Eczema is an inflammatory skin disease that affected the upper layers of the skin. eczema is considered a form of neurodermatitis, a skin disorder almost exactly the same as allergic eczema but occurring usually at a later age. The main types of eczema are contact dermatitis, atopic dermatitis, nummular dermatitis, dyshidrotic dermatitis, infected and allergic eczema. The main causes of eczema are genetic causes and family illnesses, inadequate diet and unhealthy lifestyle habits, allergic reactions, and drug intake. Blood tests and biopsies are used to determine the agent and possible causes of eczema (Papadopoulos and Walker 32).
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The main population affected by these diseases are infants. In the majority of cases, eczema is identified at an early age. “The National Institutes of Health estimates that 15 million people in the United States have some form of eczema. About 10 percent to 20 percent of all infants have eczema; however, in nearly half of these children, the disease will improve greatly by the time they are between five and 15 years of age. Others will have some form of the disease throughout their lives” (Eczema 2008).
The main signs and symptoms are eczema patches on the skin of the face; crossed eyes; blonde hair; poor differentiation of motor movement (spillover and overflow movements); allergic post-nasal drip; abnormal neurologic reflexes. In allergic eczema, allergy itself is primarily causative; in neurodermatitis, a “nervous” scratching is supposedly causative yet there remains a definite relationship with allergy. These two disorders represent well the relationship of allergy in general to brain injury.
Allergic and Irritant Contact Dermatitis is marked by nonallergic and secondary to an irritating substance or physical agent. Allergic contact dermatitis is secondary to acquired hypersensitivity to a specific allergen (Papadopoulos and Walker 43). Exfoliative dermatitis or erythroderma is a generalized, severe dermatitis, most often the result of eczema, psoriasis, a drug reaction, or an undetected malignancy. Erythroderma occurs quickly and has a thick, scaly appearance. The exfoliation process creates cutaneous heat loss, which may lead to rigors. In addition, examine the patient for lymphadenopathy. Shedding of hair and nails is seen in extreme cases.
Another common type of eczema is eczematous dermatitis. This is a superficial inflammation of the skin secondary to allergen exposure, agent exposure, or a genetic predisposition. The patient presents with pruritus, edema, and erythema. If vesiculation, oozing, or crusting is present, the process has been longstanding. Atopic dermatitis is thought to have a genetic component as an important factor. Many patients also have family members with asthma, hay fever, or atopic dermatitis. Contributing factors include stressful events; extremes in temperature or humidity; and allergies to cosmetics, rubber, and Rhus plant (e.g., poison ivy, oak).
Age is not a diagnosing factor; however, in older adults, it may be more severe and generalized than in younger patients (Burke and Walsh, 1997). It presents with extreme itching, lichenification, and eczematous changes. The neck, wrists, postauricular area, and popliteal and antecubital areas are often involved. Patch testing is sometimes done to identify the precipitating irritant. A variant, termed nummular dermatitis or discoid eczema, presents as itchy, scaly, coin-shaped lesions, usually on the posterior trunk, buttocks, and limbs. The lesions may become purulent after oozing and crusting.
The precipitating cause is unknown. Contact Dermatitis. Contact dermatitis can be a challenging diagnosis to make. The area may be chronically irritated (dishpan hands) and appear vesiculated or pustular. In the elderly, a common diagnosis is dermatitis of unknown origin. Complaints of pruritus, excoriation and dry, scaling skin are common. The location of the affected area may lead to the responsible irritant. It is caused by an irritant that penetrates and disrupts the stratum corneum, causing an inflammatory reaction within the underlying epidermis. Common irritants include acids, detergents, and solvents.
Lichen simplex chronicus or neurodermatitis is a possible diagnosis. This is a localized pruritic area characterized by extreme itching. The area appears well-circumscribed or lichenified, with scaling and papulation. It is common in the elderly, especially women. The usual sites include the occipital area, wrists, thighs, and lower limbs. Improvement is seen when itching ceases (Papadopoulos and Walker 82).
Management is multifaceted. Elimination of all irritants is vital. If the lesion is wet, dry it. If dry, hydrate it, and if it is inflamed, apply corticosteroid cream. Drying can be accomplished with Burow’s solution compresses. For chronic cases, patients must avoid drying detergents, frequent showers, and irritants. Use of topical steroids of moderate to strong potency may control symptoms.
Use of an Unna’s boot, especially on affected limbs, helps break the itch-scratch cycle. Stasis dermatitis is inflammation secondary to venous hypertension, usually in the lower limbs. Edema, venous stasis skin changes, and dilation of superficial venules around the ankles are seen. It is affected by edema, contact dermatitis secondary to medicated preparations such as neomycin, and scratching. The etiology is unknown.
Management that includes controlling the edema with elastic stockings, elevation, and hydrocortisone 1% may alleviate some symptoms (Papadopoulos and Walker 920. The treatment depends on the severity of the disease. Hospital admittance is necessary for severe cases because of the extensive heat, fluid, and protein loss. Topical use of an emollient cream is recommended. Prednisone (40 to 60 mg a day) is used when it is first diagnosed and then gradually tapered.
Eczema. Eczema Net. (2007). Web.
Papadopoulos, L., Walker, C.W. Understanding Skin Problems: Acne, Eczema, Psoriasis, and Related Conditions. Wiley; 1 edition, 2005.