Atopic Eczema

Symptoms of Atopic Eczema

One of the most common symptoms of atopic eczema is itchiness, which can be almost unbearable. Other symptoms include overall dryness of the skin, redness, and inflammation. Constant scratching can also cause the skin to split, leaving it prone to infection. In infected eczema, the skin may crack and weep creating a condition known as wet eczema.

One of the more pronounced features of atopic eczema is very dry skin that is sensitive. When this dryness becomes extreme, cracks appear in the skin that can be extremely sore. For example, when this occurs on the backs of the knees it is very difficult to walk. If the skin cracks at the side of the mouth, it is difficult to talk. It is therefore understandable that people with the condition can become irritable and stressed because of the discomfort they are enduring. The importance of routine skin care should not be underestimated.

Atopic eczema may affect the skin around the eyes, the eyelids, and the eyebrows and lashes. Scratching and rubbing the eye area can cause the skin to change in appearance. Some people with atopic eczema develop an extra fold of skin under their eyes, called an atopic pleat or Dennie-Morgan fold. Other people may have hyper-pigmented eyelids, meaning that the skin on their eyelids darkens from the inflammation or hay fever (a.k.a. allergic shiners). Patchy hair loss in the eyebrows and eye lashes can also result from scratching or rubbing.

The most common symptoms of atopic eczema are dry, itchy skin, cracks behind the ears, and rashes on the cheeks, arms, and legs. The itchy feeling is an important factor in atopic eczema, because scratching and rubbing in response to itching worsens the skin inflammation that is characteristic of this disease. People with atopic eczema seem to be more sensitive to itching and feel the need to scratch longer in response. They develop what is referred to as the "itch-scratch" cycle. The extreme itchiness of the skin causes the person to scratch, which in turn worsens the itch, and so on. Itching is particularly a problem during sleep, when conscious control of scratching decreases and the absence of other outside stimuli makes the itchiness more noticeable.

As a rule, inflamed areas of skin tend to 'flare-up' from time to time, and then tend to settle down. The severity and duration of 'flare-ups' varies from person to person, and from time to time in the same person.

Currently, there is no single test that says unequivocally "this is atopic eczema" and there is no single symptom or feature that can be used to identify the disease. Each patient may experience a unique combination of symptoms, and the symptoms and severity of the disease may vary over time. The diagnosis of atopic eczema is based on the individual's symptoms. Therefore, it is important to rule out other diseases and conditions which might cause skin irritation. In some cases, the family doctor or pediatrician may refer the patient to a dermatologist or allergist for further evaluation.

Some people with the atopic eczema develop red, scaling skin in affected areas. Others develop thick and leathery skin as a result of constant scratching and rubbing. Still others develop papules, or small raised bumps on their skin. When the papules are scratched, they may open (excoriations) and become crusty and infected. It is interesting to note that these conditions can also be found in people without atopic eczema or with other types of skin disorders.

The skin of a person with atopic eczema loses too much moisture from the epidermal layer. This allows the skin to become very dry, which reduces its protective abilities. In addition, the skin is very susceptible to recurring disorders, such as staphylococcal and streptococcal bacterial skin infections, warts, herpes simplex, and molluscum contagiosum (which is caused by a virus).

Skin Features of Atopic Eczema

• Lichenification: thick, leathery skin resulting from constant scratching and rubbing
• Papules: small raised bumps that may open when scratched, becoming crusty and infected
• Ichthyosis: dry, rectangular scales on the skin
• Keratosis pilaris: small, rough bumps, generally on the face, upper arms, and thighs
• Hyperlinear palms: increased number of skin creases on the palms
• Urticaria: hives (red, raised bumps), often after exposure to an allergen, at the beginning of flares, or after exercise or a hot bath
• Cheilitis: inflammation of the skin on and around the lips
• Atopic pleat (Dennie-Morgan fold): an extra fold of skin that develops under the eye
• Hyperpigmented eyelids: eyelids that have become darker in color from inflammation or hay fever
• Neurodermatitis is a chronic eruption of the skin that results from continuous scratching

In mild cases, a flare up may cause just one or two small, mild patches of inflammation. These often occur behind the knees or in front of elbows or wrists. Flare-ups may occur only occasionally. Characteristics of the mild stages of atopic eczema include:

• Early age of onset
• Dry, rough skin
• High levels of immunoglobulin E (IgE), an antibody, in the blood
• Ichthyosis
• Hyperlinear palms
• Keratosis pilaris
• Hand or foot dermatitis
• Cheilitis
• Nipple eczema
• Susceptibility to skin infection
• Positive allergy skin tests

In severe cases the flare-ups can last several weeks or more, and cover many areas of skin. This can cause great distress. Symptoms of severe atopic eczema include:

• Intense itching
• Rash in locations typical of the disease
• Chronic or repeatedly occurring symptoms
• Personal or family history of atopic disorders (eczema, hay fever, asthma)

Many people with atopic eczema are between these two extremes. Emotional factors and some infections can also influence atopic eczema.

Controlling Atopic Eczema

Exposure to certain substances (such as chlorine, mineral oil, or solvents) or to irritants (such as dust or sand) may also aggravate the condition. Cigarette smoke may irritate the eyelids. Because irritants vary from one person to another, each person has to determine for him or herself what substances or circumstances cause the disease to flare.

Common irritants include:

• Wool or synthetic fibers
• Soaps and detergents
• Some perfumes and cosmetics
• Substances such as chlorine, mineral oil, or solvents
• Dust or sand
• Cigarette smoke

Allergens are substances from foods, plants, or animals that provoke an over reaction of the immune system and cause inflammation (in this case, the skin). Inflammation can occur even when the person is exposed to small amounts of the allergen for a limited time. Some examples of allergens are pollen and dog or cat dander (tiny particles from the animal's skin or hair). When people with atopic eczema come into contact with an irritant or allergen to which they are sensitive, inflammation-producing cells permeate the skin from elsewhere in the body. These cells release chemicals that cause itching and redness. As the person scratches and rubs the skin in response, further damage occurs.

Certain foods act as allergens and may trigger atopic eczema or exacerbate it (cause it to become worse). Food allergens clearly play a role in a number of cases of atopic eczema, primarily in infants and children. An allergic reaction to food can cause skin inflammation (generally hives), gastrointestinal symptoms (vomiting, diarrhea), upper respiratory tract symptoms (congestion, sneezing), and wheezing. The most common allergy-causing (allergenic) foods are eggs, peanuts, milk, fish, soy products, and wheat. Although the data remains inconclusive, some studies suggest that mothers of children with a family history of atopic diseases should avoid eating commonly allergenic foods themselves during late pregnancy and (if breastfeeding) while they are breastfeeding the baby. Although not all researchers agree, most experts think that breastfeeding the infant for at least 4 months may have a protective effect for the child.

If a food allergy is suspected, it may be helpful to keep a careful diary of everything the patient eats, noting any reactions. Identifying the food allergen may be difficult if the patient is also being exposed to other allergens, and may require supervision by an allergist. One helpful way to explore the possibility of a food allergy is to eliminate the suspected food and then, if improvement is noticed, reintroduce it into the diet under carefully controlled conditions. A two-week trial is usually sufficient for each food. If the food being tested causes no symptoms after two weeks, a different food can be tested in like manner afterwards. Likewise, if the elimination of a food does not result in improvement after 2 weeks, other foods may be eliminated in turn.

Some airborne allergens may also play a role in atopic eczema. Common air borne allergens include dust mites, pollens, molds, and pet dander from animal hair or skin. These air borne allergens, particularly the house dust mite, may worsen the symptoms of atopic eczema in some people. Although some researchers think that air borne allergens are an important contributing factor to atopic eczema, others believe that they are insignificant. Scientists also don't understand the way in which air borne allergens affect the skin; whether the air borne allergen affects the person internally after being inhaled, or whether the air borne allergen actually penetrates the patient's skin.

If an air borne allergen is suspected of contributing to a patient's symptoms, it may be beneficial to reduce exposure to the offending agents. For example, encasing mattresses and pillows in special dust-proof covers, frequently washing bedding in hot water, and removing carpeting can limit the presence of the house dust mite. However, there is no way to completely rid the environment of air borne allergens.

In addition to irritants and allergens, other factors, such as emotional issues, temperature, climate, and skin infections can affect atopic eczema. Although the disease itself is not caused by emotional factors or personality, it can be exacerbated by stress, anger, and frustration. Interpersonal problems or major life changes, such as divorce, job changes, or the death of a loved one, can also make the disease worse. Often, emotional stress seems to prompt a flare of the disease.

Bathing without proper moisturizing afterward is another common factor that can trigger a flare of atopic eczema. The low humidity of winter or the dry year-round climate of some geographic areas can intensify the disease, as can overheated indoor areas and long or hot baths and showers. Alternately sweating and chilling can induce an attack in some people. Bacterial infections can also prompt or increase the severity of atopic eczema. If a patient experiences a sudden onset of illness, the doctor may check for a viral infection (such as herpes simplex) or fungal infection (such as ringworm or athlete's foot).

Treatments may include emollients such as jojoba oil to maintain skin hydration and to reduce inflammation. An emollient is an agent that softens and soothes the skin to make it softer. They are usually produced from a combination of water, oil, fat, and wax. Emollients are an essential element in the successful treatment of the dry skin found in eczema, and are safe and effective.

Stress management and relaxation techniques may help decrease the likelihood of flares due to emotional stress. Developing a network of support that includes family, friends, health professionals, and support groups or organizations can be beneficial. Chronic anxiety and depression may be relieved by short-term psychological therapy.

Recognizing the situations when scratching is most likely to occur may also help. For example, many patients find that they scratch more when they are idle. Structured activity that keeps their hands occupied may prevent further damage to the skin. Occupational counseling also may be helpful to identify or change career goals if a job involves contact with irritants or involves frequent hand washing, such as kitchen work or auto mechanics.

Although symptoms of atopic eczema can be very difficult and uncomfortable, the disease can be successfully managed:

• Wearing cotton clothes next to the skin rather than irritating fabrics such as wool.
• Avoiding getting too hot or too cold as extremes of temperature can irritate the skin.
• Rinsing clothes well after washing them with detergent.
• Reducing the number of dust mites in their homes by regularly cleaning and vacuuming with particular attention to bedrooms, mattress, and bedclothes.
• Stay well hydrated with water.
• Applying Eczema-Ltd III patented topical skin conditioner disks to the affected areas.