Eczema

The skin of people with eczema does not retain moisture well and loses its protective properties. When this occurs, various symptoms can develop according to the phase of the disease. In the acute phase, lesions are intensely red, bumpy patches or plaques that may ooze fluid when scratched. In the chronic phase, scratching and rubbing create skin lesions that appear scaly, dry, thicker, darker, scarred, or lichenified. Cracking of the skin or fissures can also occur. Other common symptoms associated with eczema include:

• Intense itching
• Swollen skin
• Dry skin (xerosis)
• Skin color changes
• Pus discharge due to secondary infection
• Rash
• Hives
• Increased lines on the palms of the hands and feet
• Dry, pale patches on the face and upper arms
• Small bumps on the upper arms and thighs
• Double skinfold underneath the inferior eyelid (Dennie-Morgan fold)

Note: Distribution of lesions is age-specific.

Infants younger than 1 year old usually have the eczema rash on their cheeks, forehead, eyelids, or scalp. It may spread to the knees, elbows, and trunk (but not usually the diaper area).

Older children and adults usually get the rash in the flexural surfaces or bends of the elbows, behind the knees, on the neck, or on the inner wrists and ankles.

The exact cause of eczema is not fully known. However, there are several theories regarding the underlying causes of eczema. These theories are not thought to be mutually exclusive and may complement each other in causing eczema.

1. Defects in skin barrier
The cells that comprise our skin are vital for optimal skin hydration. Individuals with eczema tend to have dry skin due to a defect in their skin barrier. A strong association has been found between eczema and genetic changes or mutations in the filaggrin gene (FLG). This gene is responsible for creating the tough cells that form the outermost protective layer of the skin. In patients with normal skin cells, these cells are tightly packed in an organized manner. With gene defects, less filaggrin is produced, leading to a disorganized arrangement of these skin cells. This dysfunction results in a 'leaky' skin barrier, allowing water to escape easily, resulting in dryness and dehydration. Harmful substances or allergens can penetrate the skin more readily, leading to infections.

2. Impaired defense mechanisms
Individuals with eczema have also been found to have decreased numbers of beta-defensins in the skin. Beta-defensins are proteins that play a crucial role in combating certain bacteria, viruses, and fungi. A decrease in beta-defensins leads to an increased susceptibility to skin infections.

3. Immunological causes
The immune system develops during the first six months of life, establishing an equilibrium between the two main types of T helper lymphocytes (a type of white blood cell), namely Th-1 and Th-2. In eczema, this balance is disrupted, resulting in an excess of Th-2 cells and their associated chemical messengers (cytokines). In some children, elevated levels of immunoglobulin E (IgE) antibodies and eosinophils (the white blood cells associated with allergies) are also observed. In rare cases, a single mutation in CARD11, a gene involved in the development and function of certain immune system cells, can lead to eczema.

Eczema results from a complex interplay between environmental and genetic factors.

Genetics

If a parent has atopic eczema, the child could develop it as well. If both parents have it, the risk increases. Additionally, a family history of allergies, asthma, or hay fever further elevates the risk of the child developing eczema.

Personal History

Individuals with a personal history of allergies, hay fever, or asthma have a higher likelihood of suffering from eczema. Eczema, asthma, and hay fever are known as "atopic" conditions, affecting those who are overly sensitive to environmental allergens.

Environmental Factors

The irritants in our environment that can trigger eczema include:

• Harsh soaps
• Shampoos
• Detergents and household cleaners
• Dishwashing soaps and liquids
• Perfumes
• Disinfectants
• Glues and adhesives
• Chemicals used in dyes and tattoos
• Antibacterial ointments
• Fabrics like wool and polyester
• Pollens
• Molds
• Mites
• Animal dander
• Tobacco smoke

Stress

Surprisingly, stress could also be a contributing factor for eczema. Conversely, eczema can cause excess stress. Mental, emotional, and physical stressors that may trigger eczema include:

• Depression
• Anxiety
• Inability to sleep
• Irritability

Studies suggest additional risk factors for developing eczema, including:

• Food allergies such as allergies to cow’s milk, hen’s eggs, and peanuts
• Being sensitized to food in infancy
• Cold climate
• Exposure to secondhand smoke
• Excess weight at birth
• Treatment with antibiotics in infancy
• Exposure to hard water in infancy
• Birth through cesarean section

An accurate diagnosis requires a physical examination of the entire skin surface along with a detailed medical and family history. If any family members have atopic conditions, it is an important clue. No specific investigations are required to diagnose eczema. However, when there is doubt or to confirm the diagnosis, the following tests can be performed:

• Patch test: A patch test is carried out to detect allergens. This helps your doctor plan the right treatment for the allergies. They will also create a plan of action to tackle the dryness and itchiness of the skin and bring your symptoms under control. The patch test is essential, particularly if the dermatitis becomes resistant to treatment.
• Blood tests: Blood tests might be performed to check for causes of rashes that may be unrelated to dermatitis.
• Skin biopsy: A skin biopsy can be done to distinguish one type of dermatitis from another.

Eczema is a skin condition that develops as a result of an overactive immune system, a family history, or allergens and irritants in our environment. It has no permanent cure nor can it be prevented. However, we can definitely prevent the flares if we are aware of the triggers. Some of the triggers and tips to prevent it include:

1. Dry Skin

Dry skin is the most common symptom of eczema. Weather changes, harsh soaps, and hot water can all cause our skin to dry. The best way to ensure soft skin is to look after our skin health. Here are a few tips to prevent dry skin:

• Apply body lotion, moisturizer, or emollient, or cold-pressed coconut oil after a shower to lock in moisture. Moisturize at bedtime, too. Ceramide-containing creams are particularly useful.
• Place a humidifier in your bedroom during winters to moisten the air and ensure a good night’s sleep.
• Avoid long, hot water showers during winters as the skin is sensitive to temperature changes. Allow the body to warm up before a shower. Add a few drops of body oils to your bath.
• Avoid using harsh soaps, body washes, and shampoos. Refrain from using cosmetics, perfumes, or toiletries that are loaded with chemicals and can trigger a skin infection.
• Read about how to choose a good moisturizer for your skin.

2. Irritants and Allergens

The everyday products we use contain irritants that trigger rashes on our skin. The foods that we eat can also cause flare-ups. Here are some of the common products and food items that trigger a flare-up. You can find ways to replace them with products that are gentle on the skin and foods that provide the necessary nutrients without disturbing the immune system. Some common products that contain irritants include:

• Detergents
• Handwashes
• Baby wipes
• Fragrances
• Glues and adhesives
• Skincare products
• Wool and polyester fabrics

Foods that may cause allergies are:

• Milk
• Eggs
• Nuts
• Gluten (wheat)
• Spices
• Citrus fruits
• Tomatoes

Allergens are also hidden in unexpected places such as pet dander, dust mites, cockroaches, pollen, and mold. Avoiding these may prevent skin allergies leading to eczema.

3. Stress and Anxiety

Our mental health and well-being affect our physical health and lifestyle. Stress and worry can cause flare-ups, and skin infections can lead to stress and anxiety. Finding ways to break this vicious cycle will help you manage the triggers and prevent eczema flare-ups. Sufficient sleep, gentle workouts that do not cause sweating, and meditation will help you stay calm and deal with the triggers. You could ask your doctor for therapists who can help ease your tension.

Eczema is a skin condition where patches on the skin become dry, itchy, and inflamed. It does not have a diagnostic test. However, its symptoms can be treated if you are well aware of the triggers that cause flares. Here are some of the medications that are prescribed by doctors for the treatment of the symptoms of eczema.

A. Medical management

1. Corticosteroid creams and lotions: Corticosteroids are anti-inflammatory medicines that provide relief from inflammation and itchiness. Some may require prescriptions. The most commonly used corticosteroids are:
   • Prednisolone
   • Hydrocortisone
2. Topical calcineurin inhibitors: Calcineurin inhibitors help reduce inflammation and prevent flares. Examples include:
   • Tacrolimus
   • Pimecrolimus
3. Barrier repair moisturizers: These moisturizers repair the skin by reducing water loss, enhancing the natural moisture barriers of the skin, and enabling faster healing and hydration.
4. Antihistamines: These medications are used to treat allergic skin reactions, hay fever, and allergic conditions. They may cause drowsiness and help reduce nighttime scratching, ensuring a good night's sleep.
5. Antibiotics: Prescribed for bacterial infections that may develop alongside eczema. These include:
   • Flucloxacilli
   • Erythromycin
   • Penicillin
6. Other medications: Ciclosporin is prescribed if topical treatments are not alleviating the symptoms. These medications should be taken as per doctor’s prescriptions and for a short duration.

B. Injected biologic drugs

These drugs work by blocking proteins in the immune system, calming the immune response and resulting in less severe inflammation and fewer symptoms. These include:

• Rituximab
• Omalizumab
• Dupliximab
• Infliximab
• Mepolizumab
• Tocilizumab

C. Phototherapy

This therapy is used for eczema that is widespread across the body. In this therapy, the skin is exposed to UVA and UVB waves to treat moderate dermatitis. It requires one to two months of consistent treatment to notice any improvement in symptoms.

Changing your lifestyle and eliminating products and food items that trigger flare-ups are the two most important things you can do to take care of your health. It is easier to prevent flare-ups but difficult to cure them permanently. Therefore, making gradual changes instead of a quick transition will help you eventually. Here are some changes you can make at home to help prevent skin rashes or skin infections.

• Moisturize every day: Choose gentle body lotions and moisturizers or emollients to hydrate the skin. Creams containing ceramides are more effective in managing eczema.
• Add household bleach to your bath water: This helps kill the bacteria that cause infections in eczema. It will also ease inflammation and itching. Add half a cup of bleach to a tub of water and soak for 10 minutes. Rinse well.
• Be gentle while drying the skin: Dab dry with a towel to remove moisture. Avoid scrubbing.
• Use mild soaps and body wash: Eliminate harsh soaps, shampoos, and body washes, and replace them with products that are gentle on the skin and prevent dryness.
• Try cool compress: Apply a cool compress to alleviate itching. A clean, damp cloth can provide relief. Avoid scratching.
• Say no to hot water showers: Switch to lukewarm showers during winters. Take shorter baths and pat dry the skin. Moisturize after the shower.
• Use cold-pressed coconut oil: Coconut oil is antibacterial and anti-inflammatory. It helps soften dry skin and heals bacterial infections.
• Try vitamin supplements: Inquire about vitamin supplements such as fish oil capsules, Vitamin D, Vitamin E, zinc, selenium, probiotics, and turmeric. These may help manage skin infections.
• Avoid fabrics that irritate the skin: Opt for cotton, silk, and linen clothes, as these are skin-friendly fabrics that will not cause allergies.
• Avoid high-intensity workouts: Engage in a gentle exercise regimen that will minimize sweating and skin rashes.
• Massage your body: A body massage with suitable oils or lotions can provide relief. Look for a masseur experienced in treating patients with eczema.
• Manage mental stress: Practice gentle yoga exercises and meditation for stress relief. Flare-ups can trigger anxiety, which is detrimental to health.

Eczema can be caused by various factors, and severe cases require assistance from a dermatologist. Read about home remedies to manage mild cases of eczema.

The main reason behind several complications of eczema is itching. The skin gets damaged by incessant scratching due to itchiness, resulting in various infections that can worsen the condition.

• Cellulitis: A bacterial infection where bacteria infect the deeper layers of the skin. The skin appears red, swollen, and very painful. It spreads rapidly, affecting the lower legs, face, arms, and other areas. Bacteria enter the skin through cracks, leading to swelling, pain, blisters, and fever. If left untreated, it can be life-threatening.
• Eczema herpeticum: This viral infection is caused by the herpes virus. Symptoms include painful blisters, fever, and swollen lymph nodes.
• Molluscum contagiosum: This infection is caused by a poxvirus, leading to white lesions on the skin that itch and swell. Treatment options include curettage (cutting) or cryotherapy (freezing).
• Neurodermatitis: Itching and scratching due to eczema can lead to this condition. Continuous scratching causes the skin to become thick and dry, affecting areas such as the ankles, neck, hands, elbows, feet, shoulders, wrists, and scalp. Treatment typically involves steroids and medications to improve sleep and reduce scratching.
• Scars: Constant itching and scratching can lead to scarring of the skin. Once dry, scars may fade over time.
• Seborrheic dermatitis: A type of eczema affecting the scalp, caused by the Malassezia yeast fungus found on the skin's surface. It results in severe dandruff, itching, and hair loss due to damaged hair follicles, affecting the forehead, nose, armpits, chest, and groin.
• Sleeplessness: Eczema can severely impact sleep. Itchiness often worsens at night, leading to scratching and discomfort. Avoiding triggers and receiving treatment for itching can improve sleep quality.
• Depression and anxiety: Eczema can increase stress and anxiety due to skin rashes and itching. Conversely, stress and depression can trigger flare-ups. Joining a support group and engaging in therapy can help individuals relax and manage flare-ups more effectively.

The most important part of managing eczema is understanding the triggers and making necessary changes that will help you manage your condition better. It is advised to consult your doctor before starting any alternative treatments for eczema. Some of them include:

• Supplements: Supplements fulfill the body’s requirements of essential nutrients, strengthen the immune system, and reduce inflammation in patients. However, please inquire with your doctor before starting any of the supplements.
• Fish oil
• Vitamin D
• Zinc
• Selenium
• Turmeric
• Melatonin

Read more about the right way to take Vitamin D.

• Ayurveda: This ancient medical science uses various methods to achieve a balance between the mind and the body to heal an illness. It utilizes herbs, dietary changes, oils, body massages, meditation, and yoga to help purify the body from within. But please consult with your doctor before starting an ayurvedic treatment. Various herbs such as tannins, pansy flowers, fenugreek seeds, and alsi (flaxseeds) may also help treat dermatitis.

• Mindfulness and meditation: Stress increases inflammation in the body and is known to trigger eczema flare-ups. Learning meditation will help you focus on the present and attain a state of calmness to bring down stress levels.

• Yoga: Yoga is a wonderful way to practice mindfulness and improve your breathing and flexibility. It enhances not just physical well-being but also emotional and mental well-being. The gentle exercises in yoga do not exert and cause excess sweating that could trigger skin irritation. It helps reduce stress and, therefore, inflammation that causes physical discomfort. Some of the yoga asanas for healthy skin are:
• Uttanasana
• Trikonasana
• Bhujangasana
• Janu sirsasana
• Viparita karani

• Acupressure: Acupressure uses physical pressure on certain points on the body to unlock life energy. There are limited studies that prove if acupressure can bring relief from the symptoms of eczema, but just like body massage, it might help calm the mind and relieve mental stress.

• Traditional Chinese Medicine: It incorporates acupuncture, body massage, mind-body practices, and traditional Chinese herbs to help the vital force called Qi regain balance to heal an illness.

• Gamma-linoleic acid: Gamma-linolenic acid is a fatty substance used for managing symptoms of eczema. It is found in various plant seed oils such as borage oil and evening primrose oil.

• Omega-3 fatty acids: A study demonstrated that dietary intake of omega-3 fatty acids may have a therapeutic effect on the symptoms of eczema as they help reduce the inflammation associated with eczema.

• Probiotics and prebiotics: Probiotics are live microbial food supplements. Prebiotics are indigestible carbohydrates that stimulate the growth of probiotic bacteria in the intestine. They are thought to be effective in reducing the incidence of eczema. However, further studies are required to prove their effectiveness.

Living with an illness is never easy. However, a positive mindset, mindfulness, and strategies to deal with its symptoms will help you immensely. Itchy skin is the worst part of eczema, and scratching an itch is prohibited. So, how do we deal with such a problem? Here are a few tips for easy living with eczema.

1. Know your triggers
   Be aware of the triggers and foods to which you are allergic, as well as the products that irritate your skin. Understanding allergens and irritants will help you make lifestyle changes and everyday habits that can keep discomfort under control. Avoid direct sunlight and any exercise that causes sweating. Protect yourself from sun, heat, sweat, and sudden temperature changes that can dry the skin.
2. Start an exercise routine
   Choose an exercise routine that suits you. Ensure it doesn’t overexert you or make you break into a sweat. Try something gentle like yoga or Tai Chi. The benefits of exercising are numerous; it improves physical health and enhances mental and emotional well-being. It helps you stay mindful, focus on breathing, and calm your mind. Exercising also fosters a positive attitude, which is essential for everyday life.
3. Moisturize
   Keeping the skin well-moisturized is essential to prevent itching and the development of cracks that can lead to bacterial infections. Choose lotions and creams that are gentle on the skin and contain fewer chemicals. Opt for cold-pressed coconut oil, which is antibacterial, antiviral, and rich in antioxidants that keep the skin soft and healthy.
4. Develop a hobby
   Engaging in any creative activity, such as drawing, singing, cooking, reading, writing, or gardening, can help keep your mind occupied. Indulging in these activities keeps you busy and happy while also distracting your mind from itching and other discomforts related to eczema. It provides an opportunity to spend time with yourself, doing something you enjoy.
5. Communicate
   Being open about your condition with family and friends is very important. It helps them understand your struggles and extend the help you may need. Additionally, communicate regularly with your doctor. Keep your appointments so they are aware of your symptoms, flare-ups, and discomfort, enabling them to make necessary adjustments to your treatment.
6. Self-care
   Self-care is critical when dealing with eczema. Find time for yourself and engage in activities you love. Prioritize your health and well-being. Look after yourself as you would care for your loved ones.