Eczema

Eczema: Introduction

Eczema is a generalized term that encompasses various inflammatory skin conditions. It is used synonymously with the term “Dermatitis” which means superficial inflammation of the skin (epidermis) that can be acute, chronic and recurring; can have a number of causes. Atopic dermatitis is another term used to define eczema.
Eczema is characterized by very distinctive reactive patterns of the skin, as discussed below.
Eczema is an inflammation of the skin which is characterized by dryness, flakiness, heat and, probably most importantly, itching. Eczema can occur on just about any part of the body; however, in infants, eczema typically occurs on the forehead, cheeks, forearms, legs, scalp, and neck. Affected areas usually appear very dry, thickened, or scaly. There may be some amount of hyperpigmentation of the affected parts. In children and adults, eczema typically occurs on the face, neck, and the insides of the elbows, knees, and ankles. In some people, the itchy rash can produce an oozing and crusting. In others, the condition may appear more scaly, dry, and red. Chronic scratching causes the skin to take on a leathery texture because the skin has thickened (lichenification).

There are two groups of eczemas called exogenous and endogenous. Exogenous eczema is mostly caused by contact with external factors such as irritant substances, certain allergens and due to photosensitivity.

Endogenous eczema is due to internal factors such as a generalized and prolonged hypersensitivity (atopy) to certain environmental factors. These factors could be chemicals, drugs, pollen, dust-mites, etc. These individuals also frequently exhibit one or more of other disorders such as asthma, hay fever, urticaria, food allergies, etc.

Eczema is a chronic skin disease reflected due to immunological changes within the body. Eczema is curable only if the immunological disturbance is corrected by internal medicines such as in homeopathy. Homeopathy offers effective and safe treatm

Causes of Eczema

It is difficult to determine the exact cause of eczema as there are many different types of eczema and each has its own causes. Largely, the cause of atopic (endogenous) eczema is genetic (inherited). Atopy usually runs in the family and there is a family history of one or more disorders like asthma, hay fever, urticaria, food allergies, etc. A person who has atopic eczema is more likely to develop allergic reactions to many other things as well.. The causes of certain types of eczema remain to be explained, though links with environmental factors and stress are being explored.
Fundamentally, the caused of Eczema could be understood as:
1. Genetic components (Makes proneness to eczema)
2. Environmental factors (Triggers and maintains eczema)
There are many causes for exogenous eczema and following are the few common ones:

  • Contact with irritants such as detergents, soaps, certain clothing or shoes, metal compounds (nickel, mercury, etc), dyes, cosmetic preparations (deodorants, nail paints, etc), topical creams, rubber, leather, resins, etc.
  • Exposure to sunlight.
  • Napkin rash in infants.

Eczema Symptoms in Kids & Adults

Atopic dermatitis presents with inflamed skin. The typical rash or eruptions are dry, scaly, red and with itching. The skin eruptions could affect any part of the body, however, it is more common on face, folds of hands and feet. The predominant symptom of Atopic dermatitis is intense itching. Thin watery discharge may ooze after itching. There may also be minor bleeding on scratching. Some of the lesions might get infected by contamination with bacteria, leading to pus formation.

Most of the patients which are treated conventionally with the use of cortisone in the form of topical cream or oral tablets; have a tendency to
get suppressed. The patient and parents might get a sign of relief, least realizing that the effect of cortisone is only superficially and the disease will come back with vengeance.

It is a common phenomenon that patients tend to keep on using cortisone, masking the disease, and the disease goes deeper and deeper.

Dermatological distribution of the skin lesions as per age

Symptoms in in Infants:

In infants symmetric lesions are found over face (cheeks, forehead, scalp, and trunk), on the outer surface (extensor) of the extremities, scalp (sometimes causing alopecia). In extensive cases rash can be found even on the flexor surfaces of the extremities.

Symptoms in Children:

There is presence of symmetric lesions on the wrist, ankles and the flexor areas of the limbs. Generalized lesions spread all over the body can also be found in this age group.

Eczema Symptoms in Adults:

Predominantly affects the flexor areas of the arms, legs and neck. Other areas which can be affected are groin, axillary, etc.

Stages of Atopic dermatitis:

The skin lesions of Atopic dermatitis vary according to the stage of disease.

Acute stage:

On examination the lesions appear wet due to serous (thin) exudates from the erosion. Papules (flat bumps) and vesicles (fluid-filled eruptions) are present on reddish skin.

Sub-acute:

The characteristic features of the skin at this stage of disease are – scaling of skin, excoriated and fused papules over erythematous (red) skin.

Chronic Stage:

In chronic cases the skin is typically thickened and has pigmentary changes (hyperpigmentation or hypopigmentation). The papules are excoriated and there is presence of nodules on the skin. Intense itching is present in all stages of the disease hence the person tends to scratch all the time, this often leads to secondary infection of the lesion. As a result the lesion develops yellow crust over-laying pus and is surrounded by erythema.

Related manifestations are:

1. Keratosis pilaris: Small and pointed asymptomatic rough bumps on the extensor surfaces of upper arms, buttocks and anterior of thighs.
2. Ichthyosis vulgaris: Presence of polygonal fish-like scales especially on the legs. Hyperlinear (thickened skin with increased visible lines) palms and soles.
3. Keratoconus: A cone shaped cornea develops in severe cases, mostly in the second or third decade of life.
4. Dennie-Morgan line: Prominent skin folds below the eyes
5. Fissuring of skin of palms, soles and fingers often occurs.
6. Redness of the face
7. Perioral (around the mouth) pallor
8. Dryness of skin
9. Asymptomatic hypopigmented areas on face and shoulders

Eczema Diagnosis

The diagnosis of Atopic dermatitis is largely done on the basis of history and physical examination. For identifying a skin lesion as Atopic dermatitis at least 3 major features and 3 minor features should be present.

Major features:

  • Itching (that is severe at times)
  • Chronic and recurring (repeatedly occurring symptoms)

Typical distribution of the Atopic dermatitis rash:

  • Infants and young children – Scalp, face (chin and cheeks) and extensor surfaces of extremities.
  • Older children and adults – Flexor surface of elbow and knee, neck, wrist and ankles.
  • Past/Family history of Atopic diseases like asthma, rhinitis, etc

Minor features

  • Dryness of Skin
  • Thickening of palm skin with increase in lines
  • Dry, thick and scaly skin
  • Small and pointed rough bump
  • Elevated serum IgE (Immunoglobulin E) level
  • Facial pallor (around the mouth)
  • Food intolerance
  • Impaired immunity
  • Eyes

1. Cataract
2. Cone shaped cornea (Keratoconus)
3. Prominent skin folds below the eyes

Skin Care Tips for Eczema Patients

As the ailment is chronic and of relapsing nature, persistence with proper skin care is a must. The patient and his care-takers should be educated about the disease triggers and measures to avoid them.
1. Bathe less frequently: Patient should opt to bathe just two or three times a week with lukewarm water (avoid hot water) maximum for 5-10 minutes.
2. Gently pat skin dry with a towel after bathing. Apply moisturizer immediately after bathing or swimming while the skin is still damp so as to seal in the moisture especially during winter.
3. Avoid using soap. Restrict use of soap to genitals, axillae, hands and feet.
4. Use of mild cleanser or moisturizing soap is recommended. Mild soaps clean without excessively removing natural oils.
5. To retain the moisture after application of moisturizer patient could cover the area with a wrap or if hands are involved he can use gloves. This is not advised when steroidal applications are used as it increases the potential for developing their side-effects.
6. Soaking the lesion in sodium bicarbonate or colloidal oatmeal to bath helps in reduce itching.
7. By wearing gloves in the winter patient can prevent skin from being exposed to cold air with little humidity which can dry the skin.
8. Regularly clip nails to prevent abrasion of skin while scratching. This reduces the chances of developing secondary infection.
9. Avoid contact with allergens or irritants to the skin e.g. wool, perfumes, detergents, etc.
10. Children should be encouraged to drink plenty of water.
11. Fluids help add moisture to the skin.Food substances that provoke allergies (allergens) should be avoided, e.g.: Tomatoes which can be acidic.
12. Tight-fitting, rough or scratchy clothing can irritate the skin. Wool and some synthetics are especially likely to irritate the skin. Wearing cotton and cotton blends are better choices.
13. Scratching the skin rash: Patients often find it difficult to control this urge hence they should cover the affected area with a dressing or wear gloves at night to reduce damage to the skin caused by scratching accidentally during sleep.
14. Avoid strenuous exercise during a flare-up as sweating can irritate the rash.
15. Try and reduce mental and physical stress. Stress can trigger flare-ups. Older children and adults can learn breathing techniques and meditation to reduce stress.

Eczema: About limitations of Cortisone (steroids) in the treatment of Eczema

Cortisone (Steroid) is no more effective as long-term treatment for Eczema:

  • Steroids may help initially for a short time
  • Steroid lead to relapse of eczema
  • Steroids treated relapse is more severe, more complex
  • Steroids treated eczema is more difficult to treat
  • It is wise to avoid steroid during any stage of eczema
  • Steroid puts you to the vicious cycle of dependency
  • Steroid dependents have to come out of the vicious cycle

In our experience and as per the medical philosophy of homeopathy, cortisone in any form (oral, systemic or local) is not a wise option for treating eczema. As per the homeopathic approach and the philosophy, cortisone is a suppressing measure and there are all chances of relapse after stopping the use of cortisone

It has been observed in daily practice, that, use of cortisone produces dramatic result initially. However, its influence is quite superficial, as the eruptions not only relapse after stopping the steroids, but they relapse more aggressively. The use of steroids is not recommended due to the following observations:
1. It helps only superficially and temporarily
2. Stopping of the steroids eventually leads to the reappearance of eruptions
3. The eruptions, which relapse after the use of steroids, are more resistant than before
4. The extent of eruptions increases after stopping the steroids in most cases
5. Steroids produce side effects by hampering the immunity, lowering
resistance, disturbing hormonal cycle, etc.

Let us talk a bit more about suppression with cortisone. As we understand, eczema is just an expression of some inner disharmony. Cortisone simply masks the eruption without treating the inner cause. Such a measure is understood to be suppressive. Homeopathy is against any use of local cream for treating any skin disease in general and eczema in particular. Non-suppressive treatment is considered superior for any medical disorder.

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