Eczema or dermatitis is red areas, with scaling or small vesicles, that cause itching that can appear on any area of the body. They are the result of inflammation of the skin. There are different types of eczema or dermatitis depending on the cause of the inflammation. Some are avoidable and others have their origin in the structure of the skin itself, which makes them more difficult to treat.
Types of eczema
Atopic eczema or atopic dermatitis
Its origin derives from the genetic predisposition of patients to suffer this type of injury.
Also called pompholyx eczema. It is a type of inflammation that appears on the palms of the hands and the soles of the feet and is characterized by the formation of small vesicles or blisters filled with fluid.
Skin rash with a tendency to peel on the face and scalp caused by seborrheic dermatitis.
Allergic Contact Eczema
It is caused by an allergy to a specific product that has been in contact with the skin, such as soaps or cosmetic items.
Patients present eczema plaques of different sizes in the shape of a coin. It usually appears recurrently.
It is a complication of atopic eczema which is added to an infection caused by the herpes simplex virus or oral herpes.
What are the causes of eczema?
The causes of this type of allergic response are unknown, but they are included within the generalized allergic conditions with hereditary predisposition.
In addition to genetic factors, it is thought that eczema may be influenced by alterations in the defenses or by an alteration in the skin barrier. Dermatitis episodes seem to be precipitated by excessive skin reactivity to certain environmental triggers:
Most people who suffer from the different types of eczema are allergic to certain substances, such as dust mites, pollens, and animal hair. Although in general this type of allergy is not associated with the development of an episode of eczema, it is advisable to take preventive measures to avoid contact with these substances (avoid carpets, maintain adequate cleanliness, carry out frequent washing of bed, mattresses, and pillows).
Food Allergy. Less than 10% of the population with eczema have food allergy or intolerance as precipitating factors. In general, the investigation of the possibility of a food allergy should be reserved for cases in which dermatitis does not improve with the usual treatments or there is a temporary relationship with the introduction of these foods.
Infections. Eczema patients are more prone to bacterial, viral, and fungal infections.
Possible triggers of eczema
The following have been described as factors that can precipitate an episode of eczema:
- Dry skin (xerosis)
- Temperature changes
- Emotional stress
- The use of wool clothing, acrylic fabrics, perfumed products, detergents, cleaning components, etc.).
Symptoms of eczema (atopic dermatitis)
Eczema patients often have dry skin and changes in its color. Eczema can worsen in various situations:
- In connection with allergies to pollen, dust, or animals.
- In winter after exposure to cold or wind or sudden temperature changes.
- Coinciding with a cold.
- When using some soaps, gels, shampoos, creams, or colognes that can irritate the skin or when using some rough fabrics, such as wool.
- When the skin is dry.
- In situations of stress or anxiety.
- With frequent exposure to water (swimmers).
- By consuming some foods such as eggs, milk, fish or some nuts.
Eczema patients often have several characteristic features, such as a whitish discoloration around the mouth and an increased number of folds in the lower eyelid. These patients very often present other characteristic diseases of atopy such as asthma or allergic rhinitis.
What is the treatment of eczema?
It is important to know that eczema can have multiple causes and that it does not have a specific cure, in the same way, special care must be taken in the case of dyshidrotic eczema. The following precautions should be taken:
- Precipitating factors such as stress, heat or cold, or environmental dryness should be avoided.
- The presence of dust and mites in the room where you sleep should be avoided.
- Substances that irritate the skin should be avoided.
- Neutral pH gels or soaps should be used.
- Bathing or showering with warm or cold water is recommended. Baths should be short to avoid prolonged contact with water.
- Skin hydration should be encouraged. To do this, moisturizers should be applied several times a day. Creams with a higher oil content are the most recommended.
- Use a humidifier in the room
In some cases where an inflammatory exudate predominates, astringent solutions may be indicated. They are indicated in any dermatitis when there is an active phase with exudation and in skin erosions and ulcers. They are the solutions of water and zinc sulfate at 1‰ (the most astringent), water and copper sulfate at 0.5‰, 1‰, or 2‰ (most antiseptic).
Antihistamines are often needed to control itching. In children, nails should be closely trimmed to avoid scratching injuries. Sometimes it may be necessary to put gloves on them, especially when sleeping at night, to prevent scratching.
It is not proven that any diet significantly modifies the course of the disease. However, you can reduce the consumption of foods with high allergenic potential such as eggs, nuts, and derivatives, chocolate, milk, fish, and soy.
After bathing, topical anti-inflammatories can be applied. They produce fewer adverse effects than corticosteroids, although their price is high and their safety is not fully established, so they should be used with caution. Use only under the supervision of your doctor.
Corticosteroids in the form of creams are frequently used, but those that are very powerful should be avoided since they can promote skin atrophy and can pass into the blood through the skin with consequent adverse effects.
Strong corticosteroids should be avoided on the face or between the fingers, areas where the skin can easily atrophy. If it is necessary to apply corticosteroids in these areas for prolonged periods (several weeks), it is better to use the previously mentioned anti-inflammatories. The absence of response to treatment with topical corticosteroids makes it necessary to rule out contact dermatitis. Use only under the recommendation of your doctor.
In cases of severe outbreaks that do not respond to treatment in the form of cream, it may be necessary to use corticosteroids by mouth, although when they are suspended, the outbreak often reappears. Other medications, such as immunomodulators or phototherapy, have also been used with variable success. Its use must be assessed by a specialist who evaluates the risk and benefits of said treatment.
Possible skin infections should be treated vigorously. For this, it is advisable to obtain a culture of the infected area before starting treatment with antibiotics.
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Some doctors recommend using corticosteroid or anti-inflammatory creams in phases of disease control to avoid reactivations.