, a skin biopsy may be performed to check the level of inflammation.
When to Consult a Dermatologist for Atopic Dermatitis/Eczema?
You should consult a dermatologist if you experience any of the following:
- Severe itching: If the itching is intense and affects your daily activities or sleep.
- Any flare-ups: Appearance of new lesions or persistence of old lesions.
- Skin infections: If the affected skin becomes infected, showing signs like increased redness or other color changes, warmth, fever, swelling, or oozing.
- Identify causative triggers (allergens): If you ignore the triggers causing or worsening your eczema.
- Scarring or thickened skin: If your skin becomes thickened, cracked, or scarred due to excessive scratching.
Prevention of Atopic Dermatitis/Eczema:
The first line of treatment is prevention. Although eczema can be linked to genetics, there are simple steps to prevent it or stop it from worsening, including:
- Avoid the following:
- All types of perfumes
- Rough, tight, or coarse clothing (clothes should be cotton and rinsed twice in the washing machine)
- Harsh chemicals, like strongly scented soaps and detergents
- Animal dander
- Extreme temperatures or sudden changes in climate
It’s also important to regularly check your skin and stick to a moisturizing routine. Keeping your skin moisturized and calm can go a long way in preventing flare-ups.
- Use (in case of atopic dermatitis): Specific medicated moisturizer after a shower or bath.
Eczema Treatment:
Treatment of eczema depends on the clinical stage and severity of skin lesions.
- Topical treatment:
- Medicated moisturizing creams (for atopic dermatitis)
- Topical corticosteroid cream or ointment
- Systemic treatment:
- Antibiotics if there is a secondary infection
- Corticosteroids for severe generalized forms
- Antihistamines (sedating) to alleviate itching
- Immunosuppressors and biologics in very severe cases
How soon after treatment will I feel better?
The duration it takes for treatment of eczema to give the required effects depends on the clinical stage and severity of skin lesions.
Conclusion
Living with eczema isn’t always easy—but with the right support, knowledge, and care, it becomes manageable. At Reem Hospital, we understand the daily challenges eczema can bring to our patients, and we’re here to help you with compassion and expertise. Whether you’re newly diagnosed or have been managing eczema for years, our team is committed to creating a personalized treatment plan that fits your lifestyle and brings real relief.
Remember, you’re not alone on this journey. If you have any questions or need support, book your appointment now with our top dermatologists in Abu Dhabi. We’re here for you, every step of the way.
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