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Eczema

Types, Clinical Features and Symptoms.

Oct 21, 2008 Emma Brodrick

The aim of this article is to provide a definition of eczema, an identification of the various types and the clinical features associated with eczema.

According to Buchannan and Courtney (2007) eczema is the most common inflammatory skin condition seen in the primary care setting. It is characterized by hot, red, itchy skin affecting either no particular area or the whole body.

Peters (1999) states that although the triggers of exacerbation may differ the pathophysiology is similar in all cases of eczema and all the types have several common features. As discussed below the types of eczema may be acute or chronic. Acute is a sudden onset and can be characterized by:

redness and swelling
papules, vesicles or large blisters
exudation and crusting
scaling

Chronic eczema is a continuation of an acute episode, however it is:

less vesicular
more scaly but also pigmented and thickened
more likely to develop painful blisters

An acute episode of eczema if not treated and resolved will develop into a chronic state.

Types of Eczema

The following are considered:

atopic eczema
contact dermatitis
status eczema
discoid eczema
pompholyx eczema
seborrhoeic dermatitis
asteotic eczema/eczema craquelatum

Atopic Eczema

This type is associated with an excessive IgE antibody formation, which can also predispose the sufferer to other illnesses such as asthma, hayfever, urticaria and general allergies. Atopic eczema is an acute, subacute or chronic pruritic (itchy) inflammation of the epidermis and dermis.

Atopic refers to atopy which is a form of allergy in which there is a hereditory or constitutional tendancy to develop hypersensitivity reactions in response to allergens (Oxford Dictionary of Nursing, 1998).

Contact Dermatitis

This is a generic term applied to acute or chronic inflammatory reactions to substances that come into contact with the skin. There are two types:

contact irritant dermatitis
contact allergic dermatitis.

The first example is caused by a chemical irritant and can occur in normal skin or cause an exacerbation of eczema. it will have occured from the first time the sufferer is exposed to the irritant, for example when changing soap powder or hand soap.

The second example is caused by an antigen that illicits a cell mediated hypersensitivity, one that the sufferer has been exposed to previously.

Contact dermatitis causes symptoms from severe pruritus to erythema papules (red spots) and vesicles which may occur initially on the site of contact.

Status Eczema

This is found in patients with venous incompetence, for example patients with venous leg ulcers are more likely to develop status eczema because the skin barrier is already compromised.

Discoid EczemaThis is a chronic pruritic inflammatory condition which causes the development of disque-like plaques that consist of papules and vesicles on an erythematous base. It is very difficult to control and becomes worse in winter when the skin is dry.

Pompholyx Eczema

This involves the palmer plantar region and can be acute or chronic causing deep seated pruritus and vesicle that are filled with sterile fluid. When pompholyx eczema is chronic in nature the vesicles become fissured and are prone to infection. It is more common in hot humid weather.

Seborrhoeic Dermatitis

This condition is a chronic inflammatory condition that causes erythema and scaling in the areas where sebaceous glands are most active, for example in the scalp, eyebrows, nasofolds, hairy chests in men and cradle cap in babies.

Asteotic eczema/eczema craquelatum

Physiological changes within ageing skin cause a crazy paving look that leads to fissuring and scaling that can be pruritic. It can also be caused by overuse of soaps and high environmental temperatures.

Skin damaged by eczema has an inability to hold water making it dry, scaly and very itchy. The skin looses it's ability to act as a barrier to chemicals, biological offenders such as bacteria and physical harm.

References

BuchananP, Courteney M (2007) Topicial treatments for managing patients with eczema. Nursing Standard . 21,41,45-50.

Oxford Dictionary of Nursing (1998)

Peters J (1999) Eczema. Primary Health Care. 7,29-37.

The copyright of the article Eczema in General Medicine is owned by Emma Brodrick. Permission to republish Eczema in print or online must be granted by the author in writing.