Eczema

Eczema is a term nearly synonymous with dermatitis, which generally means inflammation of the skin. Eczema is a common condition related to dry skin.  Oil glands in the skin produce a high quality oil which holds the skin cells together.  Because of this oil, the skin is an effective barrier to chemicals, bacteria and ultraviolet light.  If the skin's integrity is compromised, either through inherited conditions, allergies or improper care,  eczema can result.  In common parlance, eczema refers to a skin rash which is recurrent over several months or years, and whose cause is not known.   A more precise term is "nummular" eczema, which refers to round or oval patches of skin rash found on the trunk, arms or legs, which is quite itchy, scaly, reddened and possibly blistered.  

Occasionally small, itchy blisters along the sides of the fingers is seen as a type of eczema.  Eczema can also manifest as scaling or itching of the palms of the hands or soles of the feet.  The palms and soles are difficult areas to clear dermatitis.  One reason for this is that the skin is much thicker in these locations and takes about four times longer to heal.  If treatment is discontinued before complete healing occurs, eczema will return. 

Eyelid eczema is usually a result of direct contact with a chemical through makeup application, or touching the eyelids after the fingers have come in contact with the chemical.  Remember to wash the hands before touching the eyelids and if the eyelid eczema persists, it may be due to nail polish or other nail cosmetics, which will have to be discontinued.

In children, atopic eczema is frequently seen.  This can be accompanied by hay fever or asthma, which have been associated with both hypoglycemia and Vitamin D deficiency.  The condition usually begins in childhood with an itchy rash appearing in the creases of the elbows or behind the knees and on the face, neck and trunk.  Most of the time, allergy to foods such as dairy, eggs, chocolate or nuts plays a significant role.  Recent research also points to deficiency of Vitamin D in the causation of atopic dermatitis.

Another common form of eczema is stasis dermatitis.  Chronic pooling of blood in the legs of patients with varicose veins leads to iron deposits in the skin.  This is an eczema which can appear on one or both legs usually in the shin region and can begin as a small patch of red, itchy skin and enlarge to involve the entire calf area.  Treatment of the underlying varicose veins can improve or eliminate stasis dermatitis.

In all these cases, there is usually a combination of allergic skin reaction with an irritant form of dermatitis superimposed, and this is why the condition is so difficult to resolve.  The allergic component can be either from contact or systemic sources.  The irritant component is usually due to soap or detergent contacting the skin, drying it out further.

Consultation with a board-certified dermatologist will be helpful in educating the patient about how to properly care for the skin, as well as assisting with sorting out the probable causes of the eczema.   Appropriate care depends on the age, occupation, lifestyle, habits and concurrent medical conditions, but a few basic tips can be given here.

Treatment always involves the avoidance of the offending chemicals but first they must be identified.  Treatment also includes gentle treatment of the skin.  It's of the utmost importance to avoid soaps on the skin rash because the skin is injured, and soaps can further damage this skin.  Moisturization and probably a topical anti inflammatory medication will be prescribed to provide relief of itching.  Treatment of superimposed skin infection will also be necessary, if infection is present.   Several visits with the dermatologist may be required to sort out all the variables involved in eczema of long standing.