Eczemais a skin condition consisting of inflamed skin. It is sometimes referred to as dermatitis and most commonly occurs among infants and young adults, although it affects all people of all ages.
The beginning of eczema symptoms can cause a redden rash and sometimes have blisters that will weep fluid. During this stage and later stages, the skin will always be itchy, with the skin having an appearance of a brown color and scales. In almost every case, eczema itches. Eczema can be widespread or limited to a few areas. Atopic eczema, also called atopic dermatitis, is the most common form of eczema. Eczema runs its course through three distinct phases: acute, sub-acute, and chronic.
The usual symptoms associated with the acute stage of eczema include inflammation, pain, heat, tenderness, swelling, and possible itching. The affected areas are characterized by extreme redness and drainage at the lesion site. In acute eczema you would experience vesicles, blisters, and intense redness of the skin. The skin surface will sting, burn, or may itch intensely. The common examples for this stage of eczema would include acute nummular eczema, acute contact eczema, pompholyx eczema, and stasis eczema. Treatment in the acute stages of eczema include antibiotics to reduce inflammation and treat any infection that may be present, antihistamines to suppress the immune system, cold wet compresses, and possibly a short-term course of steroids.
The sub-acute phase of eczema includes symptoms associated with skin redness, inflammation and crusting; however, there is no extreme swelling. You may observe redness, scaling of the skin, fissures, and a parched or scalded appearance to the skin. In the sub-acute phase, itching is more of concern than pain. One may experience some blistering or oozing of the skin. The itching in the sub-acute phase is generally slight to moderate with possible stinging and burning. A skin biopsy would display evidence of inflammation of the cell structure and swelling. The common examples of the sub-acute phase include atopic eczema, contact allergy, stasis eczema, asteatotic eczema and nummular eczema. The basic course of treatment at this time would include emollients to ease dryness, a topical steroid, antibiotics and antihistamines.
Chronic eczema refers to eczema flares lasting three months or more. The cycle of intense itching and subsequent urge to scratch tend to worsen and prolong the condition. In the chronic stages of eczema the skin would show a thickened, leathery and /or fissuring appearance. The skin may appear to be darker and rather dull in appearance. At this time you would experience a moderate to intense itch. When viewed under a microscope, the epidermal or upper most layer of the skin appears elongated and is seen to proliferate. Chronic eczema is more commonly seen with atopic eczema, fingertip eczema, hyperkeratosis eczema, and lichen simplex eczema.
Types of Eczema
Eczema is a constellation of symptoms concerning any cause or effect that generates an inflammation of the skin resulting in itching and redness of the skin. In some instances the skin may ooze, blister of peel. When one hears the term eczema, the most common form atopic eczema, is what often comes to mind, although there are several other varieties of eczema including:
- Atopic Eczema is a topical skin reaction resulting from exposure to an allergen. It may also result from fear, stress or anxiety.
- Contact Eczema is a topical skin reaction resulting from physical contact with an allergen causing or irritating substance.
- Discoid Eczema is a topical skin reaction that appears as a red or pinkish round coin-shaped spot on the skin.
- Dyshidrotic Eczema results in itchy blisters on the hands or fingers and on the feet.
- Eczema Herpeticum is a very rare contagious eczema infection caused by herpes simplex virus. Please see your infectious disease doctor.
- Eczema Craquele has symptoms of a dry, parched skin surface with fine cracks or a ‘cracked paving’ appearance while being scaly and itchy.
- Infantile Eczema or cradle cap is an itchy, scaly patch of skin on the top of babies’ heads.
- Juvenile Plantar Eczema is more common in children but may occur in adults. This eczema of the feet results from an allergic reaction to man-made materials in shoes and socks.
- Light Sensitive Eczema results from over exposure to sunlight or sensitivity to sunlight caused by a reaction to medication.
- Seborrheic Eczema results from an accumulation oily yellow scales appearing on the face, scalp, ears or folds in the skin. Dandruff is a mild form of this condition.
- Varicose or Stasis or Venous Eczema are all names given to eczema resulting from poor circulation in the legs and ankles.
Itching commonly occurs with occurs with most types of eczema. Itching can vary from a mild nuisance to an extreme distraction.
Skin redness may fluctuate from barely noticeable to a bright red. Skin redness is more prominent during times of strenuous exercise or exertion, stress or when the body is hot.
Eczema affected skin will experience dryness; the skin may become thickened, rough and develop scaly patches. When the skin becomes dry, it loses moisture causing small fissures to develop on the skin’s surface causing the skin to be susceptible to fluid loss, bacterial infections, and affects the skin’s ability to regulate body temperature.
In more advanced episodes of eczema, prolonged and repetitive scratching can damage the skin’s protective uppermost surface. Once the protective barrier is breached, the skin may ooze clear liquid tissue matter; this may be mixed with small amounts of blood from leaking blood vessels. It is at this stage that eczema affected skin is most susceptible to infection.
On the hands and feet small fluid filled blisters may rupture when scratched and ooze this same clear fluid.
Understanding Eczema Skin
To understand eczema, we must begin with an understanding of the composition of the skin itself. The skin’s composition is made of three distinct layers: fat, dermis and epidermis.
The top or outmost layer of skin is the epidermis. This top layer of visible skin is comprised of keratinocytes or layers of epithelial cells. The epithelial cells are produced is the lowest level of the epidermis where the epidermis meets the dermis layer of skin. As the skin sheds, the layers gradually move up toward the surface in a constant state of renewal and regeneration.
The cell layers of the epidermis are very tightly packed in layers. The cellular layers closest to the surface are very flat and contain keratin for added strength. The blood vessels are found in the deeper layer of the dermis. The epidermis on the hands and feet are by comparison quite thick – up to a millimeter in depth, the thinnest areas of the epidermis, around the eyelids is 0.1 millimeter in depth.
Through the process of regeneration, the uppermost layer of the epidermis contains the oldest cells which die and are shed from the skin. This cell layer may appear to have very fine scales or flakes. The regeneration process from the dermis conjunction or basal layer to the surface of the skin takes about four weeks. The dead cells located on the surface of the skin form a flat, overlapping barrier called the corneum. This barrier layer is very pliable and flexible and produces a moisture shield to hold moisture in the skin with a dry surface to shield the body from bacteria and microorganisms.
The middle layer of the skin is the dermis. This layer is comprised of connective tissue made up of hair follicles and roots, blood vessels, sweat glands and lymph vessels, and nerve endings. All these combine to give the skin its elasticity and strength. The purpose of the dermis is to support and feed the epidermis to keep it viable in protecting the body from germs and bacteria.
The lowest layer of the skin is the fat layer. The fat acts as a source of nutrition producing the water, energy and food source for the dermis. It also provides the body with a cushion against cold temperatures and blows from physical injury.
In an occurrence of eczema, the flat, tight protective layers of keratinocytes that form the protective bonding layers on the surface of the skin become very dry and less flexible. They lose their bonding integrity, and begin to separate. This makes the skin more vulnerable to allergens, chemicals, bacteria and germs. If you look closely you will observe small cracks or fissures in the skin. The redness you observe is the immune system rushing blood and fluid to the area in an attempt to protect the barriers of the skin. This rush of fluid can cause itching and irritation. As you rub or scratch the area, the eczema cycle of reaction and action begins – irritation of the skin, inflammation from the immune system response and deterioration from scratching the skin.
This cycle of action and reaction inhibits the skin in its primary function to act as a barrier protecting the body from outside bacteria, chemicals, pollutants and moisture loss. The larger the affected area, the more risk to the body. In rare cases the affected area may so large that the body losses too much fluid causing severe dehydration and limiting the body’s ability to regulate temperature. In these rare, sever instances, hospitalization may be required.
The epidermis is where the environment collides with the body’s immune system. Usually the immune system reacts only to parts of the outside world that present a danger, such as insect bites. In many people with eczema, however, the immune system reacts more vigorously than usual to a wider range of normally harmless influences such as animal dander (small particles of hair or feathers), pollen and house-dust mite. As these trigger allergic reactions, these substances are known as allergens. The immune system tries to destroy allergens by releasing a mixture of its own irritant substances, such as histamine, into the skin. The result is that the allergen may be altered or removed, but at the expense of causing soreness and making the skin fragile so other problems can develop, such as bacterial infection or damage from scratching.
The epidermis is where the environment collides with the body’s immune system. Usually the immune system reacts only to parts of the outside world that present a danger, such as insect bites. In many people with eczema, however, the immune system reacts more vigorously than usual to a wider range of normally harmless influences such as animal dander (small particles of hair or feathers), pollen and house-dust mite. As these trigger allergic reactions, these substances are known as allergens. The immune system tries to destroy allergens by releasing a mixture of its own irritant substances, such as histamine, into the skin. The result is that the allergen may be altered or removed, but at the expense of causing soreness and making the skin fragile so other problems can develop, such as bacterial infection or damage from scratching.
