Welcome! First and foremost thank you to Doc Anarchy for this guest post! Today I am here to talk to you about the most inflammatory skin condition in the world, atopic dermatitis. Atopic Dermatitis is also know as atopic eczema or just eczema. It can be quite a nuisance for every age ranging from children to young adults primarily. Today we will be covering the basics of what eczema is, what can cause or trigger it, what this can look like, and most importantly how to treat/prevent it. My goal is to teach and help you understand this disease process and how you can do things at home to enjoy clear and itch free skin.
First, some statistics about eczema that may astound you:
230 million people worldwide suffer from eczema
Frequently associated with allergies and asthma
Starts in infancy and affects 20% of children
Sometimes understanding the cause for skincare disease can be important for prevention and also treatment.
Causes of Eczema
First, there is no single cause of eczema. There are multiple theories regarding this condition that have floated around the dermatology world for years and we can talk about some of them today. The current basic theory is that this is a condition of the immune system with an emphasis on the role of cytokines. In short, cytokines are polypeptide mediators and play a huge role in inflammatory responses. Think of them as messengers in the immune system that tell other immune cells when they need to do a certain job. Certain cytokines can cause inflammation and skin barrier defects resulting in symptoms related to eczema.
Another factor to consider is environmental factors which is a reason why eczema can be associated with asthma and other allergies. These things can be provoked by the environment but can largely be dependent on genetic factors as well which leads us to the next point.
The inherited barrier defect refers to abnormal skin barrier changes that can make the skin barrier more permeable and therefore more penetrable. This can ultimately lead to dryness, itchiness, and inflammation which are common symptoms related to eczema. There is a lot more details here if you are interested in reading further
Now I have bored you with some of the possible theories behind atopic dermatitis (eczema), let us dive into clinical features and how to recognize eczema in all ages!
Symptoms of Eczema
The first thing to understand is eczema is a skin condition that can be widely variable. There is no perfect way to predict how many flare ups or how long it will last but it is safe to say that a large number of children will grow out their eczema. Until that happens, here is what we look for:
Infantile Eczema
As babies, eczema most commonly occurs in the scalp, flexor surfaces, and the groin. Rough and dry skin is what is most commonly seen but occasionally can cause hair loss as well. Eczema can be more severe and therefore more widespread but this varies per baby. With time, the face and cheeks can also become involved as seen below:
Toddler Age Eczema
As babies get older, the locations can typically change. The areas that get affected can increase to elbows, wrists, knees, and ankles. Usually this is is the time that kids will scratch more and the skin can become thickened from this excessive itching. Below is an example of eczema in this age:
Adult Eczema
For the ones that do not grow out of this, it can be extremely variable. The locations involved can be a mix of all of the above and can sometimes be more widespread. Do not be discouraged as we will talk about good treatment options so that if you do have eczema as an adult you can treat this appropriately. Below is an example of adult eczema:
The main complication that occurs with eczema is secondary bacterial infection. When the moisture barrier is disrupted, the skin is less likely to be able to protect the body from bacteria. Bacteria can get into these broken down areas and cause local skin infections. It is not that common but still worth talking about. Infected areas like this may feel tender, have increased redness, and ultimately could have drainage of some kind depending on the severity. Either way, just being aware of this can help prevent further problems. Now on to the most important part of this entire post…Treatment.
Treatment
Treatment for eczema can vary widely depending on the severity of the condition as well as the age group to treat. As mentioned before, this condition largely affects children and infants so lets start there.
First thing to mention is a good resource for parents about eczema is here in this link.
General principles to treat infant and children eczema:
Baths: baths are important to help moisturize and should be 1-2x daily with warm water and for no longer than 10 minutes. In addition, bleach baths 2x a week (1/2 cup of bleach added to full bath) can provide good anti-septic coverage as well.
Moisturizers: children should use some kind of emollient moisturizer every single day. Moisturizing should be applied to the entire body even when eczema has cleared. Emollients function by creating a thin layer of oil on the skin therefore trapping water and improving the moisture barrier that becomes disrupted in eczema. Creams are typically your best bet over lotions or ointments because they are smooth and easy to spread.
Topical corticosteroids: this part is tricky because Hydrocortisone over the counter is the only option and should only be used on areas of active eczema in addition to moisturizer. When the flare up resolves then continue with moisturizer only. If topical steroid seems to be inadequate then a visit to a Dermatologist may be warranted for something stronger. Steroids will ultimately help with
Although it seems fairly straightforward, the constant revolving door of eczema can be difficult to stop and ultimately maintain. The point of these treatment principles is to develop a plan to decrease the frequency of flares because it may be impossible to fully eliminate the triggers and irritants that cause the flare ups in the first place. Understanding how to decrease severity of flares is equally important. When all else fails, a medical professional can always help you develop this plan.
Now for adults, the principles are generally the same. Adults have a better ability to understand what may flare up eczema which results in better outcomes. Adults also have more room in terms of using different medications if a Dermatologist decides that systemic medications are the best option. Being aware of the complications of eczema mainly secondary infections is an important aspect of this condition and will likely happen at some point in your life. The short answer is this: If you ever experience a red rash area that is more tender, more swollen, or draining any kind of discharge then it is most likely a sign of a secondary infection and will likely need a more aggressive plan of action. Recognizing this early can make all the difference.
For adults, the main thing to understand is that it will take consist discipline to nail down this routine. Adults have to make moisturizing as regular in their routine as showering or the cycles of severe flare ups will continue. Adults also have to understand when their efforts are maxxed out. When this occurs then a medical professional will be able to help.
The psychological impact that eczema can have on people is astounding. No one wants to be the person who has red rashy areas covering their skin and no one wants to be the one who has a kid with this either. Rest assured you are not alone and it will be okay. No matter how your skin looks, I encourage you to always stay positive in this journey and never stop learning. There will be ups and downs but never forget that people can help if you ask them.
I hope this post provided more clarity and education on a condition that affects so many people. My DMs are always open to discuss questions and concerns you have and I will do my best to answer them to the best of my ability. You can find me at The Skincare Provider.
Have a great day!