Eczema

Eczema is a type of dermatosis characterized by acute or chronic inflammation in the skin that results in symptoms such as dryness, itching, swelling, blisters and redness on the skin, which can happen to anyone, at any age, but are more frequent in children.

There are several types of eczema, which are caused by different factors, such as allergies to substances that may have come into contact with the skin or to medications, in addition to changes in the temperature of the environment, or being triggered by stress, for example.

The treatment of eczema is done by the dermatologist, and the use of moisturizers, corticoid drugs, antihistamines, immunosuppressants, biological therapy or phototherapy, for example, may be indicated, and it is also important to identify the factor responsible for stimulating the symptoms.

eczema symptoms

The main symptoms of eczema are:

• Dry skin;
• Peeling of the skin, due to dryness;
• Intense itching;
• Swelling of the skin;
• Redness;
• Blisters on the skin, which may rupture and release a fluid
• Formation of wounds on the skin, due to constant scratching;
• Change in the color of an area of ​​skin, which may be lighter or darker than normal.

In the chronic phase of eczema, the blisters begin to dry and crusts form, in addition to an increase in the thickness of the skin in the area.

In babies and children, eczema is most common on the cheeks, arms and legs, but in adults, symptoms can appear anywhere on the body.

Symptoms may vary according to the cause and type of eczema, and should always be evaluated by a dermatologist, who can recommend the most appropriate treatment to alleviate symptoms and prevent skin infections.

How the diagnosis is made

The diagnosis of eczema is made by the dermatologist through the evaluation of symptoms, as well as their onset and frequency, health history and physical examination in which the characteristics of skin lesions are observed.

Generally, tests are not necessary to confirm the diagnosis of eczema, however, the doctor may recommend an allergy test in order to identify the factor responsible for the eczema. See how the allergy test is done .

Possible causes

The causes of eczema are still not very well understood, however, it is believed that it can happen due to a combination of genetic and environmental factors, which lead to changes in the skin’s protective barrier or in the functioning of the immune system.

The main factors that can increase the risk of developing eczema are:

• Family history of eczema or dermatitis;
• Family history of allergies, asthma or allergic rhinitis;
• Extreme heat or cold;
• Low or high air humidity;
• Sweat;
• Dust mite, mold or pollen allergy;
• Plants or animal hair;
• Cleaning products such as detergent or laundry soap;
• Dust or pollution;
• Clothes, belts, jewelry or some types of fabric, such as wool or jeans;
• Medicines, such as antibiotics, phenytoin, carbamazepine, or lamotrigine;
• Foods, such as peanuts, dairy, egg or soy;
• Materials, such as latex or rubber;
• Beauty products and cosmetics, makeup, perfume, shampoo, deodorant, shower gel, soap, wax or depilatory cream;
• Stress or anxiety;
• Depression.

In addition, eczema can also arise due to hormonal changes in the menstrual cycle or pregnancy.

types of eczema

Eczema can be classified into different types according to its cause, the most common being:

• Contact eczema or contact dermatitis : arises due to contact with an irritating or allergenic object or substance, triggering an exaggerated response from the immune system;
• Stasis eczema or stasis dermatitis : it can arise when there is a change in blood circulation at the site, happening mainly in the legs;
• Eczema due to medications: which happens when the person uses some medication that leads to the development of an allergic reaction that results in the appearance of eczema;
• Atopic eczema or atopic dermatitis : it is normally associated with asthma and rhinitis and the symptoms usually appear on the face and in the folds of the arms and legs, in addition to intense itching;
• Nummular eczema or nummular dermatitis: the cause is not yet well established, but in some situations it may be related to excessive dryness of the skin, due to cold or dry weather, for example. This type of eczema is characterized by the presence of red, round, itchy patches on the skin;
• Dyshidrotic eczema or dyshidrosis : it can arise due to skin allergies, excessive humidity in the hands or feet and increased physical or emotional stress, which lead to the appearance of fluid-filled balls on the palms of the hands, on the sides of the fingers or on the soles of the feet .

In children, eczema usually appears after 3 months, and can last until adolescence.

How the treatment of Eczema is done

Eczema treatment should be indicated by the dermatologist according to the type of eczema, severity of symptoms and age of the person and aims to relieve symptoms and prevent them from reappearing, as there is no cure.

Thus, the main treatments that can be indicated by the doctor are:

1. Moisturizers

The use of neutral and unscented moisturizers, which have a greater amount of oils, may be indicated as they help to retain and maintain moisture and soothe the skin, reducing the symptoms of eczema and preventing the emergence of new crises.

2. Medicines

In some cases, depending on the intensity of the symptoms, the doctor may recommend treatment with medicines such as:

• Corticosteroid creams or ointments , such as betamethasone or dexamethasone;
• Corticosteroids in tablet form , such as prednisone or prednisolone;
• Oral antihistamines , such as diphenhydramine or hydroxyzine;
• Immunosuppressive ointments , such as pimecrolimus or tacrolimus;
• Immunosuppressants in tablet form , such as cyclosporine, azathioprine, mycophenolate or methotrexate;
• Biological therapy , such as dupilumab in the form of an injection.

In some cases, the doctor may also recommend the use of antibiotics to prevent or treat skin infections.

3. Phototherapy

Phototherapy with ultraviolet A or B radiation (UVA or UVB) may be indicated by the doctor for moderate eczema that has not improved with other treatments, as it helps to reduce skin inflammation, with few side effects compared to other treatments.

Phototherapy can be used together with an oral or topical medicine, psoralen, this treatment being called PUVA, which consists of taking or applying psoralen in the form of an ointment on the skin, and 2 hours later exposing the area that will be treated with ultraviolet radiation.

daily care

Some daily care is important to avoid the worsening of symptoms or even to prevent symptoms from appearing again, being recommended:

• Do not take very hot and prolonged baths , as they dry the skin;
• Dry the skin after the bath, with a soft, clean and dry towel , without rubbing the towel hard on the skin;
• Apply the moisturizer recommended by the doctor daily after bathing, with the skin still damp;
• Avoid scratching the affected skin site;
• Use neutral soaps and detergents to avoid skin irritation;
• Avoid using perfume or scented lotions on your skin;
• Avoid contact with substances that may develop or worsen symptoms;
• Wear cotton clothes , avoiding synthetic fabrics;
• Avoid wearing tight clothes with rough fabric;
• Use room humidifier when the weather is very dry or cold;
• Avoid very hot environments that favor sweating.

It is important that this care is continued even when the symptoms of eczema disappear to prevent the skin from becoming too dry and the emergence of new crises.