Eczema is a group of skin conditions where patches of your skin become inflamed and itchy. It is common in children; however, adults may develop it too.
Atopic dermatitis is the commonest variant of eczema. It is found to be more prevalent in children. It is usually hereditary and may be associated with hay fever and asthma. Atopic dermatitis is caused by the combination of specific genes, environmental triggers, and an over-reactive immune system.
Other Eczema variants:
- Contact dermatitis: It is a type of eczema which occurs when the body comes in contact with a certain substance.
- Dyshidrotic eczema: In this type of eczema, blisters are formed on your hand and feet.
- Hand eczema: This variant of eczema only affects the hand is observed commonly in people of certain professions who regularly require using chemicals.
- Stasis dermatitis: It is a type of eczema occurring commonly in the lower extremities due to a problem in blood flow of the legs which leads to fluid leakage into the skin. This leaked fluid results in pain, itching, and swelling of the legs
- Seborrheic dermatitis: It is an eczema variant that is usually manifested as red scaly patches on the scalp, the sides of your nose, and eyebrows.
Risk factors and CauseAtopic dermatitis commonly occurs when the natural barrier of your skin is impaired against irritants and allergens. This makes you more prone to eczema. It most commonly occurs in kids who have had asthma or hay fever, or adults, under the age of 30 who develop either of the two. Your genes or any complication in your immune system can act as a trigger for developing atopic eczema. Not only this but various triggers in the environment can be a contributor. A common environmental trigger can be due to drastically changing weather conditions like extremely hot and very cold weather and humidity level.
Clinical Features of Eczema
- Dry itchy skin. The itching is more severe at the night
- Red to grayish-brown patches develops mostly in your elbow or knee creases. Patches may be present in hands, feet, ankles, wrists, or neck too. In infants, the patches may involve the face and scalp region as well.
- In areas where the rash appears, the skin may turn lighter or darker or may get thicker
- Small bumps may be raised which ooze fluid and crust when they are scratched.
- Scratching the skin may lead to infection and swelling
Diagnosing EczemaAs for diagnosis, there’s no particular test to identify eczema. Usually, the doctors may ask some questions regarding the signs, and based upon their experiences they will be able to distinguish it based on the appearance of the rashes. However, a patch test for allergens can be performed to determine the triggers for atopic dermatitis.
During this patch test, an allergen is administered to a patch that’s set on the skin. Your skin will become inflamed and irritated if you're allergic to that allergen.
Management of EczemaTherapy for atopic eczema can alleviate the symptoms and improvements can be seen. However, as with diagnosis, currently, no medicines have been identified to completely heal atopic eczema leading to physical and mental difficulties in the affected patients.
- Moisturizing your skin twice daily. As moisture can be sealed through ointments, lotions, and cream. Choosing a product that works best for you is essential. Moisturizers help treat dry skin associated with eczema.
- Recognizing and bypassing triggers that aggravate the condition. Knowing the factor that encourages the development of atopic dermatitis is the initial step which followed by reduced exposure to the factors that can help in preventing any further emergence of the disease. You should also avoid scratching the affected areas.
- Topical corticosteroids: Corticosteroid gels and creams help reduce swelling, itching, and redness associated with the condition. Oral corticosteroids such as prednisolone may be prescribed in severe cases. Oral steroids though effective in controlling symptoms cannot be used long term due to their potential side-effects.
- Dupilumab: It is a monoclonal antibody drug that has been FDA approved for treating atopic dermatitis. It is used in cases of eczema not responding to other medications.
- Wet dressings: Wet dressing is generally reserved for severe cases of widespread atopic dermatitis. It involves covering the affected skin with topical steroids and a wet bandage.
- Light therapy: In patients who do not respond with topical therapy or have repeated episodes of flare-up light therapy can be used. In this technique, the affected skin is exposed to a controlled amount of natural light. However, it is not commonly used in children because of its side effects on long term use.
- Behavior modification therapy: These therapies have shown to be effective in people who habitually scratch their skin
Recent Advances and Treatment Modalities Currently Undergoing Clinical TrialsBathing additives: A clinical trial to assess the change in skin barrier function and its microbial content in patients with Atopic dermatitis after a bath or soaks with dilute bleach or dilute vinegar. Dilute vinegar and dilute bleach baths have shown to modulate the skin microbiota and reduce skin inflammation in atopic dermatitis.
Dupilumab: Dupilumab is an FDA approved medication used in allergic conditions such as asthma and eczema. A clinical trial is currently undergoing which aims at assessing its effects in improving quality of life in patients with atopic dermatitis. It is currently in phase 4 of its clinical trial.
Pimecrolimus: Pimecrolimus is an immune-modulating drug that is effective in treating cases of atopic dermatitis not responding to other common medications. An observational study is currently undergoing which aims to assess the risk of systemic malignancy (tumors) in the pediatric population who have been exposed to topical Pimecrolimus in the treatment of atopic dermatitis.
Crisaborole Ointment: Crisaborole ointment has shown to be useful in treating mild to moderate cases of eczema. A clinical trial is currently underway which aims at documenting the timing of improvement in the symptoms and severity of atopic dermatitis following the application of 2% Crisaborole ointment in patients with mild to moderate atopic dermatitis. It is currently in phase 4 of its clinical trial.
Apremilast: Apremilast is a drug useful in the treatment of psoriasis and immune-related diseases of the skin. A clinical trial is currently underway assessing the benefits of adding Apremilast to Dupilumab in patients with atopic dermatitis, in whom Dupilumab alone is not producing the desired clinical results. It is currently in Phase-2 of its clinical trial.