Eczema

Eczema is an array of several skin conditions, Eczema is synonym of dermatitis. Non-health professionals often use the term Eczema to refer to atopic dermatitis (a specific type of dermatitis). Terms such as lichenoid and inter-phasic dermatitis are histological concepts and do not indicate clinical dermatitis.

Author:	Doctor Cesar Velasquez
Reviewed by:	Ana Codallo, CTO
Last Updated on Aug 18, 2023

In dermatology, dermatitis describes various skin disorders that share the same inflammatory reaction pattern with similar clinical manifestations.

On histologic examination, lymphocytes leak into the dermis and then migrate into the epidermis, leading to intercellular epidermal edema (spongiosis), hyperproliferation, thickening, and hyperkeratosis. The dermatologic term for this process is spongiotic or eczematous dermatitis. Although different types of dermatitis may differ in some minor histological features, macroscopic features cannot differentiate them.

Eczema: What Is Eczema or Atopic Dermatitis?

Atopic dermatitis or eczema is a chronic, non-contagious inflammatory skin disease characterized by extreme dehydration and skin irritation.

Outbreaks are usual; in them, small eruptions appear, even on the scalp, which cause severe itching. Consequently, it usually negatively impacts the quality of life of people who suffer from the disease, causing self-esteem problems and even a lack of sleep.

Over time, this skin disease can manifest with other pathologies such as asthma, allergic rhinitis, or allergic conjunctivitis.

When the skin is very dehydrated, it becomes more permeable and no longer fulfills its barrier function against external aggressions and allergens. Even so, dry skin does not have to become atopic. Atopic skin develops from genetic conditions.

Some studies show that if one of the parents has atopic skin, the probability that the child will have the same skin characteristics is 30%. If both parents are affected, the chance young children will have it is 70%.

What Is the ICD 10 Code for Eczema?

The ICD / ICD 10 code for Eczema is "L20-L30" (Dermatitis and eczema).

Eczema: What Are the Symptoms of Atopic Dermatitis?

Atopic dermatitis usually appears in infancy, as early as three months, and is divided into acute and chronic phases.

In the acute phase, the lesions are itchy, deep red, scaly patches or plaques that may erode by scratching.

During the chronic phase, the scratching and rubbing cause skin lesions that appear dry and lichenified.

The distribution of lesions is age-specific. In infants, lesions typically occur on the face, scalp, neck, eyelids, and extensor surfaces of the limbs. In older children and adults, lesions occur in folds such as the neck and the antecubital and popliteal fossae.

Intense pruritus is a fundamental feature. Itching often precedes the lesions and is made worse by dry environments, sweating, local irritation, woolen clothing, and emotional stress.

Common environmental triggers for symptoms include:

• Excessive bathing or washing
• Hard soaps
• Cutaneous colonization by Staphylococcus aureus
• Sweating
• Rough fabrics and wool

Eczema: What Are the Causes of Atopic Dermatitis?

People with atopic dermatitis often have asthma or seasonal allergies. Usually, there is a family history of allergic conditions such as asthma, allergic rhinitis, or eczema. People with atopic dermatitis often have a positive allergy skin test. However, allergies do not cause this dermatitis. The following factors can worsen the symptoms of atopic dermatitis:

• Allergies to pollen, mold, dust mites, or animal dander
• Dry air in winter
• Colds (flu)
• Contact with irritating materials and chemicals
• Contact with rough materials such as wool
• Dehydrated skin
• Emotional stress
• Dry skin from taking frequent baths or showers or swimming frequently
• Getting too cold or too hot, as well as sudden changes in temperature
• Perfumes or dyes added to skin soaps or lotions

Eczema: What Are the Types of Atopic Dermatitis?

Among the main types of eczema, we can find:

Atopic Eczema or Atopic Dermatitis

Its origin derives from the genetic predisposition of patients to suffer from this type of condition.

Dyshidrotic Eczema

This type of eczema is also called pompholyx eczema; it is a type of inflammation that appears on the palms of the hands and the soles of the feet, characterized by the formation of small vesicles or blisters filled with fluid. It is usually seasonal, being more frequent in spring and summer. Although previously believed to be caused due to sweat as it was prevalent during the hottest season, further studies ruled out this theory, and a specific reason for this type of eczema on the feet and hands is unknown.

Seborrheic Eczema

Skin rash with a tendency to desquamation on the face and scalp caused by seborrheic dermatitis.

Allergic Contact Eczema

An allergy causes a specific product in contact with the skin, such as soaps or cosmetic items. The starting point for your treatment should be to locate the product responsible for the skin irritation and avoid contact with it. In this way, you prevent the future development of possible skin lesions.

Nummular Eczema

Patients present with eczema plaques of different sizes in the shape of a coin; it is usually recurrent. This type of eczema, whose causes are unknown, affects both sexes equally, although it is more common in men than women.

Eczema Herpeticum

It is a complication of atopic eczema, an added infection caused by the herpes simplex virus. This virus induces the appearance of vesicles around and inside the mouth. If the infection spreads to other areas of the face or body, it can become severe; therefore, early treatment is essential.

Eczema: How Is the Diagnosis of Atopic Dermatitis Made?

The suspected diagnosis of each form of eczema should be through the clinical history.

The diagnosis of atopic eczema may include the following:

• Family background
• Personal history of allergies or asthma
• Blood tests

In allergic contact eczema, epicutaneous contact tests determine the allergen responsible for the eczema plaques that the patient presents.

The diagnosis of atopic eczema comprises the appearance of the lesions after taking a complete medical history, including family and personal account of allergies and asthma, and after performing blood tests to determine the allergy antibody (immunoglobulins).

Atopic dermatitis can be confused with other skin disorders, such as seborrheic dermatitis (also known as "cradle cap"), psoriasis (a genetic disease that causes scaling and inflammation of the skin), and contact dermatitis (caused by direct skin contact with an irritating substance, such as certain metals, medicines or soaps).

However, there is no definitive test to diagnose eczema.

Eczema: What Is the Treatment for Atopic Dermatitis?

The dermatologist will identify the cause of eczema on the skin and prescribe the most appropriate treatment. Once the triggering factors have been located and eliminated, depending on the characteristics of eczema and each patient, the physician prescribes medication. This treatment may include corticosteroids, antihistamines (if it is an allergic outbreak), moisturizing creams, or antibiotics (if a bacterial infection has occurred by causing entry doors in inflamed areas).

Treatment of atopic dermatitis is most effective after addressing the underlying pathophysiological processes. Counseling on proper skin care and avoiding triggers helps patients manage the underlying skin barrier defect. Scratching of itchy lesions often increases the itch, leading to more scratching and an increased risk of complications.

It is crucial to break the itch-scratch cycle. Inflammatory crises decrease with topical immunosuppressants, phototherapy, and, if necessary, systemic immunosuppressants. Most patients with atopic dermatitis can be outpatients, but patients with severe superinfections or erythroderma may require hospitalization.

Eczema: Treatment of Atopic Dermatitis

Treatment of Atopic Dermatitis: Supportive Treatment

General skincare should address the most common sources of skin irritation, including excessive washing and harsh soaps. These measures include:

• Limit the frequency and duration of washing and bathing (showers should be limited to once a day; sponge baths can decrease the number of days with full baths.
• Limit the temperature of the bath water to lukewarm.
• Avoid excessive friction and instead pat your skin dry after showering.
• Application of moisturizers (ointments or creams; ceramide-containing products are beneficial).
• Emotional stress reduction is helpful and helps break the itch-scratch cycle. Stress can affect the family (for example, being kept awake by a crying baby) and the patient (for example, being unable to sleep due to itching).
• Dietary changes aimed at eliminating exposure to allergenic foods are generally unnecessary and ineffective and unnecessarily increase stress. Food allergies very occasionally cause atopic dermatitis.

Treatment of Atopic Dermatitis: Pharmacological Treatment

Oral antihistamines may help relieve itching due to their sedative properties. However, topical corticosteroids are the key to treatment. Creams or ointments applied twice daily are effective in most patients with mild or moderate symptoms. Low to medium-potency corticosteroids often control skin inflammation, but the resolution of chronically inflamed and lichenified skin requires high-potency corticosteroids.

Narrowband ultraviolet light phototherapy is helpful for extensive atopic dermatitis, especially when proper skin care and topical treatments fail to control inflammation.

Antistaphylococcal antibiotics, e.g., mupirocin, and oral fusidic acid, are used to treat bacterial superinfections of the skin, such as impetigo, folliculitis, and furunculosis.

Eczema: How Can Atopic Dermatitis Be Prevented?

Although genetic factors are essential in eczema (in 50-70% of patients, at least one parent was also affected), the following actions may prevent flare-ups.

• Keep skin hydrated, especially after showering or during dry weather seasons.
• Avoid baths over 36 degrees Celsius (96.8 F), and do not stay in the water for more than 10 minutes.
• Use mild soaps, both for the body and for clothes.
• Use cotton or linen instead of synthetic fabrics.
• Ventilate the house regularly by opening the windows.
• Use unscented skin products whenever possible.
• Avoid scratching so as not to enter the vicious circle of itch-scratch-itch.

Eczema: Presentation of Atopic Dermatitis in Children

At least one in 10 children has eczema (also called atopic dermatitis), a chronic skin problem that makes the skin dry, red, and itchy. Children with eczema have more sensitive skin than other people.

Skin barrier problems cause eczema. Many children with eczema lack a particular protein called 'filaggrin' in the outer layer of the skin. Filaggrin helps the skin to form a strong barrier between the body and the environment. Skin with too little of this protein has more difficulty retaining water and keeping out bacteria and environmental irritants.

Eczema rashes can be different for each child. They can be all over the body or just in certain places. The eczema rash sometimes gets worse (in episodes called “flare-ups”) and then gets better (called “remissions”). The area where the rash develops can change over time:

• In babies: Eczema usually appears on the scalp and face. Red, dry rashes may appear on the cheeks, forehead, and around the mouth. Eczema does not usually develop in the diaper area.
• In young school-age children: The eczema rash usually appears in the creases of the elbows, behind the knees, on the neck, and around the eyes.

Eczema: What Is It Like to Live With Atopic Dermatitis?

Living with eczema implies more than just having superficial lesions. Atopic dermatitis often requires daily care to control itching and skin lesions. In addition, other symptoms can develop that affect the quality of life of patients, such as lack of sleep, symptoms of anxiety, and depression due to social rejection.

Understanding the causes of atopic dermatitis is essential, as it can be frustrating and embarrassing, making patients suffer for their physical appearance. Knowing the immunological causes can help to understand the disease better and find new ways to deal with atopic dermatitis.

Dr. Hywel C G Williams: KOL #1 for Eczema

According to KOL's technology, Dr. Hywel C G Williams is the top ranking Key Opinion Leader (worldwide) for Eczema. You can see Dr. Hywel C G Williams's KOL resume and other concepts for which they rank #1 worldwide.

Hywel C G Williams

Hywel Williams was brought up in the hillside village of Cymmer Afan in South Wales, where he attended the local comprehensive schools. He trained in medicine at Charing Cross Hospital, London. After qualifying, Hywel did further medical and dermatology training in London at the Hammersmith Hospital, Charing Cross Hospital, Kingston Hospital and King's College Hospital. Whilst training in dermatology at Kings, he published an article in the Lancet about a dog detecting skin cancer and was the first to suggest the possibility of canine cancer detection. In 1994, he won a Wellcome Trust clinical epidemiology training fellowship and did an MSc in Clinical Epidemiology at the London School of Hygiene and Tropical Medicine. This led to a PhD in developing diagnostic criteria for atopic eczema in 1994 when he worked at St John's Dermatology Centre, London. That year, Hywel was appointed as Senior Lecturer in Dermatology to the clinical dermatology department at Nottingham, and became Foundation Professor of Dermato-Epidemiology in April 1998. There, he founded the Centre of Evidence-Based Dermatology.

Hywel was awarded a silver merit award from the NHS in 2007 for his work into supporting NHS-related research, and in 2013, he was awarded a gold NHS distinction award. In 2008, he was awarded an NIHR senior investigator award in the first competition round, which has renewed for a further 5 years in 2012. .In 2013 and was awarded a higher doctorate (DSc) for his international research into the causes and treatment of eczema. In 2014, he was nominated to become a fellow of the Academy of Medical Sciences. In July 2017, he was awarded the Sir Archibald Gray medal by the British Association of Dermatology. The Medal is the highest accolade for outstanding services to British dermatology. In 2017, he also became one of the first to become and NIHR Senior Investigator Emeritus. In 2021, Hywel was awarded an OBE for his services to medical research and higher education.

Biography courtesy of: https://www.nottingham.ac.uk/medicine/people/hywel.williams

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