Eczema: Causes, Symptoms and How To Treat it

What is Eczema?

Eczema is a term for a group of conditions that cause the skin to become inflamed or irritated. The most common type is atopic dermatitis, which often appears in childhood but can occur at any age. It tends to flare periodically and can be common in people who also suffer from asthma and/or hay fever.

Types of Eczema

• Atopic Eczema (Atopic Dermatitis): This is the most common form, often linked to a genetic predisposition and associated with other atopic conditions like asthma and hay fever. It typically appears in early childhood and can persist into adulthood.

• Contact Dermatitis: This occurs when the skin reacts to a specific substance, causing localized irritation. It can be further divided into allergic contact dermatitis and irritant contact dermatitis.

• Seborrheic Dermatitis: This affects areas rich in sebaceous glands (glands that produce sebum which is an oily substance secreted by the skin which acts as a barrier) like the scalp, face, and upper chest. It's associated with an overgrowth of yeast and often presents as dandruff.

• Dyshidrotic Eczema: This type causes small, itchy blisters on the edges of the fingers, toes, palms, and soles of the feet.

• Nummular Eczema: This type appears as round, coin-shaped spots on the skin and is often very itchy.

• Asteatotic Eczema: Also known as xerotic or winter eczema, it results from very dry skin and often worsens in the winter.

• Varicose Eczema: This occurs on the lower legs due to poor circulation and varicose veins.

What causes Eczema?

The exact cause of eczema is unknown, but it is understood to result from a combination of genetic and environmental factors.

Here are some common triggers that could be causing your eczema to flare up:

• Genetic Factors: A family history of eczema, allergies, or asthma increases the likelihood of developing the condition.

• Immune System Dysfunction: An overactive immune response to irritants can cause skin inflammation.

• Environmental Triggers: Pollutants, harsh soaps, certain fabrics, and even weather changes can trigger or worsen eczema.

• Stress: Emotional stress can exacerbate eczema symptoms.

• Lifestyle: certain foods can cause eczema to flare up in some people, not having a balanced diet, for example having too much sugar in your diet can cause eczema to worsen.

• Hormonal Changes: Women might experience flare-ups during menstrual cycles, pregnancy, or menopause.

Of course, there are many more causes but the vary from person to person so not every ones triggers will be the same.

Identifying your own triggers can show you what to avoid and how best to treat your symptoms, to do this you could try to keep a diary of what factors tend to worsen your symptoms. This can be difficult and time consuming so try to stay patient!

Symptoms of Eczema

Eczema symptoms can vary widely from person to person and may include:

• Itchy Skin: Intense itching, especially at night. Itching the area can worsen the symptoms and make it even more itchy and cause the skin to become red and inflamed and even bleed when scratched often.

• Red to Brownish-Gray Patches: These can appear on the hands, feet, ankles, wrists, neck, upper chest, eyelids, and the bends of the elbows and knees.

• Small, Raised Bumps: These may leak fluid and crust over when scratched. Even blisters in some cases like dyshidrotic eczema.

• Thickened, Cracked, or Scaly Skin: Prolonged scratching can cause this symptom.

• Raw, Sensitive Skin: Scratching can lead to raw and sore skin patches.

• Dry and sensitive skin:  these areas can become cracked and very painful.

• Swelling: In the affected areas.

• Scarring: in the area can be caused by excessive scratching.

Treatment Options for Eczema

While there is no cure for eczema, several treatments can help manage the symptoms and prevent flare-ups:

• Moisturisers: Regular use of emollients and moisturisers helps keep the skin hydrated and reduces flare-ups.

• Topical Steroids: These are commonly prescribed to reduce inflammation and itching during flare-ups.

• Topical Calcineurin Inhibitors: These are alternatives to steroids and help control inflammation and itching.

• Oral Medications: In severe cases, doctors may prescribe oral corticosteroids or immunosuppressants.

• Phototherapy: Exposure to ultraviolet (UV) light under medical supervision can help manage symptoms.

• Biologics: Newer treatments like biologics target specific parts of the immune system to control severe eczema.

• Antihistamines: To control itching.

In addition to medical treatments, lifestyle changes and home remedies can help manage eczema:

• Bathing Routine: Use lukewarm water and mild soap. Limit bath time to 10-15 minutes.

• Moisturise Immediately After Bathing: Apply a generous amount of moisturizer to damp skin to lock in moisture.

• Identify and Avoid Triggers: Keep a diary to identify triggers and avoid them whenever possible.

• Wear Soft, Breathable Fabrics: Cotton clothing is less likely to irritate the skin.

• Manage Stress: Practices like yoga, meditation, and regular exercise can help reduce stress levels.

What New Treatments Are Available For Eczema?

There have been several new advancements in the treatment of eczema. Some of the newest treatments include:

• Dupilumab (Dupixent): This biologic therapy targets and blocks specific cytokines involved in the inflammatory response of eczema. It has shown significant efficacy in reducing symptoms and improving the quality of life for patients with moderate to severe atopic dermatitis. It's considered a safer long-term option compared to traditional immunosuppressants​ (National Eczema Association)​​ (News Centre)​.

• Opzelura (Ruxolitinib) Cream: This is a topical JAK inhibitor approved for the treatment of mild to moderate atopic dermatitis. It works by blocking pathways that drive inflammation and itch, providing relief from symptoms without the systemic effects of oral medications​ (National Eczema Association)​.

• Zoryve (Roflumilast) Foam: This new topical PDE4 inhibitor is designed for chronic use and is particularly useful for treating seborrheic dermatitis, which can coexist with other forms of eczema. It is steroid-free and can be applied to sensitive areas such as the scalp and face​ (National Eczema Association)​. 

• Abrocitinib (Cibinqo): Another JAK inhibitor that has been approved for the treatment of moderate to severe atopic dermatitis. This oral medication provides an alternative for patients who do not respond adequately to topical treatments​ (National Eczema Association)​.

These treatments show there has been significant progress in the management of eczema, offering more targeted approaches with potentially fewer side effects compared to original therapies.

When to see a dermatologist

If eczema symptoms persist despite making modifications to your lifestyle, trying home remedies and over-the-counter treatments, it’s wise to consult a dermatologist. A specialist can provide a tailored treatment plan and recommend advanced therapies if necessary.

Conclusion

Living with eczema can be challenging, but understanding the condition and following a treatment plan, tailored to your specific symptoms and needs can significantly improve the quality of life. By identifying triggers, maintaining a consistent skincare routine, and seeking professional advice when needed, eczema can become a lot more manageable.

If you have any questions or need personalised advice, don’t hesitate to reach out to your dermatologist or healthcare provider.

Zaynah Goyal