ATOPIC DERMATITIS aka ECZEMA
Greetings to you all earth inhabitants and you sons of Adam. How has life been treating you?
These days I often find myself unconsciously referring back to something Chinua Achebe wrote in his book, Things Fall Apart. Those of you who have read the book will know that the opening statement reads,” Turning and turning in the widening gyre, the falcon cannot hear the falconer; things fall apart; the center cannot hold; mere anarchy is loosed upon the world”. Side note; some of you might know it as the poem, ‘The Second Coming’.
History seems to illustrate that the flow of events always leads to chaos and instability. First was Covid-19, and just when we thought we were going back to normalcy, Monkeypox came knocking at the door. Regardless of how chaotic the world is right now; remember you are strong and you can overcome any obstacle that comes your way.
Let’s move on to today’s business. ATOPIC DERMATITIS aka ECZEMA. Before we dive in, let us look at the skin as an organ.
The largest organ in the body is the skin. The integumentary system is made up of the skin and its by-products, including the hair, nails, perspiration, and oil glands. Protection is one of the skin’s primary roles. It shields the body from environmental dangers like temperature, toxins, and pathogens. The pigment melanin acts as a chemical pigment defense against ultraviolet light, which can harm skin cells, and the skin includes secretions that have the ability to destroy microorganisms.
The symptoms and severity of skin conditions vary widely. They could be painless or painful, transient or long-lasting. While some may have genetic origins, others may have environmental ones. Skin problems range from trivial to potentially fatal. While the majority of skin conditions are mild, some others can point to a more significant problem.
Eczema (also known as atopic dermatitis) is a skin ailment that causes dry, red, itchy, and rough skin. It is one of several kinds of dermatitis. Eczema compromises the skin’s barrier function (the “glue” of your skin). Because of the lack of barrier function, your skin becomes more sensitive and prone to infection and dryness.
Eczema is not harmful to your health. It does not imply that your skin is infected or dirty, and it is not communicable (contagious). There are treatments available to assist you to manage your symptoms.
In the term “dermatitis“, the words “derm” and “itis” imply “skin” and “inflammation,” respectively. The term as a whole signifies “skin irritation.” The term “eczema” comes from the Greek word “ekzein,” which means “to boil over” or “burst out.”
The type of eczema you have can influence the sort of rash you develop and where it appears on your body.
The GBD (global burden disease) 2017 global prevalence of Atopic dermatitis in both sexes was 2689.85 per 100 000 people. If my calculations are spot on, this means that 2.4% of the population worldwide has Atopic dermatitis. The prevalence varies significantly across countries. Adult Atopic Dermatitis, for example, has a prevalence of 4.9 percent in the United States and 2.1 percent in Japan. In some countries, such as Sweden, the prevalence of Atopic Dermatitis in children can reach 20%.
Eczema affects both men and women equally and is more prevalent in persons with a personal or family history of asthma, environmental allergies, and/or food allergies.
Causes:
Eczema’s cause is not well understood. However, researchers believe it is caused by an overactive immune system.
When your skin is exposed to external irritants, your immune system overreacts, causing your eczema to flare. As we go further, I will list down common flare-up triggers.
Furthermore, researchers discovered that some people with eczema do not produce enough of a protein called filaggrin (filament aggregating protein). This protein is in charge of keeping your skin hydrated and healthy.
Itching and redness are the earliest indicators of eczema.
Eczema can appear anywhere on your body’s skin. It is commonly observed on the hands, neck, inner elbows, ankles, knees, feet, and around the eyes of teenagers and adults.
- Your immune system: your immune system overreacts to minor irritants or allergens if you have eczema. This overreaction may cause skin irritation.
- Your genetics: if your family has a history of dermatitis, you are more likely to develop eczema. You’re also more vulnerable if you have a history of asthma, hay fever, or allergies. Allergens are substances that cause an allergic reaction, such as pollen, pet hair, or foods. There may also be a change in your genes that affect a protein that aids your body in maintaining healthy skin. Your skin will not be totally healthy unless it has appropriate quantities of that protein.
- Your environment: there are numerous things in your environment that can irritate your skin. Tobacco smoke, air pollution, harsh soaps, wool textiles, and various skin creams are among the examples. Dry and itchy skin can result from low humidity (dry air). Heat and extreme humidity can promote sweating, which can aggravate the irritation.
- Your stress. Your stress levels might either cause or aggravate your eczema. There are both mental/emotional and physical signs of stress. They are as follows:
Mental/emotional symptoms:
- Depression.
- Difficulty relaxing.
- Use of alcohol, tobacco, or illegal drugs to relax.
- A negative opinion of yourself (low self-esteem).
- Anxiety, constant worry.
- Feeling overwhelmed.
- Difficulty with concentration.
- Irritability, mood swings, or a short temper.
Physical signs:
- Nausea and dizziness.
- Sleeping too much.
- Sleeping too little.
- Diarrhea.
- Constipation.
- Muscle tension.
- Aches and pains.
As promised, here are the triggers for eczema:
Risk Factors:
The primary risk factor for atopic dermatitis is having a personal or family history of eczema, allergies, hay fever, or asthma.
Types of Eczema:
Eczema comes in a variety of forms. Other kinds of dermatitis than atopic dermatitis include:
- Allergic contact dermatitis: This is a skin reaction that occurs following contact with a substance or allergen that the immune system recognizes as foreign.
- Dyshidrotic eczema: This refers to irritation of the skin on the palms of the hands and soles of the feet. It is characterized by blisters.
- Neurodermatitis: This leads to scaly patches of skin on the head, forearms, wrists, and lower legs. It occurs due to a localized itch, such as from an insect bite.
- Discoid eczema: Also known as nummular eczema, this type presents circular patches of irritated skin that can be crusted, scaly, and itchy.
- Stasis dermatitis: This refers to skin irritation of the lower leg. It is usually related to circulatory problems.
Diagnosis:
Typically, your dermatologist or primary care physician will look for eczema symptoms such as skin redness and dryness. They will ask about the symptoms you’re experiencing. In the event of any uncertainty regarding your symptoms, they may conduct the following tests:
- An allergy skin test.
- Blood tests to check for causes of the rash that might be unrelated to dermatitis.
- A skin biopsy to distinguish one type of dermatitis from another.
Symptoms:
Atopic dermatitis symptoms can vary depending on a person’s age and the severity of the ailment, as well as by individual.
People with eczema frequently have periods when their symptoms worsen, followed by periods when their symptoms improve or clear up.
In general, eczema exhibits itself as follows:
In most cases eczema symptoms are mild. The most common symptoms of atopic dermatitis include:
- dry, scaly skin
- skin flushing
- itching
- open, crusted, or weeping sores
People suffering from severe eczema may require more intense treatment to alleviate their symptoms. Frequent rubbing and scratching can also cause skin infections.
A rash caused by eczema may appear gray or brown on People of Color. This can make it tougher to detect outbreaks.
However, people of color who suffer from eczema may develop dark or light skin patches even after the condition has resolved. These can last a long time. The medical terms for these lesions include hyperpigmentation, depigmentation, or hyperpigmentation.
These patches, which may be responsive to steroid creams, might be evaluated by a dermatologist.
Common atopic dermatitis symptoms in infants under 2 years of age include:
- rashes on the scalp and cheeks
- rashes that bubble up before leaking fluid
- rashes that can cause extreme itchiness, which may interfere with sleeping
The following atopic dermatitis symptoms are prevalent in children older than 2:
- rashes that appear behind the creases of elbows or knees
- rashes that appear on the neck, wrists, ankles, and the crease between the buttocks and legs
- bumpy rashes
- rashes that can become lighter or darker
- skin thickening, also known as lichenification, can then develop into a permanent itch
Common adult atopic dermatitis symptoms include the following:
- rashes that are more scaly than those occurring in children
- rashes that commonly appear in the creases of the elbows or knees or the nape of the neck
- rashes that cover much of the body
- very dry skin on the affected areas
- rashes that are permanently itchy
- skin infections
Adults who had atopic dermatitis as children but no longer have it may still experience dry or easily irritated skin, hand eczema, and eyelid eczema.
The look of atopic dermatitis-affected skin depends on the amount of scratching and whether the skin is infected. Scratching and rubbing can irritate the skin further, promote inflammation, and exacerbate the itch.
Treatment:
There is currently no cure for eczema. The purpose of treatment is to repair the afflicted skin and prevent recurrences of symptoms.
Doctors will recommend a treatment plan based on the patient’s age, symptoms, and current health status.
Some individuals recover from eczema over time. For some, though, the illness is chronic.
The objective is to alleviate irritation and discomfort and avoid infection and further outbreaks.
Consider these therapy suggestions:
- Use a humidifier if dry air makes your skin dry.
- See a psychiatrist for medication and a therapist for counseling if you’re experiencing symptoms of poor mental/emotional health.
- Moisturize your skin using a cream or ointment. Lotions don’t work as well. Apply several times a day, including after you bathe or shower. Use lukewarm water in the tub or shower instead of hot.
- Use mild soaps and other products that are free of perfumes, dyes, and alcohol. Look for products labeled “fragrance-free,” “hypoallergenic” and “for sensitive skin.”
- Use skin products that contain ceramide. These moisturizers replace some of the “glue” (the barrier) missing from your skin.
- Apply cortisone creams and ointments. Cortisone is an over-the-counter steroid found in hydrocortisone (Cortisone 10®) and hydrocortisone acetate (Cort-Aid®). They may help control the itching and redness.
- Take over-the-counter antihistamines for severe itching.
- Take prescription medications. Your healthcare provider may prescribe steroid creams, pills, and/or shots. Long-term risks include side effects like high blood pressure, weight gain, and thinning of the skin. There are newer medications, called topical immunomodulators (TIMs) that show progress in treating patients who do not respond to other treatments. They change the body’s immune response to allergens and have fewer side effects.
- Phototherapy: The ultraviolet light waves found in sunlight have been shown to help certain skin disorders, including eczema. Phototherapy uses ultraviolet light, usually ultraviolet B (UVB), from unique lamps.
For children with eczema, you can:
- Avoid long, hot baths, which can dry the skin. Use lukewarm water instead and give your child sponge baths.
- Apply lotion immediately after bathing while the skin is still moist. This will help trap moisture in the skin.
- Keep the room temperature as regular as possible. Changes in room temperature and humidity can dry the skin.
- Keep your child dressed in cotton. Wool, silk, and manmade fabrics such as polyester can irritate the skin.
- Use mild laundry soap and make sure that clothes are well rinsed.
- Watch for skin infections. Contact your healthcare provider if you notice an infection.
- Help them avoid rubbing or scratching the rash.
- Use moisturizers several times daily. In infants with eczema, moisturizing on a regular basis (with each diaper change for example) is extremely helpful.
Prevention:
If you have been paying attention, by now you’d know that it is impossible to prevent eczema as the origin of the condition is still under speculation. Here, I used the term, ’prevention’ in relation to eczema outbreaks. Hmmm, then maybe I should have written the subheading as, ‘Prevention of eczema outbreaks”, oh well. There are measures that may prevent attacks of eczema:
- Establish a skincare routine, and follow your healthcare professional’s recommendations for keeping your skin healthy.
- Wear gloves for jobs where you have to put your hands in water. Wear cotton gloves under plastic gloves to absorb sweat, and wear gloves outside, especially during the winter months.
- Use a mild soap for your bath or shower, and pat your skin dry instead of rubbing it. Apply a moisturizing cream or ointment immediately after drying your skin to help seal in the moisture. Reapply cream or ointment two to three times a day.
- Take baths or showers with tepid (lukewarm) rather than hot.
- Drink at least eight glasses of water each day. Water helps to keep your skin moist.
- Try to avoid getting too hot and sweaty.
- Wear loose clothes made of cotton and other natural materials. Wash new clothing before wearing it. Avoid wool.
- Avoid sudden changes in temperature and humidity.
- Learn to recognize stress in your life and how to manage it. Regular aerobic exercise, hobbies, and stress-management techniques, such as meditation or yoga, might help.
- Limit your exposure to known irritants and allergens.
- Avoid scratching or rubbing itchy areas of the skin.
Uncertain is the relationship between eczema and food allergies. If you have a food allergy, one of the reasons you must avoid that food is because it might cause or exacerbate dermatitis. Common allergens include peanuts, dairy products, eggs, sugar, alcohol, and gluten. Pay close attention to your diet. If your eczema flares up after eating a certain food, you may be allergic to it.
If you do not have a food allergy, no food, including chicken, will trigger or aggravate your eczema.
Before I sign out, it is important for me to stress that numerous people have eczema (atopic dermatitis). Occasionally, your eczema may disappear. This phase is known as “remission.” Occasionally, you may experience a “flare-up,” which is when the condition worsens. The purpose of treatment is to prevent flare-ups, so prevent your symptoms from worsening. Avoid allergens, apply moisturizer, take your medication, and do everything else your doctor suggests.
Ok, ladies and gentlemen, that’s it for today. See you next time, remember to keep soaring high like PSORIASIS.
