Causes, Treatment and Prevention of Eczema - Research Paper Example

On the Causes, Treatment and Prevention of Eczema Abstract Eczema is a primary disorder of the skin that has multiple causes and associated symptoms that require targeted therapeutic approaches. The purpose of this paper is to review the most common types of eczema, their causes and the types of treatments that are most useful in the management of this disease. The sources used to prepare this paper were relevant medical journal articles written by specialists in dermatology and involved clinical patient studies on the parameters of this disease and the most appropriate therapeutic and preventive approaches to disease management. These studies have led to the conclusion that eczema is a complex set of diseases with inflammatory components that may occur as a consequence of allergic reactions or direct or indirect effects of environmental substances on the skin epithelium. The range of severity of disease is broad, the causes are multiple and complex, and treatment approaches involved immunosuppressant and anti-inflammatory pharmacologic agents must be tailored to the type of eczema and its clinical severity in each individual patient. Body of Paper Eczema is an inflammatory disease of the skin, and in its broadest meaning, may encompass many types of epithelial inflammatory conditions (Novak et al, 2003). Most of the symptomatology of eczema is associated with redness, itchiness and rashes that are located on the skin. Eczema may occur on any part of the body. When it is caused by contact dermatitis, the exposed area is the site where eczema develops. In allergic forms of eczema the most common areas of exposure are th underside of joints, the back, the head region and the buttocks. Persistent rashes may become crusty and inflamed, resulting in discharge and secondary bacterial infections (Novak et al, 2003). Epidemiological studies have shown that eczema most commonly occurs in infancy and occurs more commonly in females than in males (Novak et al, 2003). The incidence of eczema in the US has increased significantly in the 20th century and into the 21st (Novak et al, 2003). Different types of eczema are generally classified based on the site of occurrence on the body, the type or appearance of the lesion or based on its underlying causes. The most common type of eczema is called atopic eczema (Novak et al, 2003). It occurs most often in infants and is the result of an allergic reaction. This type of eczema may be inherited. The sites of the body most affected by the rash include the head, neck, elbows, knees and buttock. This type of eczema may be difficult to distinguish from allergic contact dermatitis. Contact dermatitis comprises the second-most common form of eczema (McNally et al, 2001). It may be the result of an allergic reaction to a substance that comes in contact directly with the skin or may occur as a consequence of exposure to a substance that causes an irritation on the surface of the skin. Most forms of contact dermatitis are found in this latter group. Xerotic eczema is a form of the disease that results from very dry skin that may be itchy, thereby leading to the formation of lesions on the skin. This type of eczema is exacerbated by very cold weather when the air is dry and is sometimes referred to as “winter itch”. This type of eczema occurs most commonly in older individuals. Seborrhoeic dermatitis, also called “cradle cap” when it occurs in infants, is a type of eczema that is similar to dandruff. This type of eczema may be related to biotin deficiency and generally is not serious (McNally et al, 2001) There are other, rare types of eczema that can occur (McNally et al, 2001). These include dyshidrosis, also called “housewife’s eczema” is a form of the disorder that occurs on the palms of the hand, between the fingers or on the soles of the feet and between the toes. It is associated with a very uncomfortable itchiness. This form of eczema is generally more severe during warm summer months. Discoid eczema occurs in the form of a rash of round spots that most commonly occurs on the lower legs. It is of unknown etiology. Venous eczema is the result of circulatory disorders that block the flow of oxygenated blood to the skin. The most common site of occurrence is the ankles and the rash may be associated with edema. If untreated the disorder may result in ulceration of the legs. Another rare form of eczema is called dermatitris herpetiformis. This disease is frequently observed in patients with celiac disease (the inability to digest gluten) and results in a rash that affects the arms, legs and back. It is alleviated through dietary control. Neurodermatitis or localized scratch dermatitis is the result of scratching the skin or rubbing to produce an itchy, pigmented lesion. Autoeczematization is a form of eczema that results from infection either by bacteria, viruses or parasites that secondarily affects the skin. Thus, there are many types of eczema with many different causes and clinical presentations that depend on the underlying cause of the skin lesion (McNally et al, 2001) There are many treatments that have been developed to treat the symptoms of eczema, although the underlying disorder is often difficult to cure (Hoare et al, 2000). Moreover, there are many preventive approaches that may help to prevent its occurrence in susceptible individuals. Corcicosteroids are a first line treatment for eczema, since they can be highly effective immunosuppressants that alleviate the inflammatory components of the disease (Hoare et al, 2000). The types of corticosteroids commonly used in the treatment of eczema include hydrocortisone, fluocinonide, clobetosone butyrate, among others . The type of corticosteroid prescribed depends on the severity of the symptoms associated with inflammation, such as redness, rash itchiness and other topical symptoms. It is necessary to use corticosteroids judiciously, however, as they are not curative of eczema and may have important side effects (Hoare et al, 2000). Topical corticosteroids may cause a thinning of the epidermis which may result in secondary infection. High topical steroid use has been associated with hypothalamic-pituitary-adrenal axis suppression, as the steroid may be absorbed by the skin to produce systemic effects on organ and immune system function. Secondary infections may also result from their use as a consequence of their generalized immunosuppressive effects. Long-term therapy for eczema using topical corticosteroids is generally not advisable for these reasons. Rather, these agents should be used to treat acute eczema and followed by long term maintenance using other types of therapeutics such as emollients. Severe eczema may require the use of systemically administered corticosteroids (Thestrup-Pedersen, 2002). The most commonly used oral and injectable steroids are prednisolone and triamcinolone. These pharmacologic agents are intended for short-term use only for the treatment of cases that do not respond to topical corticosteroids and should be discontinued once the disorder is under control. The side effects of systemic corticosteroids may include general immunosuppression which is a risk factor for many human diseases (Thestrup-Pedersen, 2002). Immunomodulators such as pimecrolimus and tacrolimus represent another class of topical pharmacologic agents used to treat eczema (Hoare et al, 2000). These drugs were developed for use in place of corticosteroids. Their use may produce good results in localized lesions, but reseant clinical trials have indicated their potential association with certain forms of cancer such as lymphoma or skin cancer resulting from their use. On this basis, the US Food and drug Administration (FDA) issued a public health advisory severely limiting the use of immunomodulators to treat patients with eczema (Thestrup-Pedersen, 2002). Physicians continue to report good results without a significant association with increased cancer risk associated with the use of these drugs. Severe forms of eczema that are unresponsive to steroidal therapies may be treated with systemic immunosuppressants (Hoare et al, 2000). Commonly used drugs of this type include cyclosporine and methotrexate. These drugs may produce systemic immunosuppression associated with opportunistic infections and disease. They may also cause anemia due to their effects on blood cell proliferation and must be used very cautiously in this group of patients whose eczema is refractory to other treatments (Hoare et al, 2000). Emollients anti-histamines are frequently prescribed to lubricate the skin and provide relief from itchiness, which is not only extremely uncomfortable and even painful, but may also exacerbate the skin condition resulting from excessive scratching of the affected areas (Oranje et al, 2002). Antihistamines such as benadryl or phenergan that also induce sedation are generally most effective in controlling itchiness. The lubricating emollients not only provide comfort but may reduce the occurrence of eczema due to their protective effects on epithelial moisture. The natural oils of the skin help to control eczema and the use of emollient creams may enhance this protective effect, particularly in types of eczema associated with dry skin (Oranje et al, 2002). Examples of emollient creams include Lubriderm, Oilatum and Balneum. It is also important to note that soaps and detergents can exacerbate the symptoms of eczema and should be avoided by individuals with this disease. Forms of eczema that are the result of allergic reactions may be controlled by avoiding contact with the causative allergen(s), if this can be determined. Common environmental allergens may cause eczema in sensitive individuals (Oranje et al, 2002). These include dust mites, household chemicals and chemicals found in carpet and furniture. In addition, research studies have suggested that food allergies may be an important cause of eczema, particularly in children and infants (Oranje et al, 2002). Among the most important sources of food allergies are milk and other dairy products, soybeans, eggs, nuts and wheat products. Avoidant approaches to preventing eczema may be the most appropriate therapeutic modality in these cases (Oranje et al, 2002). In conclusion, eczema represents a group of skin conditions that have multiple causes and vary greatly in the severity of associated symptoms. Eczema is classified on the basis of the type of lesion, its location on the body and the underlying causes. The common thread uniting all forms of this disorder is that they affect the epidermal layers of the skin. Treatment approaches include the use of pharmacologic agents that suppress the inflammatory components of the disorder and systemic approaches that involve the selective avoidance of allergens or other substances that may induce the formation of lesions or exacerbate the condition. Each patient with eczema is unique and requires a thorough assessment by a qualified dermatologist to identify the type of eczema, the most appropriate treatment, and the development of strategies that may reduce the occurrence and/or severity of this debilitating condition. References Hoare, C., Li Wan Po, A., and Williams, H. (2000). Systematic review of treatments for atopic eczema. Health technology assessment (Winchester, England), 4(37):1-191. Mcnally, N. J., Williams, H. C., and Phillips, D. R. (2001). Atopic eczema and the home environment. British Journal of Dermatology, 145(5):730-736. Novak, N., Bieber, T., and Leung, D. Y. (2003). Immune mechanisms leading to atopic dermatitis. The Journal of allergy and clinical immunology, 112(6 Suppl). Oranje, A. P., Wolkerstorfer, A., and de Waard-van der Spek, F. B. (2002). Natural course of cow's milk allergy in childhood atopic eczema/dermatitis syndrome. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 89(6 Suppl 1):52-55. Thestrup-Pedersen, K.(2002) On atopic eczema hypotheses. Journal of Cosmetic Dermatology, 3(4):244+. Read More