By definition, eczema is a non-infectious, inflammatory skin disease that affects only the uppermost layer of the skin (epidermis) and possibly also the uppermost layers of the dermis, which are located directly under the epidermis and interlock with it. Since eczema is not caused by pathogens, it is also not contagious. With a prevalence between 3 and 20%, eczema is the most common skin disease.
It is assumed that almost every person suffers from eczema at least once in their life. Furthermore, eczema is by far the most common occupational disease. More information about infectious skin rashes can be found here: Is my skin rash contagious?The term “eczema” (also known as rash, dermatitis, itchy skin, itchy psoriasis or mistakenly dermatitis) is a collective term for a variety of non-infectious, inflammatory diseases that affect the top layer of skin.
There are very many different causes that can lead to eczema and depending on the cause they can also look quite different. However, a typical symptom progression is a phased pattern, with the acute phase being characterized by inflamed, itchy and reddened skin. Reliable treatment options are available for most forms of eczema, but it is essential to start as early as possible to avoid complications.
There are a variety of causes for eczema. In principle, a distinction is made between In addition, a distinction is made between and can also be classified according to the respective localization (e.g. hand-foot eczema). Roughly speaking, most eczema can be classified into three subgroups: 1. atopic eczema2.
contact dermatitis and3. seborrhoeic eczema 1. “Atopic eczema” is another term for atopic dermatitis.
This is the classic representative of an endogenous eczema, since neurodermatitis (atopic dermatitis) is caused by various inherited factors. In this case, there is a predisposition to allergies in general, so that atopic eczema often occurs together with hay fever or asthma. 2. contact eczema is again distinguished between allergic contact eczema is caused when there is an allergy to a substance that comes into contact with the skin.
A common example is nickel, other possibilities are latex or ingredients of perfumes, creams, hair dyes. This allergy is a type 4 allergy, which means that it is a late reaction. First the skin must be “sensitized” against the allergen, which is why a reaction only really occurs after repeated contact with the substance.
Then, hours or days may pass before symptoms appear after contact with the causative material. This often makes it difficult to identify the cause. Toxic contact eczema occurs when the skin is in contact with harmful substances, usually chemicals, over a long period of time.
This group includes, for example, acids, alkalis, cleaning agents, solvents and detergents. 3. seborrhoeic eczema is caused by an increased production of sebum and a defective composition of this substance. In addition, there are various other causes that can trigger eczema, for example UV radiation, medication, overproduction of sweat, etc.
The most important risk factor for eczema in general is dry skin. Persons who wash their skin very often or who stay in living rooms with dry air are therefore more likely to develop eczema. The acid mantle of the skin is disturbed and therefore more susceptible to external influences.
Also long-term UV-RADIATION can promote the risk for the emergence of the Ekzeme, since this likewise damages the skin durably.
- Endogenous (if the disease is caused by internal factors) and
- Exogenous (if the eczema is caused by external influences) eczema.
- Acute
- Chronic eczema
- Allergic and
- A toxic form.
Although eczema can differ significantly in its development and thus also in its characteristic appearance and localization, they all have in common that they take a phased course. First of all, every eczema is in the acute phase.
At this stage, the acute inflammatory reaction of the skin predominates. This means that the affected skin area is reddened, itches and often swelling occurs due to water retention. Sometimes, in addition to these typical changes, scales, blisters or lumps are also found, some of which also secrete fluid (“wetting”).
In the course of time, the bubbles dry out and crusts are formed.Skin flakes can also occur now. Especially when eczema affects the scalp, dandruff is sometimes the only symptom. Eczema becomes chronic if it recurs in the same place over and over again or never heals properly.
In this chronic stage, eczema is more likely to be characterized by a thickening and scaling of the skin and a coarsening of the skin structure (lichenification). This condition is often found in allergic eczema, which often also shows discoloration of the neck or torn earlobes (due to dry skin). In addition, chronic eczema can lead to itchy scratch marks and inflammatory nodes.
At the same time, there may also be skin areas that are still in the acute eczema stage. Depending on the cause of the eczema, there are certain places where it occurs preferentially:
- Atopic eczema often manifests itself in the folds of the scalp (e.g. in the crook of the arm or the hollow of the knee) or on the scalp (especially in babies as “milk crust”).
- Contact eczema develops where the allergenic substance came into contact with the skin. Since the classic representative of this group is nickel and many jewelry items contain nickel, allergic contact dermatitis is often seen on the ears, wrists or around the neck – just where jewelry is worn.
Light-induced eczema is mainly found on skin areas that are frequently exposed to the sun.
The diagnosis of eczema can normally be made by a dermatologist based on the clinical appearance without an examination as a gaze diagnosis. However, further examinations or tests may be necessary to find out the cause of the eczema. If the patient’s medical history (anamnesis) indicates an allergy, an allergy test (a prick test or epicutaneous test, depending on the type of allergy) may be helpful.
Since several triggers or risk factors often coincide and these are sometimes not directly associated with eczema even by a patient (e.g. wearing jewelry or taking medication several days ago), it is often not easy to find out the reason for eczema. The treatment of eczema depends on its stage and its cause. In general, eczema is usually treated externally, usually locally, using certain creams or ointments.
The more weeping the eczema is, the more water the remedy used should contain. If the skin is very dry, ointments with a high fat content are used. In the case of an acute flare, ointments containing a form of the anti-inflammatory cortisone are usually used.
Antihistamines can help against itching and can also be used generally for allergic eczema. If atopic eczema is present, it may be advisable to take additional medications that influence the immune system and/or to have a hyposensitization performed. If the local therapy has no effect, most of the mentioned medications can also be taken in the form of tablets (whereby they have a systemic effect).
If definite triggers for eczema have been identified, for example nickel, latex or even certain drugs, these substances must of course be avoided as consistently as possible. Besides avoiding triggering substances or cosmetics, the therapy of eczema consists of applying ointments. It is important that the composition of the ointment is adapted to the condition of the skin.
In the case of weeping eczema, for example, an ointment with a high water content is chosen, whereas in the case of crust and scale formation, an oily consistency is important for skin care. Ointments are particularly effective when applied in the form of compresses. Prescription drugs such as cortisone (a glucocorticoid) have anti-inflammatory and local immunosuppressive effects.
If the affected, open skin area is still infected with bacteria as a complication, an antibiotic-containing or antiseptic ointment is applied. In principle, eczema is easily treatable and therefore normally no further cause for concern. However, this requires that the cause of the eczema has been correctly identified.
If this is not done, there is a high probability that eczema will become chronic or recur again and again. In addition, eczema can be an entry point for pathogens if it is not treated properly and can thus lead to secondary infection (superinfection). It is therefore important to treat eczema adequately regardless of the cause in order to avoid secondary damage.Because there are so many different causes of eczema, there are also various preventive measures that are often aimed at avoiding a specific type of eczema.
In general, however, you can avoid dry skin if you want to prevent eczema: When wearing clothes, you should make sure that you use skin-friendly materials such as cotton or silk and wash them before you wear them for the first time. In addition, it goes without saying that if you have already had eczema before, you should take so-called secondary prophylaxis by preventing new attacks. For this purpose, it is essential to consistently avoid the triggering substance, e.g. nickel.
- Do not wash the skin too often
- Leave in water too long
- Humidify room air
- Use special, moisturizing care products
- Avoid any skin-irritating substances (or wear gloves)
- Avoid excessive solar radiation (especially of course if you have sun-sensitive eczema! )