Dermatitis - a Distressing Disease

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Eczema is a group of skin conditions with different causes, but clinically similar presentation. These are defined as a pattern of skin inflammation having characteristic morphologies during its acute, subacute and chronic phases.

Phases of Eczema

1. Acute phase.
2. Subacute phase.
3. Chronic phase.

Acute Phase:

In acute phase, there will be erythema or redness, edema or swelling, vesiculation or fluid filled lesions, discharge and crusting.

Subacute Phase:

Subacute phase exhibits hyperpigmentation, scaling and crusting.

Chronic Phase:

In chronic phase, there will be lichenification. It is a combination of thickening, hyperpigmentation and prominent skin markings.

Classification of Eczema

It can be broadly divided into two groups. They are,

1. Exogenous eczemas.
2. Endogenous eczemas.

Exogenous Eczemas

Exogenous eczemas could either be irritant or allergic in nature.

1. Irritant Contact Dermatitis:

Irritant contact dermatitis type of eczema is caused by many agents, whose toxins or excretory products cause a variable degree of involvement depending upon their concentration and duration of contact with the skin of everyone exposed to them.

These agents can be any of the following:

1. Chemical: Detergents, soaps, acids, etc.
2. Physical: Sunlight, heat, etc.
3. Biological: Bacteria, virus, mites, lice, etc.

2. Allergic Contact Dermatitis:

• Unlike irritant contact dermatitis, allergic contact dermatitis occurs in only some of those individuals who become allergic to the causative external allergens while a great majority of those exposed continue to remain unaffected regardless of the duration of exposure.

• Allergic contact eczemas may occur due to footwear, cosmetics, hair dyes, pollens, etc.

• Pollens and other air-borne allergens mainly affect face, eyes, ‘V’ of the neck and other uncovered areas of the body. Air-borne contact dermatitis (ABCD) is the name given to this group of eczemas.

• The diagnosis of allergic contact dermatitis can be established by doing patch test, in which patches of suspected allergens in appropriate concentrations are put on the non-hairy skin of the back or arms and readings taken after 48-72 hours.

• The positive patch test reaction is indicated by redness or fluid filled eruptions or ulceration at the site of the test.

Endogenous Eczemas

Some common types of endogenous eczemas are as follows.

1. Atopic Dermatitis:

Atopic dermatitis is a chronic eczema. It is one of the atopic conditions, together with asthma and hay fever, has a heritable tendency.

2. Seborrheic Dermatitis:

There is an excessive sebum secretion in this type of eczema presenting with scaly, itchy lesions over the scalp, nasolabial folds, sternal areas and body folds.

3. Discoid Eczema:

Chronic recurrent discrete coin-shaped red areas covered with exudates and crust over the limbs and trunk of the middle aged due to as yet unknown causative factors. Sometimes, it is very difficult to distinguish discoid eczema from psoriasis.

4. Pompholyx:

In this type of eczema, vesicular eruptions are generally seen on the palms or soles. The lesions may be non-inflammatory, chronic and recurrent. The exact cause of pompholyx is not known.

General Principles of Therapy

• In order to bring about rapid resolution and prevent relapses, it is helpful to explain to the patient the causes of the initiation and perpetuation of the disease and advise corrective measures.

• Discontinuation of contact with the offending agent leads to rapid resolution.

• In general, management of eczema depends on their extent and chronic nature. More acute the phase, more bland and drying the topical medicament.

• Oral antihistamines like Cetirizine or Levocetirizine diminish itching.

Local Treatment

Treatment for Acute Stage:

Normal saline or potassium permanganate (1:10,000 dilution) compresses or soaks are given to wash away serous discharge, crust and debris and it also helps to reduce oozing and inflammation. Calamine lotion should not be used. In case of discharge avoid ointment or cream, corticosteroids in lotion form may be used.

Treatment for Subacute Stage:

When there is no oozing or discharge or in cases of subacute or dry eczemas, corticosteroid cream is to be applied locally twice a day. Local antibiotic cream with or without corticosteroid, is helpful where bacteria is present.

Treatment for Chronic Stage:

When the skin becomes thick or lichenified, occlusive dressing with a corticosteroid ointment is required. Alternatively, a moderately potent corticosteroid ointment can be applied locally two to three times a day. The addition of 3% Salicylic acid to the corticosteroid ointment is beneficial.

Systemic Treatment

• It is required in widespread acute or subacute cases and in selected chronic cases.

• Intralesional steroids 0.1 - 0.2 mL (10 mg/mL) per sq.cm should be given.

• Oral antihistamine should be given in suitable dose, depending on the individual tolerance, the nature of the job and age of the patient.

• Appropriate antibiotics are useful in case of secondary infection.

• Systemic corticosteroids like oral Prednisolone with other supportive measures are tried in severe cases with extensive involvement only and not as a routine. The dose and duration depend on the merits of the case.

For further information regarding eczema and its management, consult an eczema specialist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist/eczema