Eczema: Causes, Symptoms & Treatment

Eczema or dermatitis is a skin disease that can occur in various forms. Typical signs include scaling, oozing, blistering and crusting of the skin. The most common causes are allergic reactions to certain substances and other skin diseases or skin inflammations. However, poor hygiene can also lead to eczema.

What is eczema?

Schematic diagram showing the anatomy of the skin and the causes and symptoms of allergic skin eczema. Click to enlarge. Eczema is a reaction of the skin that resembles inflammation, but is not caused by infection. Initially, the skin reddens, then forms blisters and weeps. The resolution of the disease is characterized by severe scaling of the skin and the formation of a crust. Although eczema is not infectious, it is grouped with inflammatory reactions of the skin that run similarly under the more modern collective term dermatitis.

Causes

The clinical picture of eczema is divided into three different types. Atopic eczema is also known as neurodermatitis and is usually a hypersensitive reaction of the skin. The causes of its development are not fully understood. However, it is believed that the symptoms and discomfort develop when the affected patient has a genetic predisposition to eczema and subsequently comes into contact with a trigger. Allergic contact dermatitis is an allergic reaction of the skin: it is characterized by the fact that the allergy can be recognized only by the formation of eczema on the skin. Intolerance to nickel can cause such symptoms as soon as the patient comes into contact with the substance. Toxic contact dermatitis, on the other hand, describes the reaction of the skin to a substance that is toxic or harmful to humans. The eczema is formed as a defensive reaction of the skin and is part of the normal reaction pattern upon contact with the substance in question.

Symptoms, complaints and signs

Although there are different types of eczema with different clinical pictures, typical eczema reactions occur in all of them. These are a characteristic sequence of symptoms that pass through several stages. The typical leading symptoms of eczema include itching. Other common signs of eczema are weeping, scaling, and the appearance of crusts on the affected skin. In terms of symptoms, a distinction must be made between acute and chronic eczema. In acute eczema, the first symptom is a reddening of the skin. In addition, the skin swells and itches. Normally, the symptoms disappear after a few days. In cases of pronounced eczema, blisters filled with fluid appear after the reddening. Shortly thereafter, the blisters burst open and crusts form, which are followed by the appearance of scales. The formation of scales is considered an indication that the eczema is healing. It is not uncommon for the sequence of redness/swelling – vesicle formation – crusting – scaling to occur several times in succession. A typical feature of chronic eczema is the development of a bright reddening of the skin. In the further course, swellings, vesicles or papules form. Patients often also suffer from burning and itching. The skin is usually permanently dry and constantly reddened. Because the patient often scratches himself due to the itching, there is a risk of accompanying symptoms such as inflamed nodules and scratch marks. Skin infections often occur as well.

When should you go to the doctor?

If eczema does not subside after two to three days, a doctor should be consulted. Eczema that covers large areas of skin or has become inflamed requires rapid evaluation by a medical professional. The same applies if the eczema appears on the eye or the skin comes off in blisters. If neurodermatitis is suspected, the patient should talk to their family doctor or directly to a dermatologist. Patients suffering from a skin disease are best to clarify unusual skin changes directly with the responsible physician. In particular, complaints that cannot be traced back to any other cause and have a considerable influence on well-being should be clarified quickly. As a rule, the doctor will first talk to the patient and then perform a physical examination. Simple eczema can usually be detected by visual diagnosis and treated in a targeted manner.However, if the inflammatory skin disease remains untreated, further complications may develop. Therefore, a doctor should be consulted at the first signs of eczema.

Complications

The occurrence of additional complications is possible due to eczema. These include, first and foremost, skin problems that arise because of the ongoing itching. Because the patient repeatedly scratches the affected areas, this often results in an exacerbation of the itching or inflammatory process, which in turn has a negative effect on the healing progress. In addition, the agonizing discomfort can lead to sleep disturbances at night, making restful sleep impossible. Due to the skin changes, it is not uncommon for the patient’s external appearance to be affected as well. In extreme cases, working life can no longer be reconciled with the after-effects of eczema. If sensitization to occupational substances is detected at the workplace due to allergic contact eczema, there is even a threat of occupational disability. People who suffer from eczema are also prone to other skin infections, which can extend to impetigo. Responsible for the skin infections are mostly herpes simplex viruses or bacteria such as staphylococci. By scratching the upper skin layer, the germs can penetrate the skin. Sometimes the affected person also suffers a fungal infection. Particular caution is required when symptoms such as herpes rash, redness, cold sores, and blisters filled with pus appear. If these symptoms appear, a doctor must be consulted quickly. For example, herpes infection threatens further complications such as swelling of the lymph nodes and high fever.

Treatment and therapy

Treatment depends on the condition of the eczema and the health of the skin. In the early stages of eczema, it is advisable to choose an ointment with as high a water content as possible. The skin loses water due to oozing and blistering and therefore needs new reserves to initiate the healing process. However, if the eczema is in the later stages where it forms a scaly crust, an ointment containing fat is used to help the skin regenerate healthy cells. If bacterial infections subsequently occur on the eczema, an ointment containing antibiotics and antiseptic substances is also applied. Otherwise, a product containing glucocorticoids is sufficient to prevent inflammation of the eczema. Only in severe cases, antibiotics or other healing substances are administered in tablet form, when the eczema should not be touched.

Outlook and prognosis

Eczema has various causes and, in the best case, may not recur after a single occurrence. However, if a person is prone to this condition, there is a high probability that it will recur throughout life. Especially if the cause is of psychological origin. If eczema is already treated with an ointment when it has not yet broken out strongly, it can quickly fade away. However, the danger is that the irritated and itchy skin may be scratched even more and bleeding spots may appear. Then the skin needs a longer time to heal. A thin gauze bandage around the corresponding skin area can help. Constant friction of clothing on the skin can also irritate it even more. If there is a psychological cause, this must also be treated so that the eczema disappears completely. However, if the sufferer comes to rest after a stressful period and recollects the needs of his body, the eczema will quickly disappear even in this case. Accordingly, the prospect of curing eczema depends on various factors. However, if the cause of the disease is identified and treated individually and irritation of the skin is avoided, there is a relatively high chance of curing the disease.

Prevention

People with known allergies must stay away from the particular allergen in the future to prevent the formation of eczema. However, most dangerous substances can be easily avoided – for example, those who have an intolerance to nickel must pay attention to the materials used when buying jewelry and pay particular attention to costume jewelry, because it often contains nickel. When handling acids or alkalis, which are known to be dangerous, care must be taken to wear the right protective clothing so that no accidents can occur.Eczema is often caused by occupational accidents in companies that work with such substances and where employees come into direct contact with them. If, on the other hand, there is atopic eczema, one should have the doctor clarify what caused it, in order to be able to stay away from the source of risk in the future, to avoid the formation and development of further eczema in the future.

Aftercare

In the case of eczema, there are some measures and options for aftercare available to the affected person. However, the main focus should be on early detection with subsequent treatment, as this is the only way to prevent further complications and discomfort. Eczema cannot heal itself, so that the affected person is always dependent on a visit to a doctor. Only early detection can prevent further complications and discomfort. The treatment itself is usually based on the exact symptoms and is carried out purely symptomatically. The affected person should always consult a doctor first in case of any uncertainties or questions. In general, a healthy lifestyle with a healthy diet has a positive effect on the course of the disease. Dietary measures can also be prescribed by a doctor to alleviate the symptoms. Sporting activities can also have a positive effect on the course of the disease. It is not uncommon for contact to be made with other sufferers, as this can lead to an exchange of information. The life expectancy of the affected person is not reduced by this disease.

What you can do yourself

Eczema is often accompanied by severe itching and by scratching bleeding skin. The doctor prescribes cortisone if the symptoms do not subside, but this is very controversial because of its radical effect. Therefore, many sufferers wonder what means you can use yourself against the unpleasant eczema. One behavior that should be avoided is constant unconscious scratching. Since this is especially difficult during sleep, it is recommended to apply a light bandage or wear gloves. Also, it is better not to wear tight clothes that may rub against the skin. Water often feels pleasant on the sore parts of the body, but excessive washing should be avoided, as the water dries out the skin and only increases the itching. Creams with a high fat content, petrolatum or cooking margarine should be used. Moisturizing creams are less suitable. If the itching is unbearable, a washcloth soaked in milk can be placed on the skin. If sufferers continue to suffer from eczema despite special creams or medical treatment, their lifestyle and diet should be reviewed. It is likely that those affected suffer from a lack of nutrients, eat a diet too rich in fats, consume excessive amounts of alcohol or smoke too much. All of these things can affect the skin, and skin irritation is often a sign of a diseased or stressed gut.