Eczema, also known as dermatitis, is a very common, often times chronic skin condition that is distinguished by irritated, inflamed, and itchy patches of skin. There are many different causes depending on the type of eczema as described below.

What Causes Eczema

There are many different causes for this itchy skin condition. Eczema in the classic form known as atopic dermatitis is caused by a complex interaction between genetics (i.e. filaggrin gene mutation or reduced production of natural moisturizing factors which weaken the skin barrier), immune system overactivity, environmental factors, hygiene habits, etc. Different causes come into play with other types of eczema besides atopic dermatitis.

Types of Eczema

Atopic Eczema

Atopic eczema is the most common type of eczema. Most patients experience this particular type of eczema before the age of five, but there are cases of late onset atopic eczema after puberty or in the elderly. During infancy patches appear red, scaly, weepy, and crusted and are typically located on the scalp, cheeks, neck, torso, arms, and legs while the diaper area remains clear. With time, persistent patches of eczema thicken and become drier.  In later childhood and adolescence, atopic dermatitis presents on the face (i.e. around the eyes), inner arms, backs of the legs, hands, wrists, ankles, and feet. Adults can present with atopic dermatitis affecting the hands, while also having facial involvement especially of the eyelids. Other areas of involvement also include the skin behind the ears, neck, chest, inner arms, and behind the knees.

Contact Eczema

Contact eczema develops as an inflammatory reaction to a substance that bothers the skin. There are two sub-categories of contact eczema which include irritant contact dermatitis and allergic contact dermatitis. Allergic contact dermatitis is a delayed-type immune reaction to a substance that comes into contact with the skin, which typically does not present until days after initial contact. These substances can be found in cosmetics, plants, medications, jewelry, clothing, etc. Given the delay in reaction, it may be difficult for the patient to determine the allergen. Therefore, patch testing can be very helpful in identifying the causative allergen. Irritant contact dermatitis will occur in most patients who have prolonged exposure to a known irritating and toxic chemicals such as soap, solvents, alkalis, or acids.

Asteatotic Eczema

Asteatotic eczema presents as dry, rough, scaly skin that takes on the appearance of a “dried riverbed” with fine cracks seen in the surface of the skin. Areas most affected include the shins, flanks, and skin behind the armpits. This form of eczema arises as a result of prolonged dryness of the skin whether due to low air humidity, overuse of drying soaps, excessive bathing, or inadequate use of moisturizers.

Congestion Eczema

Also known as stasis dermatitis, this form of eczema presents on the lower legs and feet in those with a history of chronic leg swelling. This condition can also present together with allergic contact dermatitis or autosensitization dermatitis, when the eczema spreads to other areas of the body besides the legs.

Nummular Eczema

Nummular eczema appears as round, coin-shaped patches of eczema typically on the lower legs, feet, forearms, and hands. It can be a presenting feature of atopic dermatitis, asteatotic eczema, and stasis dermatitis.

Treatment of Eczema

Eczema is difficult to completely eliminate and remains to be a chronic condition for most patients. It is important to remember if you suffer from eczema to not scratch active rashes. Scratching can further irritate the skin, worsen the rash, and can cause skin breakage that leads to infection. Below are some treatments that may help your eczema symptoms and reduce the number and severity of flares.

  • Gentle skin care regimen
    • Avoid hot showers and baths
    • Use fragrance-free, gentle soaps
    • Moisturize regularly with creams and emollients
  • Wet wraps in severe cases
  • Antihistamines
  • Topical steroids or calcineurin inhibitors
  • Narrow-band ultraviolet B light therapy
  • Immunosuppressive medications: Cydosporine A, Methotrexate, Azathioprine, Cellcept

Eczema symptoms may clear up for a while; however, eczema may never completely go away so controlling symptoms is the best treatment goal. For more information, a diagnosis, and help in treating your eczema be sure to schedule an appointment with Adult and Pediatric Dermatology today.