What is Eczema?

4. Neurodermatitis

Neurodermatitis affects approximately 12% of the U.S. population. Whereas atopic dermatitis tends to be widespread across the body, neurodermatitis is normally confined to one or two patches of skin. The most common areas affected are arms, shoulders, elbows, legs, ankles, wrists, hands, back of the neck or scalp. These patches of skin can be dry, thick, scaly, leathery or different colored. They are very itchy.

Neurodermatitis is more common in women than men. Many people report the itchiness being worse when trying to relax, such as at bedtime, or during periods of high stress.

5. Nummular eczema

People with nummular eczema develop coin-shaped patches of skin that are itchy and may ooze. These areas often develop on arms, legs, hands, or torso. They itch and burn, and fluid may leak out and crust on the skin. The condition is more common in males than females. It can be seen independent from other types of eczema or at the same time.

6. Seborrheic dermatitis

Seborrheic dermatitis is a skin condition most common on the scalp. It also occurs in other areas with lots of oil gland activity. Seborrheic dermatitis is characterized by red, itchy, scaly and greasy patches of skin which produce flaking. It is commonly known as dandruff in adults and teens or cradle cap in infants.

Approximately 11% of the U.S. population has seborrheic dermatitis. It is common in people with certain medical conditions such as adult Hodgkin’s lymphoma, HIV, Down syndrome and Parkinson’s disease.

7. Stasis dermatitis

Stasis dermatitis occurs in people with poor circulation (venous insufficiency) to their lower legs. It is most common in older adults and women. Common risk factors for developing poor circulation include varicose veins, high blood pressure, obesity and heart failure.

People with stasis dermatitis often start with ankle swelling and orange-brown spots. \ It may also lead to skin color changes, itching, scaliness and dry skin.

So eczema is a versatile disease. Each type has different causes and manifestations. It is important to work with an allergist or dermatologist (skin doctor) for treatment. Depending on your type of eczema, you may need to also work with other specialists to help treat conditions that may be contributing to your eczema.

What are the different types of skin changes associated with eczema?

If you were to open a dermatology textbook, you would be flooded with terms used to describe skin conditions and their manifestations. While people with eczema may not need to know all the different terms used to describe eczema, it may be helpful to understand some of the more common ones. These describe the abnormalities, or skin lesions, associated with eczema. 

• atrophy – a thinning of the upper layers of skin (or dermis). The thinning makes the skin more fragile and prone to tearing. Atrophy is more common as people age, but it also can be caused by use of topical steroid medications.
• erythema – traditionally described as reddening of the skin. However, in people with darker skin pigmentation, symptoms may be less obvious. There may be areas of darker, ashen gray, or purple skin.
• follicular accentuation – inflammation of the hair follicles. This may present as a rash that looks like goosebumps.
• hyperpigmentation – patches of skin that are darker in color than the surrounding skin.  
• hypopigmentation – patches of skin that are lighter in color than the surrounding skin.  
• lichenification – thickening of skin patches caused by chronic scratching. Lichenified skin may appear red or darker than surrounding skin.
• striae – commonly referred to as “stretch marks.” These may present as indented streaks or streaks of darker or different colored skin. Striae can also result from the use of topical steroid medications.
• telangiectasia – dilated or broken blood vessels on the surface of the skin.  
• xerosis – excessively dry skin. This may cause itching, skin flaking, or cracking. 

Pet Allergies

Pet dander (dead skin cells), saliva or urine are normally harmless proteins, but for people with eczema they can trigger skin symptoms leading to respiratory problems. Early exposure to pet dander may contribute to the development of eczema in children who are prone to the condition.

Finding a new home for the furry pet is the most effective way to reduce levels of pet allergens in the home, but if that’s not a consideration, bathe your pet at least once a week and set up no-pet zones, including the bedroom.

Hormones

In women, hormone fluctuations may trigger or worsen eczema symptoms. Hormone changes occur just before and during menstruation, during pregnancy, after pregnancy, or when transitioning to menopause.

Outdoor Temperatures

Whether because it dries out skin or causes sweating, heat is a common eczema trigger. Sweat, in particular, can collect in your armpits or inner part of your elbow, leading to skin irritation.

Meanwhile, in winter months, humidity that provides moisture in the air decreases, resulting in dry skin. In addition, a sudden rise or drop in temperature can trigger an eczema flare.

Strategies to keep comfortable in hot and cold weather include:

Hot Weather

• Wear appropriate clothing: light, breathable clothes in the summer.
• Avoid going outside during peak heat times during the day, usually between 10 a.m. and 3 p.m. If you do go outside, keep a small towel with you to wipe away excess sweat.
• Stay hydrated to moisturize from the inside out.

Cold Weather

• Wear gloves in the winter (since hands are particularly sensitive and often exposed to cold).
• Consider a humidifier to moisturize the indoor air.

Skin Irritants

While they are not true allergens, some soaps, shampoos, detergents, fragrances and wool or synthetic clothing can significantly irritate sensitive skin.

Heavy or tight clothing that rubs against the skin can also cause symptoms. Use gentle, nonirritating products and stick with them.

Natural fiber clothing such as cotton or silk is usually most comfortable. Once an area gets irritated, it can take a long time for it to calm down.

Stress

An increase in stress may either cause an eczema flare or worsen an existing one. Some patients may scratch more often when they’re feeling pressure. Managing stress effectively can reduce flares.

Coping strategies such as meditation or yoga, regular exercise, getting enough sleep, and connecting with family and friends are great ways to take your mind off your worries.

Tobacco Smoke

Cigarette smoke, including secondhand smoke, can irritate skin in addition to the lungs and eyes. Set a no-smoking policy both inside and outside your home; smoking is a major health issue for everyone.

Viral and Bacterial Infections

The common cold can cause an eczema flare. In addition, the herpes virus, which can cause cold sores in and around the mouth, can lead to flares – including a potentially serious infection that can spread cold sores to other areas of the body.

Exposure to bacteria can cause harmful toxins to secrete into the skin, prompting an immune reaction and causing skin inflammation. One of the more common bacteria is Staphylococcus aureus, which can not only worsen eczema but also slow skin healing.

What other conditions look similar to eczema?

Another challenge of diagnosing eczema is that there are other skin conditions that may appear to be eczema or have similar symptoms to eczema. As a result, people can experience symptoms and not get the right treatment due to misdiagnosis or delayed diagnosis. 

These skin conditions may include 

• psoriasis
• scabies
• allergies
• hives
• ringworm
• acne
• cutaneous t-cell lymphoma
• Netherton disease
• hereditary angioedema
• chronic idiopathic urticaria

Many of these conditions may have similar appearances to eczema or even overlap with eczema.

That’s why it is very important to work with an allergist or dermatologist for diagnosis and treatment.

What treatments are used for eczema?

Early diagnosis and treatment are essential to avoid skin complications and improve quality of life.

• moisturizers
• medications
• wet wrap therapy
• phototherapy

How do I cope with the challenges of eczema?

If you have eczema, you know that it can greatly affect your quality of life and well-being. The itching, scratching, loss of sleep and more greatly impact day-to-day living. It can also take an emotional toll on both patient and family. Although there’s no cure, there are now better treatments available that can help manage eczema.

In addition to treatments, managing the itch-scratch cycle is the best thing to do to help cope with eczema and reduce symptoms. Also, be sure to practice good self-care and seek out the support you need and deserve with this difficult condition.