Eczema
Eczema, or atopic dermatitis, is a common non-contagious, chronic inflammatory skin condition that causes dry and itchy skin that is prone to infections. It is most common in children with a lifetime prevalence of between 15%-25% Trends in eczema prevalence in children and adolescents: A Global Asthma Network Phase I Study – PMC, 60% of all cases of eczema occur within the first year of life. In adults there is a prevalence rate of between 2%-10% Patterns and trends in eczema management in UK primary care (2009-2018): A population-based cohort study – PubMed, with a preponderance towards females, especially into adulthood Global epidemiology of atopic dermatitis: a comprehensive systematic analysis and modelling study – PubMed .
The exact aetiology of eczema is not fully understood but is believed to be linked to both genetic and environmental factors. A family history of eczema, asthma or allergies is commonly found in affected individuals. Several genes associated with eczema have been identified (Filaggrin gene, ceramide synthase gene and the ABCA12 gene, Eczema and ceramides: an update – PubMed) mutations in these genes impede normal skin barrier function.
Environmental factors that can commonly trigger an eczema flare include detergents, soaps, solvents and pet dander. Stress, changes in temperature and humidity can also all contribute to flares in eczema symptoms. Eczema – StatPearls – NCBI Bookshelf. In addition, the immune system is also thought to play a role in the development of eczema due to an overactive response to these environmental triggers resulting in inflammation and skin damage. Association between atopic dermatitis and autoimmune diseases: a population-based case-control study – PubMed
What are the signs and symptoms?
Patients with eczema clinically present with chronic, relapsing and intensely itchy (pruritic) patches of dry, inflamed skin. Key features include erythematous papules (small raised bumps on the skin), vesicles (fluid-filled blisters on the skin), scaling and, in chronic cases, lichenification (thickening of the skin).
Site of involvement varies; in infants it is typically across the cheeks and extensor surfaces of the knees and elbows, and in children/adolescents it commonly affects the flexural surfaces, behind the knees and elbows. Adults is similar to adolescents but commonly affects the hands and eyelids with more chronic and thickened patches. Overview: Eczema – InformedHealth.org – NCBI Bookshelf.
How is it diagnosed?
Eczema is a clinical diagnosis, with the classical chronically relapsing itchy rash with a typical morphology in the aforementioned areas of the body depending on the person’s age. Skin biopsies are rarely needed but may be used to rule out other conditions. Allergy or blood testing may be used if allergic dermatitis is suspected to check for any underlying allergies. Allergic Contact Dermatitis – StatPearls – NCBI Bookshelf.
How is it treated?
Eczema is a chronic condition, and treatment is around management rather than cure. The main management and treatment protocols include hydration and topical anti-inflammatory medications in acute flare-ups.
- The priority is focusing on a daily skin moisturising regimen with a fragrance-free ointment with limited preservatives [The role of emollients in atopic dermatitis in children] – PubMed. Patients will be instructed to avoid any environmental allergens, such as harsh soaps. detergents and fragrances.
- Skin flare-ups can be treated with a short course of topical anti-inflammatory medications such as topical steroids, which are highly effective but not intended for long-term use. Topical Corticosteroids – StatPearls – NCBI Bookshelf.
- Sedating antihistamines may be prescribed to manage itching symptoms at night and to help with sleep. These include chlorpheniramine and hydroxyzine. However, their efficacy remains in question. Antihistamines and mast cell stabilisers – Systematic review of treatments for atopic eczema – NCBI Bookshelf and they have no direct effect on the underlying disease process.
For severe cases, phototherapy and systemic medications may be considered. Phototherapy involves the therapeutic use of non-ionising radiation, particularly within the ultraviolet spectrum, to reduce skin inflammation and alleviate symptoms. A Comprehensive Review of Phototherapy in Atopic Dermatitis: Mechanisms, Modalities, and Clinical Efficacy – PMC. In appropriate patients, Dupilumab is the primary, highly effective biologic treatment for severe cases of eczema that have not responded to other initial management options. Systemic treatments for eczema: a network meta-analysis – PubMed. This is a targeted biological therapy that target two specific key signalling proteins (interleukin-4 (IL-4) and interleukin-13 (IL-13)), which are overactive in eczema. Dupilumab – StatPearls – NCBI Bookshelf.
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