Information about Eczema/Neurodermatitis

Eczema

Eczema is a form of dermatitis, a skin irritation characterized by red, flaky skin, sometimes with cracks or tiny blisters. It is extremely itchy, but scratching damages the fragile skin and exacerbates the problem so it is important for people with eczema to try to leave the area alone.

Types

There are several causes of dermatitis, but the most common ones are related to allergies. Atopic eczema, the most common, is caused by general systemic allergic reactions, as opposed to contact with an irritant. It is very common in people with related allergic conditions, including asthma or chronic hay fever. Allergic contact dermatitis, as the name implies, is the result of direct contact with an irritant. One of the most common causes of this form are buttons and rivets in jeans, which contain nickel. Irritant contact dermatitis is similar but is caused by a reaction to some chemical substance, often unrinsed detergents left on clothing or various household chemicals being handled. Often, the inflammation occurs mainly on the hands and feet, as the hands come in contact with most of the chemicals that a person may encounter, and the environment for shoe-clad feet is warm and moist, perfect for fungal infections to begin.

Several other forms appear unrelated to the main allergic causes. Infantile seborrhoeic eczema, also known as Cradle Cap, forms on the head and quickly spreads. It looks like normal dermatitis, but apparently doesn't itch and eventually goes away on its own. Adult seborrhoeic dermatitis typically affects those between 20 and 40 years old. It affects the scalp, face, and upper body. Varicose eczema occurs later in life, the result of poor circulation in the legs. Finally discoid eczema suddenly appears as small disk shaped spots of severe dermatitis, but disappear on their own.
Stress and anxiety can make otherwise minor outbreaks spread in some people. Deep unresolved or suppressed emotions are believed by some to be expressed externally in the form of physical skin conditions such as dermatitis (this being borne out by increased irritation at times of emotional upset such as anger or stress). Low humidity is also thought to exacerbate dermatitis.

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. However, given to the many possible reasons of 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 your eczema flare is resulting from an allergen, a doctor may suggest a blood test called radioallergosorbent test (RAST). In the test, blood is mixed with an allergen; antibodies developing in the blood are the sign of an allergy.
The diagnosis may also involve a skin lesion biopsy; removal of a small piece of skin for examination in a laboratory.
Blood test and biopsy are not regular procedure for eczema diagnosis. However, doctors at time do follow it in order to draw a conclusive judgment.

Treatment

Moisturizing
Dermatitis severely dries out the skin, and keeping the affected area moistened can promote healing and retain natural moisture. This is the most important self-care treatment that one can use in atopic eczema.
The use of anything that may dry out the skin should be discontinued and this includes both normal soaps and bubble baths that remove the natural oils from the skin.
The moistening agents are called 'emollients'. The rule to use is: match the thicker ointments to the driest, flakiest skin. Light emollients like Aqueous Cream may dry the skin if it is very flaky and whist it is the moisturiser traditionally prescribed by doctors in the UK, it is in fact only licensed for use as a soap substitute on washing.
Emollient bath oils should be added to bath water and then suitable agents applied after patting-dry the skin. Generally twice daily applications of emollients work best and whilst creams are easy to apply, they are quickly absorbed into the skin and so need frequent re-application. Ointments, with their lesser water content, stay on the skin for longer and so need fewer applications but they must be applied sparingly if to avoid a sticky mess.
Typical emollients in the U.K. are: Oilatum or Balneum bath oils, Aqueous cream for washing with, Diprobase or Doublebase pump-action creams also used for washing and may be later applied directly to the skin. The prefered moisturiser of dermatologists is a mix of liquid and white-soft paraffins. Sebexol, Epaderm ointment and Eucerin lotion or cream may be helpful with itching. Moisturizing gloves can be worn while sleeping.

Itch Relief

Antihistamine medication may reduce the itch during a flare up of ezcema, and the reduced scratching in turn reduces damage & irritation to the skin (the Itch cycle).
Capsaicin applied to the skin acts as a couter irritant (see Gate control theory of nerve signal transmission)). Other agents that act on nerve transmissions, like menthol, also have been found to mitigate the body's itch signals, providing some relief. Whilst research has suggested Naloxone hydrochloride and dibucaine suppress the itch cycle in atopic-dermatitis model mice.

Corticosteroids

Dermatitis is often treated by doctors with prescribed cortisone (steroid) ointments or creams. They are highly effective in most cases, but must be used sparingly to avoid possible side effects, the most significant of which is that their prolonged use can cause the skin to thin and become fragile (atrophy). High strength steroids used over large areas may be significantly absorbed into the body causing bone demineralisation (osteoporosis). Finally by their immunosuppression action they can, if used alone, exacerbate some skin infections (fungal or viral).
Hence a steroid of an appropriate strength to promptly settle an episode of eczema should be sparingly applied. Once the desired response has been achieved, it should be discontinued and not used for long-term prevention.

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. The FDA has issued a public health advisory about the possible risk of lymph node or skin cancer from use of these products, 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).
Current (UK) practice by dermatologists is not to consider this a significant real concern and they are increasingly recommending the use of these new drugs. 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.

Antibiotics

The disruption to the skin's normal barrier protection through dry and cracked skin allows easy entry for bacteria and fungi. 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 detoriation in the condition may ensue; the appropriate antibiotic should be given.

Light Therapy

Light therapy using ultraviolet light can help. PUVA, UVB, and Narrow Band UVB are all used. Current research seems to show that Narrow Band UVB is the most effective, plus it has the lowest risk of skin cancer.
When light therapy alone is found to be ineffective, it is combined with a drug called Psoralen. This treatment is termed as photo-chemotherapy.

Traditional remedies
Other historical sources - notably 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. Toxicity may be present in some.

Some alternative (and even conventional) medicine sources state that oatmeal in solution applied topically has a healing effect. This has been noticed through occupational sources, where a person's skin is often exposed to oatmeal at work, e.g., through baking or milling. Often such people retain exceptionally soft and healthy skin into old age.
The symptoms of Biotin deficiency include Seborrheic dermatitis, a skin disorder which is similar to eczema. Current research has found that taking biotin alleviates the symptoms of eczema.

Future Treatments

Other than direct treatments of the symptoms, no "cure" for dermatitis is presently known; 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.

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