Eczema: Symptoms, Causes, Treatment, and Prevention

The skin is the second largest organ in the body and serves various purposes, besides acting as a protective covering for tissues and bones. Among its myriad functions are temperature regulation and the production of vitamin D. The skin is a highly sensitive organ and reacts to harmful stimuli by causing itching, rashes, and changes in color and texture. One condition characterized by all of these symptoms is eczema. 

Eczema, also known as atopic dermatitis, persists for months or years despite treatment and might have significant psychological effects on a patient.

What are the symptoms of eczema? 

Eczema typically comes as the itch that rashes. This means the itching comes first, followed by the rash. Over a period, the skin becomes dry and scaly leading to more itching and rashes. The symptoms of eczema vary among people. These include: 

1. Dry skin
2. Itching, which may worsen at night
3. Red to brownish-gray patches on the skin, particularly of the hands, wrists, feet, ankles, neck, upper chest, eyelids, inside the elbows and knee bends in case of adults, and in infants, the face and scalp may be affected
4. Small bumps may arise, which may leak fluid, and when scratched, they may crust over
5. Thick, cracked, and scaly skin
6. Skin may become swollen and sensitive due to scratching

The signs of eczema usually start from infancy. Over the years, they tend to flare up on and off, and persist for weeks to months. Most people outgrow the symptoms in adulthood. However, many continue to have the symptoms of eczema throughout their life.

What are the causes of eczema?

The real reason for eczema is not known. However, few probable causes are:

1. Genetics 

Eczema may run in families and is seen commonly in children aged below five. 

2. Food allergies 

A few people with eczema have a condition called histamine intolerance, which makes their skin react to a chemical called histamine. This chemical is found in foods like tomatoes, spinach, and eggplants (brinjal).

3. Immune reaction 

Many people with asthma and hay fever also have eczema, making an imbalanced immune system a possible cause for this skin condition.

4. External stimuli and chemicals

These may lead to the flare-up of an existing eczema, which was otherwise lying dormant for months. A few examples of external stimuli and chemicals include perfumes, dyes, skin lotions, cold and dry air, common cold, emotional stress, and allergies to dust and pollen.

How is eczema diagnosed?

Your physician may be able to diagnose eczema based on the history of your illness and a clinical examination. In most instances, you need not undergo any special tests. However, in case of confusion with other skin conditions like psoriasis, the doctor may order a few specific tests.

Complications of eczema

Persistent itching may cause ulceration of the skin and subsequent infections. Since the itching occurs mostly at night, it may interfere with sleep and cause daytime lethargy. The skin’s affected area may become hard, leathery, and discolored due to chronic itching and scratching. This may result in disfigurement and psychosocial effects. 

How is eczema treated? 

There is no definitive cure for this condition. The treatment is based on the management of symptoms during flare-ups. These include:

1. Applying moisturizer to keep the skin hydrated, and local creams containing steroids and medicines to control the immune reaction that causes the symptoms. Antibiotic ointments may be needed in case the skin has developed an infection due to ulceration.

2. Consuming oral drugs like antihistamines in severe cases. Oral steroids are also prescribed in some flare-ups, but their use is restricted to short-term treatment because of potentially serious side-effects.

3. Considering newer therapies with injectable antibodies that the Food and Drug Administration has approved. However, these methods are costly and reserved only for extreme cases where the patient does not respond to any other treatment.

4. Undergoing psychological counseling in case of mental distress due to the chronic and cosmetic nature of the disease. Therapy and meditation help in relieving stress and anxiety leading to a better quality of life. So, these measures should be encouraged as a part of the treatment procedure.

Preventing eczema

Complete prevention of eczema may not be possible due to multiple factors implicated in its occurrence. However, you may take a few steps to reduce flare-ups and prevent worsening of symptoms. These include:

1. Moisturizing the skin regularly, ideally while it is still damp after a bath 
2. Avoiding the use of strong soaps, lotions, deodorants, and cosmetics
3. Identifying and avoiding food that may cause flare-ups
4. Exposing the skin to ultraviolet rays present in natural sunlight can reduce symptoms during flare-ups. It also helps in the production of vitamin D in the body, which has an important role in regulating immune reactions. However, safe sun exposure is important. It is recommended to get morning sun exposure, preferably before 11 am. 
5. Meditating and maintaining healthy social interactions to help reduce stress and intense emotions, which are triggers for eczema 
6. Consuming probiotics found in curd, yogurt, and many other fermented foods to improve the function of the immune system 
7. Seeking medical and psychological help whenever required

Eczema is a chronic condition, which causes significant physical and mental discomfort. It has no cure. However, you can manage the symptoms and prevent flare-ups with appropriate therapy and by observing certain precautions, which can go a long way in improving your quality of life.

References
1. Eczema |National Health Portal Of India. nhp.gov.in (accessed Mar 2, 2021).
2. Atopic dermatitis (Eczema). MayoClinic. 2021; published online Jun 12. www.mayoclinic.org/diseases-conditions/atopic-dermatitis-eczema/diagnosis-treatment (accessed Mar 2, 2021).
3. Tintle S, Shemer A, Suárez-Fariñas M, et al. Reversal of atopic dermatitis with narrow-band UVB phototherapy and biomarkers for therapeutic response. J Allergy Clin Immunol 2011; 128: 583–93.e1–4. 
4. Williams HC. The epidemiology of atopic dermatitis.Clin Exp Dermatol. 2000; 25: 522–9.
5. Thomsen SF. Atopic dermatitis: natural history, diagnosis, and treatment. ISRN Allergy 2014; 2014: 354250.