The Eczema is one of the most frequent reasons for consultation in dermatology . Despite this, its prevalence is difficult to estimate, as it is a very broad concept that encompasses many diseases. Victoriano Morales , dermatologist at the Quirónsalud Madrid University Hospital, and Juan Gavín, member of the Spanish Academy of Dermatology and Venereology (AEDV) , explain to CuídatePlus what aspects you should know about this skin problem.
What is eczema and what are its causes?
“Eczema is a way of reacting the skin to different types of alterations or aggressions,” says Gavín. It is “a skin problem that causes dry skin, with a tendency to irritation and itching, scaling and a reddish color . It can affect any age, both children and adults, and is more frequent in certain family groups, ”adds Morales.
“Although its cause is not completely known, genetics seems to have a determining role. People with a family history of eczema have a higher risk in terms of the development of the condition. In these people there is an alteration in the skin barrier that becomes more permeable and less effective, leading to the loss of water in the skin and favoring the acquisition of skin infections such as impetigo , contagious molluscs , viral warts or herpes simplex in these zones ”, says the dermatologist of Quirónsalud Madrid.
Despite the great popular roots, this specialist in Dermatology considers that the relationship between eczema in children and food allergies is very unlikely.
The AEDV member summarizes the causes of eczema in two large groups: alterations of the structure and skin function that trigger inflammation and external triggers that, by a process of irritation or allergy, trigger the lesions.
Are there different types of eczema?
Gavín classifies eczema according to its etiology (or cause) or its evolution. “Depending on the cause, we distinguish atopic eczema (more frequent in childhood), seborrheic , asteatotic , varicose , irritant contact , allergic contact or triggered by drugs . Depending on the evolution, we see acute eczema , where exudative, subacute and chronic lesions predominate , where the skin has thickened as a scratch adaptation mechanism. ”
What symptoms does it give?
The first symptoms of eczema, according to Morales, “usually develop in childhood, usually before the age of five. The presence of intense itching, redness, scaling and small blisters is common . This intense itching leads to scratching by the child, which, in turn, worsens the sensation of itching and can infect the area. This itching is usually more intense at night and interfere with the child’s sleep by increasing his irritability and drowsiness during the day. ”
In addition to the itching, Gavin speaks of burning or discomfort , and considers that “depending on the type of eczema the characteristics of the itching are modified. For example, in atopic eczema, scratching is pleasant, while in intense contact irritating eczema there is usually more discomfort than frank itching. ”
Are there factors that trigger eczema?
There are a number of triggers that should be avoided in people with eczema:
- Very cold and dry environment.
- Excessive sweating.
- Emotional stress or anxiety .
- Sudden changes in temperature.
- Exposure to certain chemicals such as detergents, perfumes, wool, synthetic fiber fabrics, dust, sand and tobacco smoke.
What measures are necessary if you suffer?
Morales explains two concrete measures to adopt for patients with eczema:
Keep the skin hydrated with oily creams or ointments. The best time to apply them is just after the bath, with the skin still moist. Moisturizing lotions should be avoided, as they are less effective.
Short baths of less than 10-15 minutes with warm water. The additives (oils, lotions, powders) that are added in some cases to the bath water with the intention of improving eczema have not been proven effective in the studies carried out and are not advised.
Apart from daily hydration to prevent its appearance, Gavín advises “avoid contact with potentially irritating substances or allergens. In the case of injuries, it is important to consult the dermatologist to arrange the relevant treatment, because what you should never do is self-medicate. ”
On whether eczema requires extra care in summer, the AEDV member considers that it is necessary “to avoid dry skin due to repeated immersions in the water and drying. However, many eczemas even improve in summer. ”
What treatments are there?
If, despite following the above recommendations, the person develops eczema, it will be necessary to start treatment. The first indication will be to use a corticosteroid cream – there are different powers; something that the dermatologist must evaluate in each specific case.
As an alternative to cream corticosteroids, Morales specifies, “we can use tacrolimus or pimecrolimus (calcineurin inhibitors), more indicated to control or maintain eczema, since they do not have an action as fast as the previous ones. They are especially interesting for use in the facial area and folds and their use is authorized after two years of age. Oral corticosteroids or oral immunosuppressants are reserved for cases of more extensive eczema that does not respond well to usual treatment and its use is valued in these special cases. ”
Phototherapy or exposure to ultraviolet rays is very effective for eczema. In this case, patients with greater extent of eczema or in whom their eczema is more resistant should also be selected, since the risk of skin cancer increases .
The most novel medication for the treatment of eczema is called dupilumab . “It is a therapy called ‘biological’ and its administration is by subcutaneous injection. Its high cost and potential for adverse effects make it reserved only for adults with moderate or severe eczema and who have not previously responded to other treatments, ”says Morales. “These biological therapies that are beginning to be used in atopic eczema will mean a major change in the management of pathology,” confirms Gavín.
Morales cites a last resort, the wet dressings or bandages wet to reduce the itching and scratching of the patient overnight.