Eczema: Diagnosis and Treatment - Essay Example

Eczema also known as Atopic Dermatitis is a chronic skin condition characterized by superficial skin inflammation, with diffuse redness, swelling, oozing, crusting, scaling, and itchiness. The term eczema is broadly applied to a range of persistent or recurring skin rashes . Eczema is frequently associated with a genetic predisposition and is more common in people with a family history of allergic disorders, such as hay fever and asthma. However, the symptoms may sometimes be triggered by environmental factors. Although foods and inhalants produce reactions when they are tested, eliminating these substances don't always cause remission. In first few months of life, symptoms may begin with red, moist, crusted lesions on the face, scalp, diaper area, arms, and legs. Older children and adults are more likely to have localized and chronic eczema, typically appearing as redness around the elbow joint, behind the knees, and on the eyelids, neck, and wrists. Eczema often resolves spontaneously by the age of three or four, although it commonly worsens again, either during childhood, adolescence, or adulthood. Eczema classification remains haphazard and unsystematic due to the proliferation of synonyms. According to incidence frequency, eczema can be classified as: Atopic eczema (aka infantile e., flexural e., atopic dermatitis) is thought to be hereditary, and often runs in families whose members also have hay fever and asthma. Itchy rash is particularly noticeable on face and scalp, inside of elbows, behind knees, and buttocks. Contact dermatitis is of two types: allergic (resulting from a delayed reaction to some allergen, such as poison ivy or nickel), and irritant (resulting from direct reaction to, say, a solvent). About three fourths of contact eczema are of the irritant type, which is the most common occupational skin disease Xerotic eczema (aka asteatotic e., e. craquele or craquelatum, winter itch, pruritus hiemalis) is dry skin that becomes so serious it turns into eczema. It worsens in dry winter weather, and limbs and trunk are most often affected and is very common among the older population. Seborrheic dermatitis (aka cradle cap in infants, dandruff) causes dry or greasy scaling of the scalp and eyebrows. Scaly pimples and red patches sometimes appear in various adjacent places. In newborns it causes a thick, yellow crusty scalp rash called cradle cap which seems related to lack of biotin. Less common eczemas include Dyshidrosis that only occurs on palms, soles, and sides of fingers and toes as tiny opaque bumps called vesicles, thickening, and cracks. Discoid eczema is characterized by round spots of oozing or dry rash, with clear boundaries, often on lower legs. Venous eczema occurs in people with impaired circulation, varicose veins and edema, and is particularly common in the ankle area of people over 50. The disorder predisposes to leg ulcers. Dermatitis herpetiformis causes intensely itchy and typically symmetrical rash on arms, thighs, knees, and back. Neurodermatitis (aka lichen simplex chronicus, localized scratch dermatitis) is an itchy area of thickened, pigmented eczema patch that results from habitual rubbing and scratching. Autoeczematization (aka id reaction, autosensitization) is an eczematous reaction to an infection with parasites, fungi, bacteria or viruses.There are also eczemas overlaid by viral infections (e. herpeticum, e. vaccinatum), and eczemas resultant from underlying disease (e.g. lymphoma). Constant itching, scratching, and rubbing of the skin may give rise to secondary bacterial infections. Some known factors like emotional stress, fragrances, environmental temperature, humidity, house dust mites, upholstered furniture, carpeting, chemicals, fabric softeners, and wool clothing can worsen symptoms of eczema. Diagnosis of eczema is based on the patient's family history of allergy, hay fever, or asthma, duration of the skin condition (allergic eczema is a chronic condition), and the appearance of the skin. Dietary habits, lifetyle habits, allegic tendencies, any prescribed drug intake and chemical materials at home and work place are important in diagnosis. To determine whether an eczema flare is the result of an allergen, it is necessary to test the blood for antibodies and the numbers of certain types of cells. In eczema, the blood may show a raised IgE or an eosinophilia.The blood can also be sent for a specific test called Radioallergosorbent Test (RAST) or Paper Radio-immunoabsorbent test (PRIST).In the test, blood is mixed separately with many different allergens and the antibody levels measured. High levels of antibodies in the blood signify an allergy to that substance. Another test for eczema is skin patch testing. The suspected irritant is applied to the skin and held in place with an adhesive patch. Another patch with nothing is also applied as a control. After 24 to 48 hours, the patch is removed. If the skin under the suspect patch is red and swollen, the result is positive and the person is probably allergic to that substance. Occasionally, the diagnosis may also involve a skin lesion biopsy: removal of a small piece of skin for microscopic examination in a laboratory. Blood tests and biopsies are not always necessary for eczema diagnosis. However, they might be required at times when the symptoms are unusual, severe or in order to identify particular triggers. In infants, a condition called seborrheic dermatitis is a differential diagnosis because it can appear quite similar to eczema. In people of all ages, inflammation of the skin after contact with a substance, called contact dermatitis can also mimic eczema. The use of soap can further dry and irritate the skin. Conventional treatments for adults include antihistamines, ultraviolet radiation, psoralen, and corticosteroid creams and ointments. Oral corticosteroids are sometimes used as a last resort. Antihistamine medication may reduce the itch during a flare up of ezcema, and the reduced scratching in turn reduces damage & irritation to the skin (the Itch cycle). Dermatitis is often treated with prescribed Glucocorticoid (a corticosteroid steroid) ointments or creams. For mild-moderate eczema a weak steroid may be used (e.g. Hydrocortisone or Desonide), whilst more severe cases require a higher-potency steroid (e.g. Clobetasol propionate). They are highly effective in most cases, but must be used sparingly to avoid possible side effects, the most significant of which is that their prolonged use can cause the skin to thin and become fragile (atrophy). High strength steroids used over large areas may be significantly absorbed into the body causing bone demineralisation (osteoporosis). Finally by their immunosuppression action they can, if used alone, exacerbate some skin infections (fungal or viral). If using on the face, only a low strength steroid should be used and care must be taken to avoid the eyes. Hence a steroid of an appropriate strength to promptly settle an episode of eczema should be sparingly applied. Once the desired response has been achieved, it should be discontinued and not used for long-term prevention. Any skin infection further irritates the skin and a rapid detoriation in the condition may ensue; the appropriate antibiotic should be given. The disruption to the skin's normal barrier protection through dry and cracked skin allows easy entry for bacteria and fungi. Scratching by the patient both introduces infection and spreads it from one area to another. Light therapy using ultraviolet light can help. PUVA, UVB, and Narrow Band UVB are all used. Current research seems to show that Narrow Band UVB is the most effective, in addition to having lowest risk of skin cancer. When light therapy alone is found to be ineffective, it is combined with a drug called Psoralen. This treatment is termed as photo-chemotherapy. Some alternative (and even conventional) medicine sources state that oatmeal in solution applied topically has a healing effect. Flaxseed oil is a good source of essential fats, which help to decrease inflammation. Zinc supplements are said to be effective for eczema. Skin and lymph cleansing herbs like yellow dock, burdock, cleavers, nettle, and red clover are all herbs that can help "drain" the skin and clear skin rashes. Chickweed, Chamomile, Calendula, St. John's Wort, and Goldenseal can be applied topically to the skin to promote healing of cracked, painful, or dry skin. Dermatitis severely dries out the skin, and keeping the affected area moistened can promote healing and retain natural moisture and is the most important self-care treatment for atopic eczema. Eczema often comes and goes in cycles, meaning that at some times of the year sufferers are able to feel normal, while at other times they will distance themselves from social contact. In cases of children with eczema, visible scars or scratch marks can lead to suspicion of home abuse or self-mutilation, which causes possible peer rejection and may add to a general level of stress. SELF HELP ORGANISATIONS: The National Eczema Society is a self-help organization dedicated to improving the quality of life for people with eczema, other skin diseases, related conditions, and their care providers National Eczema Association for Science and Education is a National network. Founded 1988. it provides support for persons with atopic dermatitis (a common, chronic, non-contagious, inflammatory skin condition), as well as other forms of constitutional eczema, Promotes education and research and Offers information and referrals, networking, and newsletter. REFERENCES: "Arm With Eczema" Online Image. Atopic Dermatitis, Eczema April 15, 2005 Dermatitis ( Eczema) Dermnet. Dermnet NZ April 2005, April 14, 2005 DermNet NZ April 15 2005, Miller et al. Prentice Hall Biology. New Jersey: Pearson Education, 2002 Skin Care Information On Dry Skin, Eczema, Acne, Psoriasis 2001 April 16, 2005. Skin (Integumentary) System 2001, April 15 2005 "View of Skin With Layers" Online Image. 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