Eczema Skin – In the field of skin diseases, the terms "eczema" and "dermatitis" are often used interchangeably, although they have different characteristics. These skin diseases can confuse many, and knowing their differences and similarities is crucial for accurate diagnosis and effective treatment.

Demystifying eczema and dermatitis

Let’s delve into the intricacies of eczema and dermatitis and explore their origins, symptoms, stages, variants, and natural treatment options.

What is eczema? 

Eczema typically begins with dry, itchy skin that, with persistent scratching, turns into the familiar angry, red rash. It occurs primarily on areas of skin such as the elbows, knees, and neck. Although eczema can affect people of any age, it most commonly appears before the age of five, affecting 10 to 20 percent of children. It is notable that nearly half of these young patients clear up the eczema before reaching adulthood. Diagnosis is based primarily on clinical observation and assessment of symptoms.

What is atopic dermatitis?

Atopic dermatitis, the most common form of eczema, is a component of the "atopic triad" along with asthma and allergies. Interestingly, approximately 70 percent of patients with atopic dermatitis have a positive family history of atopic disease. Common triggers for eczema flares include dietary factors, stress, irritants, and environmental elements. The incidence of eczema has increased 21-31% worldwide since the 1970s. In Western treatment paradigms, the first line of therapy is usually emollients and topical corticosteroids. In cases where treatment does not respond, topical calcineurin inhibitors, phototherapy, or immunosuppressants may be used.

Navigating the phases of eczema

For effective treatment, it is important to understand the different stages of eczema. Let's explore them in detail:

Acute dermatitis: In acute eczema, itching often precedes the appearance of the rash. The intense itching can lead to incessant scratching, resulting in red, weeping and cracked skin.

Subacute dermatitis: The subacute phase bridges the gap between acute and chronic dermatitis. Symptoms are usually less severe, itching subsides, but a burning or stinging sensation from open scratches is possible. The edges of the rash are less pronounced, and the rash is dry rather than blistering and weeping. Many acute eczemas naturally progress to the subacute phase during the healing process.

Chronic dermatitis: Chronic dermatitis refers to flare-ups of eczema that last for a long period of time, often three months or more. However, chronic eczema is not only defined by its duration, but also has a number of its own symptoms.

Four dermatitis- variants at a glance

There are different forms of dermatitis, each with its own characteristics:

1. Atopic dermatitis:

As already mentioned, atopic dermatitis is part of the “atopic triad” and often occurs together with asthma and allergies. It mainly affects skin areas such as elbows, knees and neck.

2. Contact dermatitis:

Contact dermatitis can be allergic, caused by a delayed reaction to allergens such as poison ivy, or it can be irritant, occurring when chemicals or physical agents damage the skin faster than it can repair itself.

3. Xerotic dermatitis: 

Also known as asteatotic eczema, often referred to as eczema craquelé because of its cracked appearance, it is a common form of dermatitis caused by excessively dry skin. It can manifest itself on various parts of the body, including the upper limbs and trunk, with the shins being most commonly affected. It typically worsens in winter and in cold, dry weather.

4. Seborrheic dermatitis: 

Closely related to dandruff, it causes dry or oily peeling of the scalp, eyebrows, face and upper body.

Investigation of causes and risk factors

It is important to understand the causes and risk factors associated with eczema:

Impairment of the skin barrier

Research has shown that the development of atopic dermatitis is genetically linked to chromosome 1q21, which results in mutations in the filaggrin-Gene. This gene encodes a protein that is critical for the barrier function of the epidermis, which can lead to increased exposure and sensitization to skin antigens.

Genetics and family history

About 70 percent of people with eczema have a positive family history of atopic diseases, including asthma and allergies.

Influences of birth and childhood

Early childhood experiences can trigger epigenetic and developmental changes. Factors such as the type of birth (vaginal or cesarean section), the type of feeding (breast-fed or bottle-fed), and exposure to environmental allergens play a crucial role in the development of eczema. Where you grow up, including exposure to environmental allergens such as pollen and pets, can also contribute to the development of eczema. 

Gut health and microbiome

Research shows the connection between eczema, gut health and the microbiome. 

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Sources

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3. Gupta, J. and Margolis, DJ (2020) Filaggrin Gene Mutations with Special Reference to Atopic Dermatitis, Current Treatment Options in Allergy, 7(3), 403–413, published online 2020 Jul 10, Available here.
4. Biagini Myers, JM, & Khurana Hershey, GK (PhD, MD). (Title: Eczema in Early Life: Genetics, the Skin Barrier, and Lessons Learned from Birth Cohort Studies). Available here.
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7. West, M. (2022, March 24). The link between eczema, gut health, and the microbiome. MedicalNewsToday. Retrieved from https://www.medicalnewstoday.com/articles/eczema-gut-health. Medically reviewed by Kelsey Trull, PA-C.
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9. Anderson, S.E., & Meade, B.J. (2014). Potential Health Effects Associated with Dermal Exposure to Occupational Chemicals. Environ Health Insights, 8(Suppl 1), 51–62. Published online 2014 Dec 17. doi: 10.4137/EHI.S15258. Available here.