What Is Eczema?
Eczema is a descriptive term for a chronic skin condition that usually begins in early childhood. It is seen most commonly in individuals who have family members who have asthma and hay fever. This is not to say that eczema is a classical allergic disease. There seems to be general agreement that this condition is inherited because of the complete loss or relative lack of a skin protein.
Who Can Get Eczema?
There are criteria that must be met before the diagnosis of eczema is considered. In most patients, the condition began in childhood. Patients develop plaques of weeping, oozing skin that are very itchy. A personal or family history of eczema, asthma, and/or inhalant allergies is helpful. In older children or adults, the lesions of eczema tend to occur in the folds of the skin in front of the elbows and in the folds of skin behind the knees. Eczema tends to improve in most patients as they get older.
What Are the Causes of Eczema?
The belief that the cause of eczema seems to be a defect in the production of a particular skin protein (filaggrin) is currently quite popular. All of the other problems that seem to be present in those afflicted include dry skin, hyper-reactivity to wool, itching during sweating, colonization by pathogenic staph bacteria, predisposition to disseminated herpes simplex infections, and a variety of immunologic abnormalities.
Eczema Symptoms
There is a debate about which comes first in atopic eczema, the itching or the rash. This is analogous to the chicken and egg controversy. It really does not matter. When the rash is in an acute stage, it is weepy and oozy. Later after the patient has been rubbing and scratching for some weeks, it becomes a plaque of thickened skin. This is called lichenification.
Signs in Babies, Children & Adults
Atopic eczema has a typical distribution on the surface of the skin; this can be quite helpful in making the correct diagnosis. In crawling children in diapers, the rash is frequently seen on the elbows and knees but spares the diaper area. In older children and adults, the rash is often present in the folds of skin opposite to the elbow and kneecap but spares the armpits. Other areas commonly involved include the cheeks, neck, wrists, and ankles.
Types of Eczematous Dermatitis
Atopic eczema (atopic dermatitis) is one of a number of eczematous eruptions that need to be distinguished. This is important because treatment depends on the correct diagnosis. We’ll take a look at the listed types on the following slides.
Atopic Dermatitis
Atopic eczema is an inherited skin condition more common in individuals with a personal or family history of eczema, inhalant allergies like asthma or hay fever. Patients develop weeping, oozing, itchy lesions in a characteristic distribution. The severity depends to a great extent on the amount of moisture in the skin.
Atopic eczema is less common in very humid environments and is harder to control in arid areas in the wintertime. It often begins in infancy and improves in most people as they reach adulthood.
Contact Eczema
Contact dermatitis is a dermatitis that occurs in response to exposure to an irritant or allergenic substance. Irritants cause skin damage by producing direct toxic damage to the skin cells. Contact allergens are not necessarily irritating or toxic but are recognized by the immune system. Once the immune response is stimulated, a dermatitis occurs at the site of exposure.
Seborrheic Eczema
Seborrheic dermatitis is a chronic recurrent dermatitis, and it is probably the most common of all rashes in adults. The rash characteristically appears on the scalp, forehead, brows, ears, the folds that extend from the nose to the lips (nasolabial folds), middle of the chest, and middle of the back. It occurs in infants as cradle cap. Its course is distinguished by periods of improvement followed by flares.
Nummular Eczema
With nummular eczema, round plaques of eczematous skin often appear on the lower legs. It often is seen in the elderly and seems to be associated with dry skin.
Neurodermatitis
Lichen simplex chronicus (also termed neurodermatitis) is a localized, thickened area of skin caused by itching and rubbing. Although there is usually some inciting cause, the origin of the problem is entirely obscured by the eruption. Any of the eczematous eruptions can evolve into lichen simplex chronicus if rubbed long enough.
Stasis Dermatitis
Stasis dermatitis usually occurs on the lower legs of patients who have sustained damage to the valves present in the large veins responsible for returning blood to the heart. These valves, along with muscular contractions of the leg muscles, help propel venous blood from the periphery to the lungs and heart. Damage to these valves causes a long column of blood to produce enough hydrostatic pressure on the wall of the vein so small leaks occur. The lower legs swell and brownish blood pigment is deposited in the skin from degradation of hemoglobin. A dermatitis often occurs, and skin ulcers are common.
Dyshidrotic Eczema
Dyshidrotic eczema (pompholyx) is a common but poorly understood condition in which very itchy small blisters occur on the lateral surface of the fingers, toes, hands, and feet. Many patients note exacerbations during periods of high stress (for example, finals week).
Diagnosis of Eczema
In order to make an accurate diagnosis of eczema, it is important for your physician to take a complete history and examine all of the areas of skin that are affected. Occasionally, certain laboratory tests can be helpful in distinguishing various types of eczema. A pathologist may need to examine skin scrapings and even a small piece of biopsied skin.
Eczema Treatment: Basic Therapies
Once the diagnosis of atopic eczema is established, there are certain well-established approaches to treating this condition. One of the most important is to keep the skin well moisturized. There are many inexpensive approaches to maintaining the moisture content of the skin. Once the skin is wet, a thin layer of a cream or ointment is applied to prevent the moisture from evaporating. Judicious use of such substances (emollients) can be very effective in limiting flares of atopic eczema.
Eczema Treatment: Medications
Corticosteroid creams are very effective at controlling the inflammatory component of atopic eczema. The thickened, itchy, weepy lesions respond well to the applications of such creams. In addition, oral antihistamines are effective in suppressing the itching sensation as well as acting as a sleep aid during flares.
Eczema Treatment: Immunomodulators and UV Therapy
Newer drugs have become available for the treatment of atopic eczema; they claim to be devoid of the side effects of topical steroids. These newer medications inhibit the immune response by inhibiting calcineurin, an enzyme necessary for a normal inflammatory response. Though they are quite effective, they are also quite expensive and seem to lack potency when compared to the strongest topical steroids. Ultraviolet light exposure can effectively control eczema in certain patients because of its effect on inflammatory cells in the skin. Discuss any treatments with your doctor before using.
Can Eczema Be Prevented?
Applying a good moisturizer to damp skin is the most effective method for limiting flares of atopic eczema. Try the measures listed on this and the following slide to control and help prevent outbreaks of eczema.
Can Eczema Be Prevented? (continued)
Since the condition is inherited, it would be very difficult to prevent its development entirely. Living in a warm, humid environment seems to limit flares of atopic dermatitis. Sleeping with a humidifier in the bedroom can be of some help. In some patients, adding chlorine bleach to bathwater can be quite helpful (1/2 cup of bleach to a bathtub of warm water). It is important to rinse off before applying an emollient.
Skin Problems: Rosacea, Acne, Shingles, Covid-19 Rashes
- Reviewed By: Charles Patrick Davis, MD, PhD
Skin Problems?
Is your skin itchy, oozing, or breaking out? Moles, psoriasis, hives, eczema, and recently associated Covid-19 coronavirus rashes are just a few of the more than 3,000 skin disorders known to dermatology. Changes in color or texture can result from inflammation, infection, or allergic reactions anywhere on the body. Some skin conditions can be minor, temporary, and easily treated — while others can be very serious, and even life-threatening. Read on to see signs and symptoms of the most common skin disorders and learn how to identify them.
Covid-19 (Coronavirus) Skin Rashes
Skin rashes have been associated with COVID-19 infection. Much like other viral diseases such as HIV and bacterial diseases like syphilis, COVID-19 rashes can take many different forms. One study from Spain identified five patterns of COVID-19 rash. The most common type was a “macropapular rash.” These rashes feature both small, flat discolorations (“macules”) and small, elevated lesions (“papule”). These rashes are associated with more severe COVID-19 infection, as 2% of those who got them in the Spain study reportedly died from the illness. Other rashes associated with COVID-19 include thickened lesions developing on the heels of the feet, lesions that resemble chickenpox, and rashes that resemble those seen with dengue fever.
Some dermatologists have reported cases of so-called “COVID toe” in both adults and children. These lesions may be reddish, elevated lesions that flatten after about a week. Some of the patients found their COVID toe rashes itchy, and others did not. Some found it painful when their toes were pressed, and others did not. More research is needed, as some of the rashes reported in COVID-19 patients resemble drug reactions. For safety reasons, researchers have been unable to determine if drug interactions are responsible in these cases, or whether the novel coronavirus itself causes these rashes.
Shingles (Herpes Zoster)
Shingles, also known as herpes zoster, is a skin disease caused by the return of a chickenpox infection from latently infected nerve cells in the spinal cord or brain. It begins as a painful sensation which is often mistaken for a musculoskeletal injury or even a heart attack. It is soon followed within one or two days by a red, blistering unilateral (one-sided) rash distributed to the skin supplied by a sensory nerve (a dermatome). Zoster tends to occur most often in the elderly and can be largely prevented or made less severe with a vaccination. Treatment with antiviral drugs within 48 hours of the onset of the eruption may limit the development of a persistent, severe pain (neuralgia) at the site of the eruption.
Hives (Urticaria)
Hives, also known as urticaria, is one of the most common allergic skin conditions. It most often occurs due to antibodies in the bloodstream that recognize foreign substances. This eruption appears suddenly anywhere on the body as elevated blanched bumps surrounded by an intensely itchy red rash. There may be many lesions, but each one only exists for eight to 12 hours. As older ones resolve, newer ones may develop. Most of the time, urticaria resolves spontaneously within eight weeks and is treated with oral antihistamines for symptomatic relief.
Psoriasis
Psoriasis is a chronic, inflammatory genetic condition in which patients develop scaly red bumps that coalesce into plaques. Symptoms of psoriasis typically occur but are not limited to the scalp, elbows, and knees.
Psoriasis is not curable; flare-ups come and go by themselves. There are a variety of treatments depending on the severity and extent of involvement, which vary from topical creams and ultraviolet light exposure to oral drugs and injectable medications. Patients with psoriasis more commonly develop cardiovascular disease and diabetes, which may be attributable to system-wide inflammation.
Eczema (Dermatitis)
Eczema (sometimes called “dermatitis”) is a genetic condition associated with itchy, dry skin. It usually develops in early childhood with symptoms of a chronically itchy, weeping, oozing sores. Eczema tends to be found on arm creases opposite the elbow and on leg creases opposite the knee.
Many eczema patients also have inhalant allergies such as asthma and hay fever. Eczema improves with age. Treatment involves applying emollients to wet skin and using topical steroids.
Types of Eczema
There are many types of eczema, and many types include the word “dermatitis” (in dermatology, dermatitis is another word for eczema). For instance, eczema types include stasis dermatitis and dyshidrotic eczema. A dermatologist can help you understand what type you have. Two of the most common types are:
- Atopic dermatitis
- Contact dermatitis
Rosacea
Rosacea is a chronic inflammatory condition of the face that is characterized by redness, dilated blood vessels, papules, pustules, and occasionally by the overgrowth of nasal connective tissue (rhinophyma). It superficially resembles teenaged acne, but it occurs in adults. Persistent facial flushing is an early sign of the skin’s uncontrolled sensitivity to certain naturally produced inflammatory chemicals. Treatment of rosacea involves topical and oral drugs.
Cold Sores (Fever Blisters)
Herpes labialis (cold sore) is caused by the herpes simplex virus. Cold sores commonly appear on the edge of the lip. This virus exists in a dormant state in the spinal cord nerve cells, and after certain environmental triggers like a sunburn or a cold, the virus is induced to travel along a peripheral nerve to the same skin site over and over again. The eruption is self-limited to about seven to 10 days so that treatment is unnecessary unless the eruption becomes too frequent.
Plant Rashes
In allergic individuals, the development of a linear blistering eruption occurs within 24-48 hours of exposure to a member of the poison ivy or poison oak family of plants. Since the plant contains highly allergenic chemicals, most people will become allergic after a single priming exposure. The eruption will resolve within three weeks but will occur again the next time the skin comes in contact with the plant.
Treating Plant Rashes
The repeated application of cool wet compresses to the blisters followed by evaporation of the water can be soothing and speed healing. Treatment with steroids creams or even oral steroids may be required in severe cases. Once a person is allergic, this is permanent; it is important to avoid this plant family assiduously so this very unpleasant allergic reaction will not recur. Many of those allergic to poison ivy or poison oak (Toxicodendron) are also sensitive to mango skin and cashew nut oil.
Razor Bumps
This eruption occurs in areas of the skin in which hairs have been recently cut or extracted. This is commonly present in the beard area of individuals with very tightly coiled hair. When the hair is cut off or plucked out below the level of the follicular pore, it tends to curl into the side of the follicle and cause an inflammatory bump. Not shaving closely is very important in preventing this skin condition.
Skin Tags
Skin tags are small, fleshy, fibrovascular, pedunculated (on a stalk) growths that are often are found on the neck and armpits. They are generally asymptomatic unless they become irritated by frictional forces or their blood supply becomes compromised. They are very common and need not be removed or destroyed unless they become irritated.
Acne
Acne vulgaris is usually a noninfectious eruption of papules and pustules (pus-filled blisters) on the face and occasionally on the chest and back. Acne occurs in all teenagers as they progress through puberty. Symptoms like comedones (blackheads) and inflammatory papules and pustules all appear simultaneously.
Despite rumors to the contrary, acne is not caused by dirty skin. Instead, it is mediated by hormones that begin to circulate during puberty and excess sebum or oil production. The condition generally resolves around the age of 20-30 but may produce scarring if severe and left untreated.
Athlete’s Foot
One of the most commonplace skin conditions is athlete’s foot. And one of the most common causes of athlete’s foot is an infection of the dead superficial layer of the skin called the stratum corneum by a fungal mold (tinea pedis) called a dermatophyte.
If inflammatory, this condition may cause fluid-filled blisters that are quite itchy. Noninflammatory tinea pedis produces scaly, dry skin. Often it is only mildly irritating. Tinea pedis is probably frequently contracted by walking barefoot in locker rooms. Topical antifungal creams are available over the counter and can be helpful in treating this skin infection. More powerful medications can be prescribed by a dermatologist.
Moles
Although the term mole may cover a variety of different sorts of skin growths, most often it refers to a localized accumulation of pigment-producing cells called melanocytes. These are generally uniform in color and round in shape. In dermatology, moles are sometimes known as benign neoplasms.
Melanocytic nevi (moles) range in color from beige to black, they’re about ½ an inch in diameter, and are often located on sun-exposed skin. Poorly pigmented individuals may have an average of 35 of these growths by the time they are 35 years old. These are benign lesions but can be confused with various pigmented skin cancers. Pigmented lesions that itch, bleed, or grow could be cause for concern.
Age or Liver Spots
Liver spots (also called age spots) are a common skin condition that typically appears on the face and forearms of older individuals. Although these flat brown spots cause no symptoms, patients detest them because of their unsightly appearance. They can be treated in a variety of ways, but treatment is not medically necessary.
Pityriasis Rosea
This rash usually begins in a young adult as a single scay bump or patch and then extends to cover much of the torso with many scaly spots that are elliptical in shape. They are associated with modest itching which only occasionally requires treatment. The condition usually lasts about 6-8 weeks in total.
Melasma
Melasma is another commonly experienced skin condition. The main symptoms are brown patches of skin. These patches are typically found on your face.
This condition occurs most commonly in women of childbearing age and is often associated with pregnancy or the ingestion of oral contraceptive medication. This flat brownish pigmentation occurs on the forehead, cheeks, and in the mustache area of the upper lip. It often persists after pregnancy or after birth control has ceased. Sunlight will make it darker. Successful treatment is not easy, and strict sun protection is a necessity.
Warts
The development of small keratotic tumors of the skin is caused by one of about 200 members of the human papillomavirus group. They often spontaneously go away, but particularly stubborn warts may require medical intervention. The proliferation of various treatments reflects the fact that successful resolution mostly depends upon the patient’s immune response. There are a variety of treatments available without a prescription that ought to be tried prior to seeing a physician.
Seborrheic Keratoses
This is the single most common benign bump present on people as they age. (Benign means it does not indicate skin cancer). Lesions may be present anywhere on the body and generally do not produce symptoms. They appear as black, brown, or yellow bumpy lesions which give the appearance of having been “glued” onto the skin. They are of no medical significance aside from the fact that they are occasionally confused with pigmented skin cancers.
Seborrheic Dermatitis
Seborrheic dermatitis is the single most common rash of adults. When it occurs in infancy, it is commonly called cradle cap. The adult disease tends to favor the scalp, skin behind the ears, forehead, brows, nasolabial folds of the face, mid-chest area, and the mid-back, producing an itchy, red scaling dermatitis. The scaling in the scalp can be conspicuous, producing impressive dandruff. The cause of this condition is unclear, but it responds well to topical steroids and to topical antifungal creams. Medicated shampoos containing tar, selenium sulfide, and zinc pyrithione are often effective. This condition commonly improves spontaneously but will ultimately recur. There is no cure so treatment must continue indefinitely.
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