Eczema

Overview

The term ‘eczema’ literally means to ‘boil over’ (Greek).[1]

This reflects that the skin can become so acutely inflamed that fluid weeps out or vesicles appear.

It is synonymous with the term dermatitis and the two words are interchangeable.

It is estimated that 10% of people have some form of eczema at any one time, and up to 40% of the population will have an episode of it during their lifetime.[2]

Epidemiology

Causes

Atopic eczema i.e.:

• Hereditary
• Irritants- e.g. soap, detergents, shampoo Etc.
• Environmental allergens- for example, cold dry weather, dampness, dust, mites etc.
• Food allergies
• Hormonal changes
• Skin infection [1][2]

Discoid eczema i.e.:

• Infective organisms
• Hereditary
• Skin infection, etc. [1][2]

Hand eczema i.e.:

• Irritants
• Fungal infection
• Skin infections [1][2]

Seborrheic eczema i.e.:

• In brief, Overgrowth of Pittosporum ovale (also called Malassezia furfur in its hyphal form) cutaneous immune response to this yeast produces the characteristic inflammation and scaling of seborrheic eczema. [1][2]

Venous eczema i.e.:

• The exact cause remains unknown but it has been suggested that venous hypertension causes endothelial hyperplasia
• In detail, Extravasation of red and white blood cells which in turn causes inflammation, purpura and pigmentation.[1][2]

Asteatotic eczema i.e.:

• Repeated use of soaps
• Hypothyroidism [1][2]

Contact eczema – irritant i.e.:

• Environmental irritants

Contact eczema – allergic i.e.:

• Occurs after repeated exposure to a chemical substance

Photosensitive eczema i.e.:

• Light in the ultraviolet (in other words, UV) part of the spectrum
• UVB and UVA

Lichen simplex/nodular prurigo i.e.:

• Chronic scratching or rubbing in the absence of an underlying dermatosis. [1][2]

Classification

1. Endogenous:

• Atopic
• Discoid
• Hand
• Seborrheic
• Venous (i.e. ‘gravitational’)
• Asteatotic

2. Exogenous:

• Contact– irritant
• Contact– allergic
• Photosensitive
• Lichen simplex/nodular prurigo [2]

Risk factor

• Infection of bacteria
• Viral infections
• Multiple small blisters
• Pyrexia
• Malaise
• Cataract [1][2]

Pathogenesis

Pathophysiology

• Skin is affected from any Allergens. Additionally, It penetrates into the skin.
• Furthermore, Inflammation of skin take place, Skin becomes itchy and Patient starts to scratch his/her skin, Scratching damages the skin barrier so again the allergen is penetrated into the skin
• This process is taken place again also again therefore the more area is affected.[3]

Clinical Features

Sign & Symptoms of Eczema

Atopic Eczema i.e.:

• Generally, Itchy erythematous scaly patches in front of the elbows and ankles, behind the knees, around the neck.
• Acute lesions
• Small vesicles
• Besides this, Scratching can produce excoriations
• Repeated rubbing produces skin thickening
• Pitting and ridging of the nails.[1][2]

Discoid eczema i.e.:

• Scaly patches on the limbs
• Infection of bacteria
• Vesicles

Hand eczema i.e.:

• Itchy vesicles
• Blisters on the palm also Fingers
• Erythematous scaling
• Hyperkeratosis of the palms
• Most marked at the finger tips.[2][1]

Seborrheic eczema i.e.:

• Basically, Affects body sites rich in sebaceous glands
• In child Yellowish, greasy, thick crusts are seen on the scalp
• In child scaly rash can be seen over the trunk
• In detail, In adult scaling along the sides of the nose
• In adult It may affect the skin over the sternum groins, also the glans penis
• Overall, In elder people involve large areas of the body and even cause erythroderma.

Venous eczema i.e.:

• Occur in older people
• Appears on the lower legs around the ankles.
• Brownish pigmentation
• Either Venous leg ulcer or varicose veins may be present.[1][2]

Asteatotic eczema i.e.:

• Dry plate-like cracking of the skin
• Occurs lower legs also the backs of the hands, especially in winter
• Itching

Contact eczema – irritant i.e.:

• Either Unusual or localized distribution
• Paches
• Irritation

Contact eczema – allergic i.e.:

• Occurs on the hands after repeated exposures to irritants
• Vesicles
• Blisters

Photosensitive eczema i.e.:

• Photosensitive rashes.
• Sites exposed to the sun’s rays, face, chest, the ears hands.

Lichen simplex/nodular prurigo i.e.:

• Itching
• increased either rubbing or scratching
• Emotional stress.[1][2]

Clinical Examination

Diagnosis

• In general, By high serum IgE levels
• Skin-prick testing
• Skin biopsy
• History
• Diagnosis is based on clinical findings e.g. onset in infancy
• Severe pruritus
• Blood tests
• Typical distribution, additionally morphology of lesions
• Either Personal or family history of atopic dermatitis, allergic rhinitis or asthma.[1][2]

Differential Diagnosis

• Seborrheic dermatitis
• Psoriasis
• Neurodermatitis
• Scabies
• Dermatophyte infection
• Immunodeficiency disorder

Complications

Investigation

• Physical examination
• Allergy test to check allergies
• Skin biopsy

Treatment of Eczema

Atopic Eczema i.e.:

• Topical steroid
• Antibiotics
• Paste bandaging
• UV therapy
• Avoiding known irritants
• Wearing cotton clothes [1][2]

Discoid eczema i.e.:

• Antibiotics
• Avoid irritants
• UV therapy
• Personal hygiene, etc. [2]

Hand Eczema i.e.:

• Topical antibiotics
• UV therapy
• Antihistamine tablets
• Petroleum- or glycerin-based moisturizers
• Avoid irritants [2]

Seborrheic eczema i.e.:

• This is suppressive rather than curative
• Combination of a mild steroid ointment
• Tacrolimus ointment
• Ketoconazole shampoo also arachis oil are useful for the scalp.[1][2]

Venous eczema i.e.:

• Emollients
• Topical steroid
• Either Stockings or compression bandages [2]

Asteatotic eczema:

• Avoidance of soaps
• Humidifying centrally heated rooms may help.
• Topical steroids [1][2]

Contact eczema – irritant i.e.:

• As for atopic eczema
• Wearing of protective clothing such as gloves or in extreme cases even changing occupation or hobbies.

Photosensitive eczema i.e.:

• Phototherapy
• Photoprotection
• Use of sunblock’s
• Desensitization

Lichen simplex/nodular prurigo i.e.:

• Topical steroids
• Tar bandaging
• Intralesional steroids
• Phototherapy

Prevention

• Avoid substances that trigger or worsen your symptoms
• Take your medicines as prescribed.
• Apply ointments and creams
• Moisturize frequently
• Avoid sudden change in temperature or humidity.
• Use fragrance free detergents, cleanser and skin care products.
• Wear protective gloves and clothing when handling chemicals.
• Reduce stress. (7)

Homeopathic Treatment of Eczema

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis. 

Which includes 

The medical history of the patient, 

Physical and mental constitution, 

Family history, 

Presenting symptoms, 

Underlying pathology, 

Possible causative factors etc. 

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions. 

What Homoeopathic doctors do? 

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’? 

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition. 

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines. 

Homeopathic Medicines for Eczema: 

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor. 

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).  

Medicine:

Arsenicum Alb:

People who need this remedy usually are anxious, restless and compulsively neat and orderly.

Chronic eczema; eruption upon scalp and face dry and scaly, or pimples and vesicles upon face with acrid, sometimes foetid, discharge and intense burning itching, the same on likes and genitals.

Margin of hair, itching and burning, by scratching, followed by bleeding.

Indigestion with burning pain and a general feeling of chilliness.

Harsh, dry, rough skin in papers not affected by the eruption; emaciation from disturbances in vegetative sphere; emaciation of urine shows deficiency of urea.[5]

Aggravation at night and in cold air, Amelioration from warmth. Barnlike, scaly eruption, on forehead.

Asterias Rubens:

Eczema on thighs, legs, ankles and instep.

Itching vesicles break and form small ulcers which spread superficially.

Scrofulous and sycotic constitutions.[5]

Calcarea Carb:

This remedy is suited to people who are chilly with clammy hands and feet, and tend to develop eczema and cracking skin that is worse in the wintertime.

They are easily fatigued by exertion and feel anxious and overwhelmed if ill or overworked.

Thick, large, yellow scabs form on the occiput first and spread thence to face.

Eruption mostly dry, but thick, bland pus under the crusts.

Itching not very intense, but on awakening from sleep teething children are apt to scratch their head and make it bleed.

Moist eruption upon legs, about navel and flexure of extremities; no dread of water, but eruptions are aggravated by water.

Chronic eruption with cold feet, as it there were damp stockings on them; chalky stools; skin inclined to ulcerate. Eczema scrofulosum.[5]

Antimonium Crud:

People likely to response to this remedy have eczema with thick, cracked skin and also prone to indigestion.
Suppurating, yellow-crusted eruption, pain to touch and easily detached.

Green sanious pus oozes out from beneath the thick, hard, yellow crusts, irritating the surrounding parts, itching violently.

Aggravation from poultices, bathing, working in water, from alcoholic drinks and in the sun.

Gastric derangement with violent thirst and map tongue; especially on face and genital organs; impetigo scroti.[5]

Cantharis:

Eczema Solare with Much Burning and Itching; when touched burning and smarting.

Complications with urinary troubles; eruption begins in a small spot and spreads so as to involve a large surface, with a watery discharge underneath the scabs.

Amelioration from lying down and in cool weather; Aggravation from warmth.

All in all, Scales form on scalp like enormous dandruff; hair falls out; besides this, perspiration smells urinous; eruption mostly on right side.[5]

Graphitis:     

People likely to respond to this remedy have either tough or leathery skin with cracks and soreness and often have a long-term history of skin disorders.

Furthermore, Eruptions cracked, moist, easily bleeding.

Eczema of lids, eruptions moist also fissured.

Dry, rough skin that breaks easily also exudes gluey moisture.

Either Moist eczema or eruptions behind ears.

Moist eczema around mouth also chin.

Eczema oozing glutinous fluid which is watery also transparent.

Such fluid may be thick, honey-like. Lastly, Very dry skin; never perspires.[6]

Hepar sulph:

Basically, It spreading by means of new pimples appearing just behind the original affected parts.

Violent itching.

Sticking or pricking felt especially; on the parts, which may be painful to touch.[6]

Mezereum:

A person who needs this remedy often has strong anxiety, felt physically in the stomach.

It affects, especially, those parts of the skin that are normally deficient in fat.

With intolerable itching, worse in bed and from touch; copious serous exudation.

Eczema also itching eruptions after vaccination.

In detail; The head is covered with thick leather-like crust under which pus collects here and there and the hair is glued together.

Child scratches face incessantly; then it becomes covered with blood: inflammatory redness of face.

Besides this; Craving for fat and a tendency to feel better in open air.

Face becomes covered with a scab which the child constantly tears off anew, leaving raw spots on which fat pustules form.

Lastly, Ichor excoriates other parts. [6]

Rhus tox:

A person whose eczema has blister like eruptions that look red and swollen, itch intensely and are soothed by hot applications.

Moist eruptions on head, beginning with small yellow vesicles with red areolae, forming thick crusts and hard horny scabs which eat off the hair, offensive itching, worse at night.

Surface raw, excoriated, extends to shoulders or eczema scroti on insides of thighs.

Discharging freely, or thickened, infiltrated and between the fields sore and humid.

Aggravation by changes of weather, especially wet weather, in winter.

Eczema of right hand.

Cold fresh air is not tolerated on head making scalp painful.[5]

Sulphur:

Dry, offensive, scabby, easily-bleeding, burning eruption, beginning along margin of hair from ear to ear posteriorly, with sore pain and cracks.

Offensive with thick pus; yellow crusts, itching and burning, painful especially around chin and under the toes.

Colicky babies with dry roughness of the skin of body, which itches from warmth and feels good from scratching.

Soreness between nates and in groins, most comfortable when dirty, hates to be washed in fresh air.

Amelioration from scratching or humid.[5]

Diet & Regimen

• Dietary Considerations:

  • Identify Potential Triggers: Common culprits include dairy, eggs, gluten, soy, nuts, and seafood. A food diary can help pinpoint which foods worsen your eczema.
  • Anti-inflammatory Foods: Emphasize fruits, vegetables, whole grains, and foods rich in omega-3 fatty acids (like fatty fish) to help reduce inflammation.
  • Probiotics: Some studies suggest probiotics may improve gut health, which could benefit eczema. Yogurt, kefir, and fermented foods are good sources.
  • Hydration: Drink plenty of water to keep your skin hydrated.
  • Vitamin D: May be helpful, but more research is needed. Talk to your doctor about potential supplementation.

  Regimen:

  • Moisturize Regularly: Use a thick, fragrance-free moisturizer several times a day, especially after bathing.
  • Gentle Skincare: Avoid harsh soaps and hot water, which can dry out the skin. Opt for mild, fragrance-free cleansers and lukewarm water.
  • Avoid Irritants: Identify and avoid triggers like harsh fabrics, chemicals, and allergens.
  • Stress Management: Stress can worsen eczema. Practice relaxation techniques like yoga, meditation, or deep breathing.
  • Bathing and Moisturizing Routine: Develop a consistent routine that includes lukewarm baths followed immediately by moisturizer application.
  • Medication: Your doctor may prescribe topical or oral medications to manage inflammation and itching.

Do’s and Dont’s 

Of Eczema

Do’s:

• Moisturize regularly: Use emollients (moisturizers) frequently to hydrate the skin and maintain its barrier function.
• Take lukewarm baths or showers: Avoid hot water, which can dry out the skin.
• Use gentle, fragrance-free cleansers: Avoid harsh soaps and cleansers that can irritate the skin.
• Wear soft, breathable fabrics: Cotton and linen are good choices, while wool and synthetic fabrics can irritate the skin.
• Identify and avoid triggers: Common triggers include allergens, irritants, and stress.

Don’ts:

• Scratch: Scratching can damage the skin and worsen inflammation.
• Use harsh soaps or cleansers: These can strip the skin of its natural oils and exacerbate dryness.
• Overheat: Sweating can irritate the skin and trigger flares.
• Stress out: Stress can worsen eczema symptoms.

"Atopic Dermatitis: The Essential Guide" is a valuable resource for patients and caregivers, providing practical tips and strategies for managing eczema effectively.[13]

Terminology

References  

1. KV Krishna Das – Textbook of Medicine, 5th Edition
2. Kumar and Clark Clinical Medicine 7th edition 2009 by WINBOY
3. https://pubmed.ncbi.nlm.nih.gov/29063428/#:~:text=The%20pathophysiology%20of%20atopic%20dermatitis,mediated%20hypersensitivity%2C%20and%20environmental%20factors.
4. https://www.verywellhealth.com/what-to-eat-when-you-have-eczema-4692428
5. Homoeopathic Therapeutics by Lilienthal
6. The Homoeopathic Prescriber by K. C. Bhanja
7. Ghosh, S., & Banerjee, S. (2023). Current Burden of Atopic Dermatitis in India: A Systematic Literature Review. ResearchGate. https://www.researchgate.net/publication/373546002_Current_Burden_of_Atopic_Dermatitis_in_India_A_Systematic_Literature_Review
8. Kumar, R., & Kaur, S. (2008). Atopic dermatitis in infants and children in India. Indian Journal of Dermatology, Venereology, and Leprology (IJDVL), 74(5), 452-455.
9. Rook’s Textbook of Dermatology Edition: 10th Edition Authors: Christopher Griffiths, Jonathan Barker, Tanya Bleiker, Richard Chalmers, Fiona Creamer, et al.(2020)Publication: Wiley-Blackwell
10. Bolognia Dermatology Edition: 4th Edition Authors: Jean L. Bolognia, Joseph L. Jorizzo, Julie V. Schaffer  (2018)Publication: Elsevier
11. Fitzpatrick’s Dermatology in General Medicine Edition: 9th Edition Authors: Klaus Wolff, Lowell A. Goldsmith, Stephen I. Katz, Barbara A. Gilchrest, Amy S. Paller, David J. Leffell (2019) Publication: McGraw Hill Professional.
12. Andrews’ Diseases of the Skin: Clinical Dermatology Edition: 13th Edition Authors: William D. James, Timothy G. Berger, Dirk M. Elston (2020) Publication: Elsevier
13.  Atopic Dermatitis: The Essential Guide Edition: 1st Edition Author: Alan Irvine Year of Publication: 2018 Publication: Springer.

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