Eczema: Atopic Dermatitis Diagnosis

  • Diagnosis

    Eczema is a long-term inflammation or irritation, of the skin with sudden and often intense flare-ups. People with eczema have patches of dry, red, inflamed, and extremely itchy skin. Figure 01 During an eczema flare, affected areas of the skin become very dry, reddened, and irritated. Repeated scratching can cause the skin to thicken. It can also break the skin and introduce bacteria, causing an infection. When this happens, the skin will look wet, and a crust may form over the surface. Repeated outbreaks can lead to a type of eczema that is characterized by raw, thick, and scaly (lichenified) skin.

    Eczema is a general term that covers many types of skin inflammation. Atopic dermatitis (AD), for example, is a chronic (long-lasting) type of eczema that occurs in people with a genetic predisposition.

    Other types of eczema—such as contact dermatitis—are not long-lasting. These types, triggered by an external irritant, go away once the irritant is removed. However, people with AD will continue to have flares, and their skin can be easily inflamed even when the trigger is no longer present.

    Eczema is similar to other conditions like asthma and seasonal allergies in that it involves a bodily response to the environment. Eczema often flares up as a result of triggers such as sweat, heat, or exposure to irritating chemicals. Often, this type of sensitivity tends to run in families.

    While eczema primarily affects young children, 90% grow out of it by puberty.

    Eczema is a fairly common skin disorder. It affects approximately 7% of all children and typically appears in the first year of life, gradually subsiding as children grow older. If the eczema persists beyond a child's second birthday, he or she is more likely to have lifelong skin allergies. At least 60% of children with eczema will have some form of skin irritation throughout their lives.

    The face, neck, knees, elbows, and wrists are the most common sites of eczema outbreaks in children.

    In very young children, eczema tends to appear on the face, elbows, knees, and wrists because these are the places that rub against bedding. Scratching and rubbing often lead to eczema flare-ups. In adults and older children, eczema will tend to appear in areas where moisture collects—on the insides of elbows, the backs of knees, or the neck.Figure 02

    In most cases, self-care, over-the-counter medications, or prescription drugs can control eczema.

    Click to enlarge: Eczema

    Figure 01. Eczema

    Click to enlarge: Areas where eczema breakouts often occur

    Figure 02. Areas where eczema breakouts often occur

    The cause of eczema remains unclear, but is thought to be a combination of environmental triggers, heredity, and infections.

    Eczema erupts when scratched, rather than being a rash that itches. Therefore, it has been called "the itch that rashes."

    Stimuli or triggers that can cause itching include sweating, high or low humidity, wool, emotional stress, allergens, soaps, and foods. Certain types of bacteria may also contribute to AD. For example, the bacteria Staphylococcus aureus live on the skin of 90% of people with AD. Only 5% of people who do not have AD carry the bacteria.

    Family inheritance is involved in the development of eczema.

    Also, eczema appears to be linked to other familial diseases such as asthma.

    Food allergies may cause flares in some children.

    The following foods may cause an allergic reaction:

    • eggs
    • milk
    • peanuts
    • soy
    • wheat
    • nuts
    • fish

    A doctor can help you address dietary issues or refer you to a pediatrician who specializes in nutrition. In addition, food sensitivities tend to decrease over time. The majority of adults with AD do not have a food allergy.

    People who have eczema should keep their skin moist, as dry skin contributes to eczema flares. Use a moisturizer that does not sting the skin when applied, and that does not contain additives that might cause allergies.

    Symptoms of eczema include the characteristic skin rash, defined by patches of redness, inflamed skin, skin thickening and discoloration, and sores.

    Symptoms can be relatively mild and treatable with self-care, or unbearable and treatable only with potent prescription medications. The rash of eczema first appears as a red patch. If scratched, it may progress to blisters, more patches, raised plaques, and, in time, thickened, scaly skin.

    If the skin on or around an eruption is broken, the area may appear wet ("weeping"), and a crust may form on the surface.

    If this happens, it is important to be alert for an infection. If there is an area of spreading redness around the rash, if it is painful, or if the person has a fever, see a physician.

    Adults may have inflammation, cracking, dryness, and itching of the palms of the hands and soles of the feet.

    Itching and irritation from eczema tends to be worse in the evening.

    As a result, many eczema sufferers may have difficulty sleeping. This pattern may be responsible for the irritability and anxiety seen in children who suffer from the disease.

    AD patients tend to have allergies.

    These might include allergies to:

    • dust mites
    • animal dander
    • weeds
    • mold.

    In some cases, avoiding these substances, particularly dust mites, seems to calm eczema flares.

    Having a history of hay fever or asthma increases your risk for eczema.

    A family history of eczema or other allergic disorders increases your risk for eczema. Approximately 80% of people with eczema have at least one family member who also has eczema. If a child has only one parent with eczema, he or she has a 25% chance of having eczema. If both parents have eczema, the child's risk for having eczema increases to more than 50%.

    Eczema outbreaks can be triggered by environmental factors. Table 01 Tobacco smoke, harsh chemicals such as chlorine or hand soap, irritating clothing, high or low temperatures, and emotional stress can trigger an eczema reaction. Exposure to some foods may also trigger eczema attacks; especially among children.

    Table 1.  Triggers of Existing Eczema

    Tobacco smoke
    Excessive temperatures (hot or cold)
    Harsh chemicals such as solvents, detergents, bleach, and paint
    Skin care products that contain alcohol and some soaps
    Irritating fibers such as wool and synthetics
    Cosmetics and perfumes
    Emotional stress
    Food allergies (especially allergies to soy protein, cow's milk, fish, eggs, and peanuts)
    Other allergies (pollen, pets, dust mites)
    Sweat

    Physicians are often able to diagnose eczema based on medical history and the characteristic appearance of the rash alone. After a thorough family medical history and a personal history of allergy-related conditions is taken, physicians will typically examine the entire surface of the body to note the pattern, severity, and characteristics of the rash. The following criteria are considered basic grounds for a diagnosis of eczema:

    • a pattern of itching and scratching
    • a rash that increases and decreases in severity
    • a rash that has a typical distribution of reddened, itchy patches
    • a personal or family history of allergic conditions
    • the condition lasts longer than six weeks.

    Almost all people with eczema have dry skin, which makes the problem worse.

    Blood tests may be done to check for levels of a type of antibody called IgE, which are often, but not always, elevated in people with eczema. Your doctor may want to test the skin to see if it is hypersensitive to other substances. Though rarely required, a skin biopsy may be performed to rule out other causes of skin irritation.

    Eczema begins at an early age. If what appears to be eczema comes on after the age of three or four, there's a good chance it is not eczema, but some other type of skin irritation.

    The skin of people with an eczema flare tends to show what is called "white dermatographism."

    This means that if the skin is scratched with a pointed instrument, a red line will form, and then will turn white within about 10 seconds. After a flare, the person may have white spots on their skin. These are the harmless after-effects of the eczema inflammation. Some people with eczema will have pale skin around their eyes. They may also have an extra fold of skin beneath their lower eyelid. This fold is sometimes called Dennie's line, and may be due to extra water in the tissues of the face.

    Eczema cannot be prevented, but outbreaks can be controlled. Table 02

    Table 2.  Control Techniques for Eczema

    Keep skin moisturized with non-medicated lotions, especially after bathing.
    Avoid ointments that are too heavy, like petroleum jelly, which can worsen the condition by blocking pores.
    Take short showers and baths; pat yourself dry, and avoid rubbing with a towel.
    Avoid extreme temperatures.
    Wear cotton clothing?avoid wools and synthetics that are irritating.
    Avoid perfume, which can be found in detergents, cosmetics, lotions, sprays, and deodorants.
    Try to reduce stress.
    Get regular exercise. If sweat aggravates your eczema, avoid exercise during flares.
    Consider special air filter and hypoallergenic bedding if allergic to dust mites.
    Use a humidifier to keep air moist.

    Keep your skin moisturized. Use room humidifiers and frequently apply nonmedicated lotions and moisturizers to keep skin moist. Avoid harsh soaps and chlorine-based cleaning products. Take short showers or baths. When washing your hands or face in the sink, do so quickly and only use soap when necessary. Do not rub yourself dry after showering, but instead gently pat the skin with a towel and follow immediately with moisturizer. Avoid skin ointments that are too heavy, such as vegetable shortening or petroleum jelly, which can block the sweat glands and worsen symptoms.

    Avoid anything that triggers your allergies, such as extreme hot and cold temperatures, clothes made from irritating materials such as wool, and perfumes and detergents that contain dyes and perfume.

    Avoid foods that have triggered eczema reactions in the past. Avoid extremely hot or cold temperatures. Avoid wearing clothes made from irritating materials, such as wool or synthetics. Try wearing only natural fibers, such as cotton. Do not wear perfume, perfumed lotions, or non-hypo-allergenic cosmetics. Avoid using clothes detergents or lotions that contain dyes or perfumes.

    Take measures to control dust mites.

    These can include special air filters and special bedding, and may prove helpful in cases where eczema seems to be focused on the head, neck, and hands.

    Take steps to reduce stress in your life. Sometimes stress can bring on an eczema flare. Exercise and pursue relaxing activities to reduce emotional stress. If sweat makes your eczema worse, try to avoid exercise during a flare-up.

  • Prevention and Screening

    Eczema cannot be prevented, but outbreaks can be controlled. Table 02

    Table 2.  Control Techniques for Eczema

    Keep skin moisturized with non-medicated lotions, especially after bathing.
    Avoid ointments that are too heavy, like petroleum jelly, which can worsen the condition by blocking pores.
    Take short showers and baths; pat yourself dry, and avoid rubbing with a towel.
    Avoid extreme temperatures.
    Wear cotton clothing?avoid wools and synthetics that are irritating.
    Avoid perfume, which can be found in detergents, cosmetics, lotions, sprays, and deodorants.
    Try to reduce stress.
    Get regular exercise. If sweat aggravates your eczema, avoid exercise during flares.
    Consider special air filter and hypoallergenic bedding if allergic to dust mites.
    Use a humidifier to keep air moist.

    Keep your skin moisturized. Use room humidifiers and frequently apply nonmedicated lotions and moisturizers to keep skin moist. Avoid harsh soaps and chlorine-based cleaning products. Take short showers or baths. When washing your hands or face in the sink, do so quickly and only use soap when necessary. Do not rub yourself dry after showering, but instead gently pat the skin with a towel and follow immediately with moisturizer. Avoid skin ointments that are too heavy, such as vegetable shortening or petroleum jelly, which can block the sweat glands and worsen symptoms.

    Avoid anything that triggers your allergies, such as extreme hot and cold temperatures, clothes made from irritating materials such as wool, and perfumes and detergents that contain dyes and perfume.

    Avoid foods that have triggered eczema reactions in the past. Avoid extremely hot or cold temperatures. Avoid wearing clothes made from irritating materials, such as wool or synthetics. Try wearing only natural fibers, such as cotton. Do not wear perfume, perfumed lotions, or non-hypo-allergenic cosmetics. Avoid using clothes detergents or lotions that contain dyes or perfumes.

    Take measures to control dust mites.

    These can include special air filters and special bedding, and may prove helpful in cases where eczema seems to be focused on the head, neck, and hands.

    Take steps to reduce stress in your life. Sometimes stress can bring on an eczema flare. Exercise and pursue relaxing activities to reduce emotional stress. If sweat makes your eczema worse, try to avoid exercise during a flare-up.

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