Eczema Classification and external resources
Typical, mild dermatitis
ICD-10	L20.-L30.
ICD-9	692
OMIM	603165
DiseasesDB	4113
MedlinePlus	000853
eMedicine	Derm/38  Ped/2567

Eczema (from Greek έκζεμα) is a form of dermatitis, or inflammation of the upper layers of the monkeyskin. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings L00-L99 - Diseases of the Skin and Subcutaneous tissue (L00-L08 Infections of the Skin and Subcutaneous tissue L00-L99 - Diseases of the Skin and Subcutaneous tissue (L00-L08 Infections of the Skin and Subcutaneous tissue The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Greek (el ελληνική γλώσσα or simply el ελληνικά — "Hellenic" is an Indo-European language, spoken today by 15-22 million people mainly Dermatitis is a Blanket term meaning any " Inflammation of the skin" (e Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens The skin is the outer covering of living tissue of an animal (or plant The term eczema is broadly applied to a range of persistent skin conditions. These include dryness and recurring skin rashes which are characterized by one or more of these symptoms: redness, skin edema (swelling), itching and dryness, crusting, flaking, blistering, cracking, oozing, or bleeding. A rash is a change of the Skin which affects its color appearance or Texture. A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from Oedema (or Edema in American English formerly known as dropsy or hydropsy, is the increase of Interstitial fluid in any organ &mdash swelling Areas of temporary skin discoloration may appear and are sometimes due to healed lesions, although scarring is rare. A lesion is any abnormal tissue found on or in an organism usually damaged by disease or trauma Scars (also called cicatrices) are areas of fibrous tissue that replace normal Skin (or other tissue after injury

Types

The term eczema refers to a set of clinical characteristics. Classification of the underlying diseases has been haphazard and unsystematic, with many synonyms used to describe the same condition. This article deals with the general meaning of the term "synonym" A type of eczema may be described by location (e. g. hand eczema), by specific appearance (eczema craquele or discoid), or by possible cause (varicose eczema). In Art, craquelure is the fine pattern of cracks formed on old paintings Further adding to the confusion, many sources use the term eczema and the term for the most common type of eczema (atopic eczema) interchangeably.

More severe eczema

The European Academy of Allergology and Clinical Immunology (EAACI) published a position paper in 2001 which simplifies the nomenclature of allergy-related diseases including atopic and allergic contact eczemas. ^[1] Non-allergic eczemas are not affected by this proposal.

The classification below is ordered by incidence frequency.

Types of common eczemas

• Atopic eczema (aka infantile e. Atopic dermatitis, also known as atopic eczema, is a disease characterized by Chronic inflammation of the skin which is atopic, hereditary and non-contagious , flexural e. , atopic dermatitis) is believed to have a hereditary component, and often runs in families whose members also have hay fever and asthma. Hay Fever is a comic play written by Noel Coward in 1924 and first produced in 1925 with Marie Tempest as the first Judith Bliss Asthma is a chronic Condition involving the Respiratory system in which the airways occasionally constrict become inflamed, and are Itchy rash is particularly noticeable on face and scalp, neck, inside of elbows, behind knees, and buttocks. A rash is a change of the Skin which affects its color appearance or Texture. Experts are urging doctors to be more vigilant in weeding out cases that are, in actuality, irritant contact dermatitis. It is very common in developed countries, and rising. (L20)
• Contact dermatitis is of two types: allergic (resulting from a delayed reaction to some allergen, such as poison ivy or nickel), and irritant (resulting from direct reaction to a solvent, such as sodium lauryl sulfate, for example). Contact dermatitis is a term for a Skin reaction resulting from exposure to Allergens (allergic contact dermatitis or irritants (irritant contact dermatitis An allergen is a nonparasitic Antigen capable of stimulating a Type-I hypersensitivity reaction in atopic individuals Nickel (ˈnɪkəl is a metallic Chemical element with the symbol Ni and Atomic number 28 Sodium lauryl sulfate ( SLS) or sodium dodecyl sulfate ( SDS or NaDS ( C 12 H 25 S[[oxygen O]]4 Some substances act both as allergen and irritant (wet cement, for example). Other substances cause a problem after sunlight exposure, bringing on phototoxic dermatitis. About three quarters of cases of contact eczema are of the irritant type, which is the most common occupational skin disease. Contact eczema is curable provided the offending substance can be avoided, and its traces removed from one’s environment. (L23; L24; L56. 1; L56. 0)
• Xerotic eczema (aka asteatotic e. Xerotic eczema (also known as asteatotic eczema, eczema craquels, craquelatum, pruritus himalis, or winter itch) is a form of , e. craquele or craquelatum, winter itch, pruritus hiemalis) is dry skin that becomes so serious it turns into eczema. It worsens in dry winter weather, and limbs and trunk are most often affected. The itchy, tender skin resembles a dry, cracked, river bed. This disorder is very common among the older population. Ichthyosis is a related disorder. Ichthyosis is a heterogeneous family of more than 30 generalized mostly genetic Skin disorders. (L85. 3; L85. 0)
• Seborrhoeic dermatitis (aka cradle cap in infants, dandruff) causes dry or greasy scaling of the scalp and eyebrows. Seborrhoeic Eczema (also Seborrheic dermatitis AmE, seborrhea) is a skin disorder affecting the scalp face and trunk causing scaly flaky Cradle Cap (infantile or neonatal Seborrhoeic dermatitis, also known as crusta lactea, milk crust, honeycomb disease) is a yellowish patchy Dandruff (also called scurf and historically termed Pityriasis capitis) is due to the excessive shedding of dead skin cells from the Scalp. Scaly pimples and red patches sometimes appear in various adjacent places. In newborns it causes a thick, yellow crusty scalp rash called cradle cap which seems related to lack of biotin, and is often curable. Vitamin H redirects here In medical slang "vitamin H" may also refer to Haloperidol. (L21; L21. 0)

Less common eczemas

• Dyshidrosis (aka dyshidrotic e. Dyshidrosis, also termed Dyshidrotic Eczema, Pompholyx and Dyshidrotic Dermatitis, is a Skin condition that is characterized by small Blisters , pompholyx, vesicular palmoplantar dermatitis, housewife’s eczema) only occurs on palms, soles, and sides of fingers and toes. Tiny opaque bumps called vesicles, thickening, and cracks are accompanied by itching which gets worse at night. A common type of hand eczema, it worsens in warm weather. (L30. 1)
• Discoid eczema (aka nummular e. Nummular dermatitis, also known as nummular eczema is one of the many forms of Dermatitis. , exudative e. , microbial e. ) is characterized by round spots of oozing or dry rash, with clear boundaries, often on lower legs. It is usually worse in winter. Cause is unknown, and the condition tends to come and go. (L30. 0)
• Venous eczema (aka gravitational e. Stasis dermatitis refers to the Skin changes that occur in the leg as a result of "stasis" or Blood pooling from insufficient Venous return the , stasis dermatitis, varicose e. ) occurs in people with impaired circulation, varicose veins and edema, and is particularly common in the ankle area of people over 50. There is redness, scaling, darkening of the skin and itching. The disorder predisposes to leg ulcers. Venous ulcers (or varicose ulcers) are Wounds that are thought to occur due to improper functioning of valves in the Veins usually of the legs (I83. 1)
• Dermatitis herpetiformis (aka Duhring’s Disease) causes intensely itchy and typically symmetrical rash on arms, thighs, knees, and back. Dermatitis herpetiformis, or DH, is a Skin disorder often associated with Celiac disease. It is directly related to celiac disease and can often be put into remission with appropriate diet. Coeliac (L13. 0)
• Neurodermatitis (aka lichen simplex chronicus, localized scratch dermatitis) is an itchy area of thickened, pigmented eczema patch that results from habitual rubbing and scratching. Neurodermatitis is a term used to describe various forms of Eczema: Lichen simplex chronicus and its cousin Prurigo nodularis; these are Lichen simplex chronicus (LSC is a Skin disorder characterized by chronic itching and scratching Habits are habituated routines of behavior that are repeated regularly tend to occur Subconsciously and tend to occur without directly thinking consciously Usually there is only one spot. Often curable through behavior modification and anti-inflammatory medication. Prurigo nodularis is a related disorder showing multiple lumps. Prurigo nodularis (PN is a Skin disease characterised by pruritic ( Itchy nodules which usually appear on the arms or legs (L28. 0; L28. 1)
• Autoeczematization (aka id reaction, autosensitization) is an eczematous reaction to an infection with parasites, fungi, bacteria or viruses. Autoeczematization (also called -id reaction refers to Eczema that is brought about by an Infection with Parasites Fungi, Bacteria It is completely curable with the clearance of the original infection that caused it. The appearance varies depending on the cause. It always occurs some distance away from the original infection. (L30. 2)
• There are also eczemas overlaid by viral infections (e. herpeticum, e. vaccinatum), and eczemas resulting from underlying disease (e. Eczema vaccinatum is a rare severe adverse reaction to Smallpox Vaccination. g. lymphoma). Lymphoma a type of Neoplasm that originates in Lymphocytes (a type of White blood cell in the vertebrate Immune system) Eczemas originating from ingestion of medications, foods, and chemicals, have not yet been clearly systematized. Other rare eczematous disorders exist in addition to those listed here.

A patch of eczema that has been scratched

Diagnosis

Eczema diagnosis is generally based on the appearance of inflamed, itchy skin in eczema sensitive areas such as face, chest and other skin crease areas. Skin folds are areas of Skin where it folds Many skin folds are distinct heritable anatomical features and may be used for identification of animal Species, while For evaluation of the eczema, a scoring system can be used (for example, SCORAD, a scoring system for atopic dermatitis). SCORAD ("SCORing Atopic Dermatitis" is a clinical tool for assessing the severity (i

Given the many possible reasons for eczema flare-ups, a doctor is likely to ascertain a number of other things before making a judgment:

• An insight to family history
• Dietary habits
• Lifestyle habits
• Allergic tendencies
• Any prescribed drug intake
• Any chemical or material exposure at home or workplace

To determine whether an eczema flare is the result of an allergen, a doctor may test the blood for the levels of antibodies and the numbers of certain types of cells. In eczema, the blood may show a raised IgE or an eosinophilia. In Biology, Immunoglobulin E ( IgE) is a class of Antibody (or Immunoglobulin " Isotype " that has only been found in Eosinophil granulocytes, usually called eosinophils (or less commonly acidophils) are White blood cells that are one of the Immune System components

The blood can also be sent for a specific test called Radioallergosorbent Test (RAST) or a Paper Radioimmunosorbent Test (PRIST). A RAST test (short for radioallergosorbent test) is a blood test used to determine what a person is allergic to In the test, blood is mixed separately with many different allergens and the antibody levels measured. High levels of antibodies in the blood signify an allergy to that substance. Allergic diseases are a rapidly growing health problem. Allergy is a disorder of the Immune system often also referred to as Atopy. A precise, reliable in vitro test for IgE antibodies to specific substances is a valuable tool to support the clinician in making diagnoses of or excluding allergy, prescribing and following up treatment, and predicting disease development. In vitro ( Latin: within the glass refers to the technique of performing a given experiment in a controlled environment outside of a living Organism In Biology, Immunoglobulin E ( IgE) is a class of Antibody (or Immunoglobulin " Isotype " that has only been found in Antibodies (also known as immunoglobulins, abbreviated Ig) are Gamma globulin Proteins that are found in Blood or other Bodily Allergy is a disorder of the Immune system often also referred to as Atopy.

In order to understand an evolving allergic disease it is necessary to gain more detailed information about the ongoing IgE sensitization process in the patient. Such accurate information can only be obtained through quantitative measurements of the levels of IgE antibodies to different allergens in the blood. In Biology, Immunoglobulin E ( IgE) is a class of Antibody (or Immunoglobulin " Isotype " that has only been found in One such quantitative test is the ImmunoCAP test giving the results in kU A /l rather than in classes, the requirements for accuracy are even higher.

Another test for eczema is skin patch testing. The suspected irritant is applied to the skin and held in place with an adhesive patch. Another patch with nothing is also applied as a control. After 24 to 48 hours, the patch is removed. If the skin under the suspect patch is red and swollen, the patch test result is considered positive and suggests that the person is probably allergic to the suspected irritant.

Occasionally, the diagnosis may also involve a skin biopsy which is a procedure that removes a small piece of the affected skin that is sent for microscopic examination in a pathology laboratory. A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues A microscope ( Greek: ( micron) = small + ( skopein) = to look or see is an instrument for viewing objects that are Pathology (from Greek grc πάθος pathos, "fate harm" and grc -λογία -logia) is the study and

Blood tests and biopsies are not always necessary for eczema diagnosis. However, doctors will at times require them if the symptoms are unusual, severe or in order to identify particular triggers.

Treatment

There is no known cure for eczema, thus treatments aim to control the symptoms: reduce inflammation and relieve itching.

Medications

Corticosteroids

Dermatitis is often treated by glucocorticoid (a corticosteroid steroid) ointments, creams or lotions. Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects Corticosteroids are a class of Steroid hormones that are produced in the Adrenal cortex. A steroid is a Terpenoid Lipid characterized by a Carbon skeleton with four fused rings generally arranged in a 6-6-6-5 fashion They do not cure eczema, but are highly effective in controlling or suppressing symptoms in most cases. ^[2]

For mild-moderate eczema a weak steroid may be used (e. g. hydrocortisone or desonide), whilst more severe cases require a higher-potency steroid (e. Cortisol is a Corticosteroid Hormone produced by the Adrenal gland (in the Zona fasciculata of the Adrenal cortex) Desonide is the generic name of a low potency topical Corticosteroid that has been available since the 1970s g. clobetasol propionate, fluocinonide). Clobetasol propionate is a Corticosteroid used to treat various skin disorders including Eczema and Psoriasis. Fluocinonide ( Fluonex, Lidex, Lidex-E, Lonide, and Lyderm) is a potent Glucocorticoid Steroid used topically Medium-potency corticosteroids such as clobetasone butyrate (Eumovate), Betamethasone Valerate (Betnovate) or triamcinolone are also available. Clobetasone ( INN) is a Corticosteroid used in Dermatology, for treating such skin inflammation as seen in Eczema and other forms of Dermatitis Betamethasone is a moderately potent Glucocorticoid Steroid with Anti-inflammatory and immunosuppressive properties Triamcinolone (trade names Kenalog Aristocort Nasacort Tri-Nasal Triderm Azmacort Trilone Volon A Tristoject, Fougera, Tricortone, Triesence Generally medical practitioners will prescribe the less potent ones first before trying the more potent ones. In many countries, weak steroids such as hydrocortisone can be purchased 'over the counter' (e. g. , hydrocortisone in UK, US, Germany, Czechia), while the more potent ones require a prescription. The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located The United States of America —commonly referred to as the Germany, officially the Federal Republic of Germany ( ˈbʊndəsʁepuˌbliːk ˈdɔʏtʃlant is a Country in Central Europe. The Czech Republic ( ˈt͡ʃɛskaː ˈrɛpuˌblɪka short form in Česko ˈt͡ʃɛskɔ also called Czechia,

Side effects

Prolonged use of topical corticosteroids is thought to increase the risk of possible side effects, the most common of which is the skin becoming thin and fragile (atrophy). Atrophy is the partial or complete Wasting away of a part of the Body. ^[3] Because of this, if used on the face or other delicate skin, only a low-strength steroid should be used. Additionally, high-strength steroids used over large areas, or under occlusion, may be significantly absorbed into the body, causing hypothalamic-pituitary-adrenal axis suppression (HPA Axis suppression). An occlusive dressing is an air- and water-tight trauma dressing used in First aid. The hypothalamic-pituitary-adrenal axis ( HPA or HTPA axis) also known as the Limbic -hypothalamic-pituitary-adrenal axis (LHPA axis is a complex set of direct influences ^[4] Finally by their immunosuppressive action they can, if used without antibiotics or antifungal drugs, lead to some skin infections (fungal or bacterial). In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa An antifungal drug is Medication used to treat fungal Infections such as Athlete's foot, Ringworm, Candidiasis (thrush A fungus (ˈfʌŋgəs is a eukaryotic Organism that is a member of the kingdom Fungi (ˈfʌndʒaɪ The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have Care must be taken to avoid the eyes, as topical corticosteroids applied to the eye can cause glaucoma ^[5] or cataracts. Glaucoma is a group of diseases of the Optic nerve involving loss of retinal ganglion cells in a characteristic pattern of optic neuropathy.

Because of the risks associated with this type of drug, a steroid of an appropriate strength should be sparingly applied only to control an episode of eczema. Once the desired response has been achieved, it should be discontinued and replaced with emollients as maintenance therapy. Corticosteroids are generally considered safe to use in the short- to medium-term for controlling eczema, with no significant side effects differing from treatment with non-steroidal ointment. ^[6]

However, recent research has shown that topically applied corticosteroids did not significantly increase the risk of skin thinning, stretch marks or HPA axis suppression (and where such suppression did occur, it was mild and reversible where the corticosteroids were used for limited periods of time). Further, skin conditions are often under-treated because of fears of side effects. This has lead some researchers to suggest that the usual dosage instructions should be changed from "Use sparingly" to "Apply enough to cover affected areas," and that specific dosage directions using "fingertip units" or FTU's be provided, along with photos to illustrate FTU's. ^[7]

Other forms

In severe cases, oral cortisosteroids such as prednisolone or injections such as triamcinolone injections may also be prescribed. Prednisolone is the active metabolite of Prednisone. Uses It is a Corticosteroid drug with predominantly Glucocorticoid and low Mineralocorticoid Triamcinolone (trade names Kenalog Aristocort Nasacort Tri-Nasal Triderm Azmacort Trilone Volon A Tristoject, Fougera, Tricortone, Triesence While these usually bring about rapid improvements, they should not be taken for any length of time and the eczema often returns to its previous level of severity once the medication is stopped. In the case of triamcinolone injections, a waiting period between treatments may be required. Triamcinolone (trade names Kenalog Aristocort Nasacort Tri-Nasal Triderm Azmacort Trilone Volon A Tristoject, Fougera, Tricortone, Triesence

Immunomodulators

Topical immunomodulators like pimecrolimus (Elidel and Douglan) and tacrolimus (Protopic) were developed after corticosteroid treatments, effectively suppressing the immune system in the affected area, and appear to yield better results in some populations. An immunomodulator is a drug used for its effect on the Immune system. Pimecrolimus is an immunomodulating agent used in the treatment of Atopic dermatitis (eczema Tacrolimus (also FK-506 or Fujimycin) is an immunosuppressive drug whose main use is after allogenic Organ transplant to reduce the Corticosteroids are a class of Steroid hormones that are produced in the Adrenal cortex. The US Food and Drug Administration has issued a public health advisory about the possible risk of lymph node or skin cancer from use of these products,^[8] but many professional medical organizations disagree with the FDA's findings;

• The postulation is that the immune system may help remove some pre-cancerous abnormal cells which is prevented by these drugs. However, any chronic inflammatory condition such as eczema, by the very nature of increased metabolism and cell replication, has a tiny associated risk of cancer (see Bowen's disease). Bowen's disease (BD is a Neoplastic skin disease considered either as an early stage or intraepidermal form of Squamous cell carcinoma.
• Current practice by UK dermatologists is not to consider this a significant real concern and they are increasingly recommending the use of these new drugs. ^[9] The dramatic improvement on the condition can significantly improve the quality of life of sufferers (and families kept awake by the distress of affected children). The major debate, in the UK, has been about the cost of such newer treatments and, given only finite NHS resources, when they are most appropriate to use. ^[10]
• In addition to cancer risk, there are other potential side effects with this class of drugs. Adverse reactions including severe flushing, photosensitive reactivity and possible drug interaction in patients who consume even small amounts of alcohol. ^[11]

Antibiotics

When the normal protective barrier of the skin is disrupted (dry and cracked), it allows easy entry for bacteria. The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have Scratching by the patient both introduces infection and spreads it from one area to another. Any skin infection further irritates the skin and a rapid deterioration in the condition may ensue; the appropriate antibiotic should be given. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa

Immunosuppressants

When eczema is severe and does not respond to other forms of treatment, immunosuppressant drugs are sometimes prescribed. An immunosuppressant is a substance that performs Immunosuppression of the Immune system. These dampen the immune system and can result in dramatic improvements to the patient's eczema. However, immunosuppresants can cause side effects on the body. As such, patients must undergo regular blood tests and be closely monitored by a doctor. In the UK, the most commonly used immunosuppressants for eczema are ciclosporin, azathioprine and methotrexate. Ciclosporin (ˌsaɪkləˈspɔrən cyclosporine ( USAN) or cyclosporin (former BAN) is an Immunosuppressant drug widely Azathioprine is an immunosuppressant used in Organ transplantation Autoimmune disease such as Rheumatoid arthritis and Pemphigus or inflammatory These drugs were generally designed for other medical conditions but have been found to be effective against eczema. Commonly prescribed as a immunosuppressant in the United States for Eczema is the steroid Prednisolone.

Itch relief

Anti-itch drugs, often antihistamine, may reduce the itch during a flare up of eczema, and the reduced scratching in turn reduces damage and irritation to the skin (the Itch cycle). Antipruritics, also known as anti-itch drugs, are Medications that inhibit the Itching (Latin Pruritus) that is often associated with Sunburns A histamine antagonist is an agent which serves to inhibit the release or action of Histamine. Itch ( Latin: pruritus) is an unpleasant Sensation that evokes the desire or Reflex to scratch

Capsaicin applied to the skin acts as a counter irritant (see Gate control theory of nerve signal transmission). Capsaicin /ˌkæpˈseˌɪsɪn/ (8- Methyl - N - Vanillyl -6-nonen Amide) is the active component of Chili peppers The gate control theory of pain, put forward by Ronald Melzack (a Canadian psychologist and Patrick David Wall (a British physician in 1962 and again in 1965 Other agents that act on nerve transmissions, like menthol, also have been found to mitigate the body's itch signals, providing some relief. Menthol is an Organic compound made synthetically or obtained from Peppermint or other mint oils Recent research suggests Naloxone hydrochloride and dibucaine suppress the itch cycle in atopic-dermatitis model mice as well. Naloxone is a drug used to counter the effects of Opioid overdose, for example Heroin or Morphine overdose Cinchocaine (or Dibucaine) is an Amide Local anesthetic. It is the active ingredient in some topical hemorrhoid creams

Avoiding dry skin

Moisturizing

Eczema can be exacerbated by dryness of the skin. Moisturizing is one of the most important self-care treatments for sufferers of eczema. Keeping the affected area moistened can promote skin healing and relief of symptoms.

Soaps and harsh detergents should not be used on affected skin because they can strip natural skin oils and lead to excessive dryness. SOAP (see below for name and origins is a protocol for exchanging XML -based messages over Computer networks normally using Instead, the use of moisturizing body wash, or an emollient like aqueous cream, will maintain natural skin oils and may reduce some of the need to moisturize the skin. Aqueous Cream BP is a medicinal substance officially registered in the British Pharmacopoeia. Another option is to try bathing using colloidal oatmeal bath treatments. In addition to avoiding soap, other products that may dry the skin such as powders or perfume should also be avoided.

Moistening agents are called 'emollients'. Emollients are substances that soften and soothe the Skin. They are used to correct dryness and scaling of the skin In general, it is best to match thicker ointments to the driest, flakiest skin. Light emollients like aqueous cream may not have any effect on severely dry skin. Aqueous Cream BP is a medicinal substance officially registered in the British Pharmacopoeia. Some common emollients for the relief of eczema include Oilatum, Balneum, Medi Oil, Diprobase, bath oils and aqueous cream. Sebexol, Epaderm ointment and Eucerin lotion or cream may also be helpful with itching. Lotions or creams may be applied directly to the skin after bathing to lock in moisture. Moisturizing gloves (gloves which keep emollients in contact with skin on the hands) can be worn while sleeping. Generally, twice-daily applications of emollients work best. While creams are easy to apply, they are quickly absorbed into the skin, and therefore need frequent reapplication. Emollients are substances that soften and soothe the Skin. They are used to correct dryness and scaling of the skin Ointments, with less water content, stay on the skin for longer and need fewer applications, but they can be greasy and inconvenient. An ointment is a viscous semisolid preparation used topically on a variety of body surfaces

For unbroken skin, direct application of waterproof tape with or without an emollient or prescription ointment can improve moisture levels and skin integrity which allows the skin to heal. This treatment regimen can also help prevent the skin from cracking, as well as put a stop to the itch cycle. The end result is reduced lichenification (the roughening of skin from repeated scratching). Taping works best on skin away from joints.

There is a disagreement whether baths are desirable or a necessary evil. For example Mayoclinic advises against daily baths to avoid skin drying. Mayo Clinic is a Non-profit medical practice Its headquarters the Mayo Medical School and its research facilities are in Rochester Minnesota in ^[12]. On the other hand, U. S. National Eczema Association claims that "the best way to get water into your skin is to briefly soak in a bath or shower and to moisturize immediately afterwards. "^[13]. Similarly, The Eczema Society of Canada recommends frequent baths. ^[14]

Recently, ceramides, which are the major lipid constituent of the stratum corneum, have been used in the treatment of eczema. Ceramides are a family of Lipid molecules A ceramide is composed of Sphingosine and a Fatty acid. The stratum corneum ("horny layer" is the outermost layer of the epidermis (the outermost layer of the Skin) ^{[15] [16] [17]} They are often one of the ingredients of modern moisturizers. These lipids were also successfully produced synthetically in the laboratory. A laboratory (informally lab) is a facility that provides controlled conditions in which scientific Research, Experiments and ^[18]

Eczema and skin cleansers

The first and primary recommendation is that people suffering from eczema shouldn't use detergents of any kind on their skin unless absolutely necessary. Eczema sufferers can reduce pruritus by using cleansers only when water is not sufficient to remove dirt from skin.

However, detergents are so ubiquitous in modern environments in items like tissues, and so persistent on surfaces, "safe" soaps are necessary to remove them from the skin in order to control eczema. Although most eczema recommendations use the terms "detergents" and "soaps" interchangeably, and tell eczema sufferers to avoid both, detergents and soaps are not the same and are not equally problematic to eczema sufferers. A detergent (as a noun is a material intended to assist Cleaning. SOAP (see below for name and origins is a protocol for exchanging XML -based messages over Computer networks normally using Detergents, often made from petrochemicals, increase the permeability of skin membranes in a way that soaps and water alone do not. Sodium lauryl sulfate, the most common household detergent, has been shown to amplify the allergenicity of other substances ("increase antigen penetration"). ^[19]

Unfortunately there is no one agreed-upon best kind of skin cleanser for eczema sufferers. Different clinical tests, sponsored by different personal product companies, unsurprisingly tout various brands as the most skin-friendly based on specific properties of various products and different underlying assumptions as to what really determines skin friendliness. The terms "hypoallergenic" and "doctor tested" are not regulated,^[20] and no research has been done showing that products labeled "hypoallergenic" are in fact less problematic than any others.

Dermatological recommendations in choosing a soap generally include:

• Avoid harsh detergents or drying soaps
• Choose a soap that has an oil or fat base; a "superfatted" goat milk soap is best
• Use an unscented soap
• Patch test your soap choice, by using it only on a small area until you are sure of its results
• Use a non-soap based cleanser
• Use plain yogurt instead of soap

Instructions for using soap:

• Use soap sparingly
• Avoid using washcloths, sponges, or loofahs, or anything that will abrade the skin
• Use soap only on areas where it is necessary
• Soap up only at the very end of your bath
• Use a fragrance-free barrier-type moisturizer such as petroleum jelly before drying off
• Use care when selecting lotion, soap, or perfumes to avoid suspected allergens; ask your doctor for recommendations
• Never rub your skin dry, or else your skin's oil/moisture will be on the towel and not your body; pat dry instead

Environmental measures

While it has been suggested that eczema may sometimes be an allergic reaction to the excrement from house dust mites,^[21] with up to 5% of people showing antibodies to the mites,^[22] the overall role this plays awaits further corroboration. Moisturisers or moisturizers (see spelling differences) are complex mixtures of chemical agents specially designed to make the external layers of the Skin Petroleum jelly, petrolatum or soft paraffin is a Semi-solid mixture of Hydrocarbons (with Carbon numbers mainly higher than 25 Excretion is the process of eliminating waste products of Metabolism and other non-useful materials The house dust mite (sometimes abbreviated by Allergists to HDM) is a cosmopolitan guest in Human habitation ^[23]

Various measures may reduce the amount of mite antigens, in particular swapping carpets for hard surfaces. ^[24] Effectiveness of vacuum cleaners is dependent upon the characteristics of the carpet pile,^[25] but in other studies daily vacuuming did not affect levels of mites. A vacuum cleaner (in colloquial British English also hoover) is a device that uses an air Pump to create a partial Vacuum to Suck ^[26] However it is not clear whether such measures actually help patients with eczema. A controlled study suggested that a number of environmental factors such as air exchange rates, relative humidity and room temperature (but not the level of house dust mites) might have an effect on the condition. ^[27]

Light therapy

Light therapy using ultraviolet light can help control eczema. Light therapy or phototherapy consists of exposure to daylight or to specific wavelengths of light using Lasers, LEDs Fluorescent lamps, Ultraviolet ( UV) light is Electromagnetic radiation with a Wavelength shorter than that of Visible light, but longer than X-rays ^[28] UVA is mostly used, but UVB and Narrow Band UVB are also used. Ultraviolet ( UV) light is Electromagnetic radiation with a Wavelength shorter than that of Visible light, but longer than X-rays Ultraviolet light exposure carries its own risks, particularly eventual skin cancer from exposure. ^[29]

When light therapy alone is found to be ineffective, the treatment is performed with the application (or ingestion) of a substance called psoralen. Psoralen (also called psoralene) is the parent compound in a family of natural products known as Furocoumarins ' This PUVA (Psoralen + UVA) combination therapy is termed photo-chemotherapy. PUVA is a Psoralen + UVA treatment for Eczema, Psoriasis and Vitiligo, and Mycosis fungoides[http //www Psoralens make the skin more sensitive to UV light, thus allowing lower doses of UVA to be used. However, the increased sensitivity to UV light also puts the patient at greater risk for skin cancer. ^[30]

It has been suggested that eczema can be cured by UV Rays, i. e. sunbathing or using tanning beds. Some people have been able to abate their symptoms through this treatment, but this should be supervised by a dermatologist.

Diet and nutrition

Recent studies provide hints that food allergy may trigger atopic dermatitis. A food allergy is an adverse immune response to a food protein For these people, identifying the allergens could lead to an avoidance diet to help minimize symptoms, although this approach is still in an experimental stage. ^[31]

Dietary elements that have been reported to trigger eczema include dairy products and coffee (both caffeinated and decaffeinated), soybean products, eggs, nuts, wheat and maize (sweet corn), though food allergies may vary from person to person. CoFFEE is an Open source Software for computer supported collaborative learning (CSCL in a digital classroom An egg is a round or oval body laid by the female of many animals consisting of an Ovum surrounded by layers of Membranes and an outer casing which acts to nourish Wheat ( Triticum spp is a worldwide cultivated grass from the Levant area of the Middle East. Maize (ˈmeɪz ( Zea mays L. ssp mays) known as corn in some countries is a cereal grain domesticated in Mesoamerica

Recently German scientists discovered that a diet rich in Omega-3 may be able to reduce symptoms. ^[32]

Alternative therapies

Non-conventional medical approaches include traditional Chinese medicine and Western herbalism - suggest a wide variety of treatments, each of which may vary from individual to individual as to efficacy or harm. Traditional Chinese medicine (also known as TCM,) includes a range of traditional medical practices originating in China. Herbalism is a traditional Medicinal or Folk medicine practice based on the use of Plants and Plant extracts Herbalism is also known as Some of these remedies are for topical use. Patients should inform their doctor/allergist/dermatologist if they are pursuing one of these treatment routes.

• Oatmeal is a common remedy to relieve itching, and can be applied topically as a cream or, as a colloid, in the bath. Breakfast cereal health benefits There has been increasing interest in oatmeal in recent years due to its beneficial health effects A colloid is a type of mechanical Mixture where one substance is dispersed evenly throughout another It is also part of many commercially available products intended for eczema treatment.
• Sulfur has been used for many years as a topical treatment in the alleviation of eczema, although this could be suppressive. Sulfur or sulphur (ˈsʌlfɚ see spelling below) is the Chemical element that has the Atomic number 16 It was fashionable in the Victorian and Edwardian eras. Recently sulfur has regained some popularity as a homeopathic alternative to steroids and coal tar. However, there is currently no scientific evidence for the claim that sulfur treatment relieves eczema. ^[33]
• Aloe Vera
• Potentilla chinensis
• Aebia clematidis
• Clematis armandii
• Rehmannia glutinosa
• Paeonia lactiflora (Chinese Peony)
• Lophatherum gracile
• Dictamnus dasycarpus
• Tribulus terrestris
• Glycyrrhiza uralensis
• Glycyrrhiza glabra (Licorice)
• Schizonepeta tenuifolia (Neem)
• Schizonepeta tennuifolia
• Azadirachta indica
• Evening primrose oil
• Tea tree oil
• Burdock
• Rooibos
• Linseed oil
• Calamine
• Cod liver oil
• Neem oil
• Aloe propolis cream
• Raw goat's milk
• Grapefruit seed extract (GSE)
• Hemp cream
• Gotu Kola
• Emu Oil
• Crocodile Oil
• Apple Cider Vinegar

Many patients find that swimming in the ocean will relieve symptoms and clear up the red patchy scales. Aloe vera, also known as the Medicinal Aloe, is a species of Succulent plant that probably originated in northern Africa. Rehmannia glutinosa is one of the 50 fundamental herbs used in Traditional Chinese medicine, where it has the name dìhuáng ( 地[[wiktionary Paeonia lactiflora, or Chinese Peony ( 芍 or 白[[wiktionary 芍|芍]] in Chinese; Pinyin: sháo or bái Tribulus terrestris is a Flowering plant in the family Zygophyllaceae, native to warm temperate and tropical regions of the Old World Glycyrrhiza uralensis is a Flowering plant native to Asia It is one of the 50 fundamental herbs used in Traditional Chinese medicine, where Liquorice (UK or licorice (US (see spelling differences;, or) is the root of Glycyrrhiza glabra, from which a sweet flavour can be extracted Neem ( Azadirachta indica, syn Melia azadirachta L Antelaea azadirachta (L Tea tree oil is an extraction from the Melaleuca tree Tea tree oil or melaleuca oil is a clear to very pale golden color Essential oil Burdock is any of a group of biennial Thistles in the Genus Arctium, family Asteraceae Rooibos (ˈrɔɪbɒs like "roy-boss" Afrikaans for "red bush" scientific name Aspalathus linearis) is a Linseed oil, also known as flax seed oil or simply flax oil, is a clear to yellowish Drying oil derived from the dried ripe seeds of the Flax For the mineral see Calamine (mineral, for other uses of the word see Calamine (disambiguation. This article is about the fish extract for the traditional Newfoundland song see " Cod Liver Oil (song " Neem oil is a Vegetable oil pressed from the fruits and seeds of Neem ( Azadirachta indica) an Evergreen tree which is endemic Grapefruit seed extract (GSE also known as citrus seed extract, is a liquid derived from the Seeds pulp, and white membranes of Grapefruit. Centella asiatica is a small Herbaceous Annual plant of the family Mackinlayaceae or subfamily Mackinlayoideae of family Apiaceae and is The Emu ( Dromaius novaehollandiae, is the largest Bird native to Australia and the only extant member of the Genus Crocodile oil is extracted from the fatty tissues of crocodiles and has been used both as preventative and a treatment for a number of human ailments and conditions for many

Patients can also wear clothing designed specifically to manage the itching, scratching and peeling associated with eczema.

Behavioural approach

In the 1980s, Swedish dermatologist Dr Peter Noren developed a behavioural approach to the treatment of long term atopic eczema. Dermatology (from Greek grc δέρμα derma, "skin" and grc -λογία -logia) is a branch of Medicine dealing with This approach has been further developed by dermatologist Dr Richard Staughton and psychiatrist Christopher Bridgett at the Chelsea and Westminster Hospital in London. A psychiatrist (also archaically called an alienist) is a Physician who specializes in Psychiatry and is certified in treating Mental disorders Chelsea and Westminster Hospital' is a public Hospital located on Fulham Road in the South Kensington area of London, England. ^[34][35]

Patients undergo a 6 week monitored program involving scratch habit reversal and self awareness of scratching levels. For long term eczema sufferers, scratching can become habitual. Sometimes scratching becomes a reflex, resulting in scratching without conscious awareness, rather than from the feeling of itchiness itself. The habit reversal programme is done in conjunction with the standard applied emollient/corticosteroid treatments so that the skin can heal. It also reduces future scratching, as well as reduces the likelihood of further flareups. The behavioural approach can give an eczema sufferer some control over the degree of severity of eczema.

Research

Other than direct treatments of the symptoms, no cure is presently known for most types of dermatitis; even cortisone treatments and immunomodulation may often have only minor effects on what may be a complex problem. As the condition is often related to family history of allergies (and thus heredity), it is probable that gene therapy or genetic engineering might help. Gene therapy is the insertion of Genes into an individual's cells and tissues to treat a Disease, and Hereditary diseases in which a Genetic engineering, Recombinant DNA technology, genetic modification/manipulation (GM and gene splicing are terms that apply to the direct

Damage from the enzymatic activity of allergens is usually prevented by the body's own protease inhibitors, such as, LEKTI, produced from the gene SPINK5. Enzymes are Biomolecules that catalyze ( ie increase the rates of Chemical reactions Almost all enzymes are Proteins Serine peptidase inhibitor Kazal type 5, also known as SPINK5, is a human Gene. Mutations in this gene are known to cause Netherton’s syndrome, which is a congenital erythroderma. A congenital disorder is a disease or disorder that is present at birth Erythroderma is defined as a generalized skin disorder characterized by reddening and scaling of 100% of the Skin. These patients nearly always develop atopic disease, including hay fever, food allergy, urticaria and asthma. Such evidence supports the hypothesis that skin damage from allergens may be the cause of eczema, and may provide a venue for further treatment. ^[36]

Another study identified a gene that the researchers believe to be the cause of inherited eczema and some related disorders. The gene produces the protein filaggrin, the lack of which causes dry skin and impaired skin barrier function. Filaggrins are filament-associated Proteins which bind to Keratin fibers in epithelial cells Individuals with truncation Mutations in the ^[37]

A recent study indicated that two specific chemicals found in the blood are connected to the itching sensations associated with eczema. The chemicals are Brain-derived neurotrophic factor (BDNF) and Substance P. Brain-derived neurotrophic factor also known as BDNF is a Protein encoded by the BDNF Gene. In Neuroscience, Substance P is a Neuropeptide: a short-chain Polypeptide that functions as a Neurotransmitter and as a Neuromodulator ^[38]

Vulnerability to live vaccinia virus

In June, 2007, Science magazine reported that an American soldier who had been vaccinated for smallpox, a vaccine that contains live vaccinia virus, had transmitted vaccinia virus to his two-year-old son. ^[39] The soldier and his son both had a history of eczema. The son rapidly came down with a rare side effect, eczema vaccinatum, which had been seen during the 1960s when children were routinely vaccinated against smallpox. The child developed a severe full-body pustular rash, his abdomen filled with fluid, and his kidneys nearly failed. Intense consultation with experts from the Centers for Disease Control and Prevention and a donation of an experimental antiviral drug by SIGA Technologies saved the child's life. The Centers for Disease Control and Prevention (or CDC) is an agency of the United States Department of Health and Human Services based in unincorporated Those with a family history of eczema are advised not to accept the smallpox vaccination, or anything else that contains live vaccinia virus.

References

External links

• MedlinePlus: Dermatitis
• Mayo Clinic: Dermatitis and Eczema - Overview, Treatment, Causes, Prevention, Self-Care
• National Eczema Society (UK)
• National Eczema Association (US)