What is eczema?

Eczema definition

Eczema encompasses a group of inflammatory skin diseases characterized by dry, itchy skin, red patches, blisters, weeping, and crusting, typically flaring-up periodically¹ ² ³ ⁴. Various types of eczema exist, and it's possible for someone to have more than one type at the same time¹ ². Commonly, "eczema" refers to atopic eczema or atopic dermatitis, the most common type. 

Atopic eczema or atopic dermatitis¹ ² ³ ⁴

Atopic dermatitis is a chronic inflammatory skin disease usually starting in childhood. It stems from skin dysfunction, making it overly sensitive to environmental factors.  
While most cases of atopic eczema resolve clear up in childhood (50% by age 5), about 10 to 15% continue into adulthood⁴. Less frequently, the first eczema flare-ups may appear during adult age.   

Contact eczema¹ 

This eczema type arises from contact with irritants or allergens, like chemicals, metals, or fragrances, affecting areas in direct contact with these substances (hands, neck, face). 

Other types of eczema² ³

Additional types of eczema include dyshidrotic eczema, nummular eczema, and varicose eczema. 

Atopic skin vs normal skin: understanding the difference

What is atopy?⁴

"Atopy" indicates a hereditary predisposition to developing various allergic disorders, affecting the skin like atopic eczema or the respiratory system like asthma and allergic rhinitis. Atopy is strongly genetic: 50-70% of individuals with atopy have a first-degree relative (parent, sibling) also affected. The likelihood of developing atopic eczema significantly increases, up to 80%, if both parents are atopic. 

Identifying atopic eczema: symptoms and key indicators

Symptoms of atopic eczema¹ ³

Atopic eczema cycles between flare-ups and symptom-free remissions, with durations varying. 
Flare-up symptoms include: 

• Dry and scaly skin. 
• Itching (or pruritus). 
• Skin lesions: raised, red, irritated patches giving the skin a rough, swollen appearance. Blisters on these patches break, leading to oozing and crusting. 

Over time, affected skin can become discolored, thicker, and drier (lichenification). 

Differentiating eczema from other skin conditions

Several skin conditions may mimic eczema symptoms (such as patches, redness, itching, scales, or flare-ups), making diagnosis challenging.

Understanding the causes and triggers of atopic eczema

Eczema: a multifactorial disease¹ ³ ⁴

Eczema's exact causes are not fully understood, but it results from a mix of genetic, immune, and environmental factors: 
Genetic component: people with eczema often carry a mutation of the filaggrin gene, affecting the skin's outer layer formation. Consequently, their skin is permeable and less effective at retaining moisture and protecting against external substances such as irritants, allergens, and microorganisms. Furthermore, their epidermis contains fewer beta-defensins proteins, which are important for fighting bacteria, viruses, and fungi. 

Reactive immune system: individuals with atopic dermatitis have an overreactive immune system, producing excessive allergic-type (IgE) antibodies in response to environmental allergens like dust mites, animal hair, or pollen.  

Environmental influences: various environmental factors can trigger eczema flare-ups, such as soap, rough fabrics, certain foods, weather conditions, sweat, cigarette smoke, pollution, bacterial and viral infections. 

Atopic eczema triggers¹ ³ ⁴

Atopic eczema triggers are individual and vary from person to person, commonly including temperature changes, hot showers, hygiene products, perfumes, irritating textiles, and stress.

Is atopic eczema dangerous?

A "benign" disease¹ ³ 

Eczema isn't life-threatening but can be very uncomfortable, significantly affect health and well-being, or lead to other complications.  

Complications of atopic eczema¹ ³ 

1. Lichenification: chronic eczema causes a change in skin texture, becoming rough and thick, known as "lichenification." 
2. Skin Infections: damaged skin, especially from scratching, becomes vulnerable to bacterial, viral, and fungal infections. 
3. Sleep disorders: severe itching can disrupt sleep, affecting overall health and well-being.  
4. Psychological issues: Managing a chronic condition, itching, and discomfort can lead to anxiety and depressive disorders. 

Effective eczema treatments

The treatment of atopic eczema primarily focuses on symptom relief during acute episodes and proactive measures to prevent future flare-ups. 

Treating eczema flare-ups³ ⁶ ⁷

Doctors typically prescribe topical corticosteroids, available as creams or ointments, to directly alleviate inflammation and itching during flare-ups.  

Preventing disease flare-ups³ ⁶ ⁷

A key aspect of eczema management is the daily hydration of the skin, crucial for maintaining long-term disease control. Emollient are instrumental in reinforcing the skin's barrier function, ensuring it remains healthy and flexible. They effectively combat dryness, alleviate itching, and minimize flaking. For optimal results, apply these emollients across the entire body once or twice daily, ideally following a brief shower and gentle pat drying. Opt for fragrance-free emollients that feature a straightforward formula with minimal ingredients for the best care.