Eczemas : What Is It ? Natural Treatment, Diagnosis Management and Advice For Patient
Eczemas are groups inflammatory skin conditions manifesting either as acute eczematous lesions, which are characterized by active papules; erythema, excoriations and oozing (weeping), sub acute eczemas, also have excoriation, erythema with papules and scales or as a chronic eczematous lesion, characterized by thickening of the skin, and accentuation of the creases (lichenification) and hyperpigmentations
Atopic dermatitis
The term atopy is a Greek word meaning "out of place” or strange. The hereditary tendency to develop allergies to food and inhalant substances as manifested by eczema, asthma and hay (allergic conjunctivitis and allergic rhinitis) fever is called atopy.
The prevalence of atopic diseases appears to be rising. Atopic dermatitis now affects about 10 to 20% of the population.
It is the interaction of genetics and environmental factors that results atopic eczema. More than ¼ of the offsprings of atopic mother develop atopic dermatitis in the first 3 months of life. If one parent is atopic, more than 50% of the children would develop allergic symptoms by the age of two years and if both parents are affected, the chance of the child to have allergic symptoms would be about 79%.
Diagnostic Criteria for Atopic Dermatitis
The diagnosis of atopic eczema is made by constellation of criteria.
Major criteria: one should have three of the following major criteria.
1. pruritus
2. typical morphology and distribution
A. flexural lichenification in adults
B. facial and extensor involvement in children
3. chronic or chronically relapsing dermatitis
4. personal or family history of atopic diseases (asthma , allergic rhinitis, allergic conjunctivitis and atopic eczema )
Minor Criteria One Must Have Three of the Following
-Dryness of the skin (xerosis, xeroderma)
-Ichthiosis/hyperlinear palms and soles
-IgE reactivity
-Elevated serum IgE
-Early stage of onset
-Tendency to cutaneous infection
-Pityriasis alba
-Itching when sweating
-Intolerance to wool and lipid solvents perifollicular accentuation
For young infants the diagnostic criteria is modified
The three major criterias are
1. family history of atopic diseases
2. Typical facial or extensor dermatitis
3. Evidence of pruritus
-Three minor features are:
-Xerosis/ ichthiosis / hyperlinearity of palms and soles
-Perifollicular accentuation
-Post auricular fissure
-Chronic scalp scaling
The hall mark of atopic eczema is pruritus and dryness of the skin. Long standing pruritus results in lichenified dry skin which would call for further scratching and in this way the itch -scratch cycle establishes which assumes a vicious form. The flexures like the popilitial fossa, wrist, and anticubital fossa are affected.
The pattern of distribution in atopic eczemas depends on the age and activity of the disease. Based on that atopic eczemas are classified in to: infantile eczema (from 2 months up to 2 years), childhood atopic eczema (from 2 years to 10 years) and atopic eczema of adolescents and adults.
Infantile Atopic eczema
Atopic dermatitis usually starts in the first year of life. During this phase, there is facial erythema, vesicles, oozing and crusting located mainly on the face, scalp, forehead and extensor surface of the extremities. Buttocks and diaper area are frequently spared.
Childhood eczema:
The lesions tend to be drier and scaly. Flexor surfaces and skin creases are predominantly involved. Facial lesions with eyelid involvement and lesions around the neck also occur. Lichenification from chronic itching and scratching occur over flexor surfaces. Psychological effects often are very prominent
Adolescent and adult atopic dermatitis:
Flexural predilection of lesions persists. Localized, eczematous or lichenified plaques often predominates the clinical picture. Prurigo papules and nodules tend to occur. Resolved cases show dryness and irritability of the skin with a tendency to itch with sweating and other triggers. Recurrent and persistent hand dermatitis is a frequent feature.
TREATMENT
General Measures
- Counseling; that it is not curable but controllable by treatments;
-Avoidance of factors that promotes dryness, itching or inflammation, such as excessive bathing and exposure to volatile chemicals (gasoline, kerosene)
-Avoidance of contact with local irritants like woolen garments; use soft cotton garments.
-Clothing and linens should be washed in mild detergents and rinsed well.
-Soaps should be used when they are necessary
-In severe cases, hospitalization for a short period may promote rapid reduction of symptoms mainly by providing a changed environment
Specific
Specific measures are aimed at modifying the following pathogenetic factors: dryness, inflammation, infection, and itching.
Topical Steroids
High potency steroids are used for a short period to rapidly reduce inflammation. Hove ever they should not be used on the face. Maintenance therapy, if needed is best done with mild steroids like hydrocortisone.
On face and intertriginous areas, mild steroids should be used; mid-potency formulations are used for trunk and limbs. Topical steroids are applied initially twice or thrice a day after the symptoms are lessened, frequency of application should be reduced. Intermittent use if topical steroid may be alternated with application of emollients. Ointments are superior to creams or lotions.
Systemic steroids : a short course of systemic steroids (prednisolone, triamcinolone) may occasionally be needed to suppress acute flare-ups Emmolients – liquid paraffin, Vaseline, olive oil used after bath
Antihistamines - Non-sedating antihistamines like cetirizine, loratadine or fexofenadine may be used to alleviate pruritus .
Infections and colonization with Staphylococcus aureus may aggravate or complicate Atopic dermatitis Erythromycin, or cloxacillin is usually prescribed
Course and prognosis
Most infantile and childhood cases improve over time and the prevalence of atopic dermatitis diminishes significantly in older ages. Children tend to outgrow the condition.
Some patients’ disease may persist through adulthood. In others, a tendency for dry and irritable skin that easily develops eczematous changes may persist after AD resolves. A propensity for recurrent hand dermatitis may remain in adults who had AD in their childhood. Many children later on develop allergic rhinitis or bronchial asthma.
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