Lifestyle Choices

Although some people use the words eczema and dermatitis to mean different things, most skin doctors now use the words interchangeably and there is no suggestion that one implies an inherited factor rather than an environmental cause. Eczema comes from a Greek word meaning to ‘boil out’ and, as we shall see, this is a good description for one variety of the disease. Dermatitis means inflammation of the skin and this is also accurate.

Eczema is not a single disease but a group of irritating and sore conditions. In severe forms the skin may even weep and blister. There may be an inherited cause, an external trigger or a combination of events leading to the final picture. Eczema affects something like five million people in Britain in degrees from very mild to extremely severe, irregularly or persistently and in ages ranging from the newborn to old age. It is no wonder that a huge amount of money and time is spent on researching the causes and improving the care of sufferers. It is another example of a problem that may not kill people but causes a remarkable amount of suffering.

Briefly they are atopic eczema: this has an inherited factor and produces a dry, itchy skin often reacting to wool, dust, cosmetics and changes in humidity or temperature; seborrheic eczema which is less itchy, may affect any age and usually involves the scalp; irritant contact which is a wear and tear problem often brought on by soaps, washing powders and certain industrial oils; allergic contact eczema which is a genuine allergy to an everyday item e.g. nickel, rubber or perfume nappy rash.

Skin changes

Although there are several types of eczema they all produce comparable changes of inflammation in the skin. Some types are more likely to go on to the chronic stage and others may be itchier, and lead to more scratching, but under the microscope the initial changes are always similar.

Acute stage

The skin is red, hot, itchy, swollen and many small blisters may form. Most people experience a smarting pain. The surface is wet, particularly if the blisters burst, and this happens quite readily on all surfaces except the palms and soles - here the blisters have a thicker root and remain intact. The acute stage is usually brief and either settles or goes on to a more drawn-out subacute stage.

Subacute stage

Less discomfort is felt but iching may supervene. Swelling settles but dried fluids may produce a crust. Redness is prominent, showing that inflammation is still active. Bacteria on the skin surface multiply on the crusted surface and may penetrate through cracks, leading to infection. While it normally remains a localized problem the infection may spread and form a lymphangitis (this refers to a visible red line traveling up the limb to the lymph glands).

Chronic stage

If the cause of the eczema cannot be removed, or if treatment is not rapidly effective, the disease may enter a chronic stage. Vigorous and persistent scratching is directly responsible for the thickened, scaly areas which are the hallmark of this stage. The change is called lichenification and is a protective reaction against further damage.

We have seen that there are several types of eczema and that each can have acute and chronic stages. Although the eczemas and their treatment have much in common there remain important differences and it is best to discuss them one at a time. Atopic eczema is common and may be the most severe: many of the general principles of skin care are mentioned in this section.

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