Can You Get a Tattoo If You Have Eczema?

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Introduction

Tattoos can be a brilliant way to show off your style or give yourself a new look, but if you have Eczema then it can be a worry. Can you get a tattoo in spite of your skin condition and what should you think about in advance of getting inked?

Whether you’re looking for tattoo shops in NYC where there are some incredible options, or you’re in a remote location, never settle for less than an amazing tattoo shop, as this ink is supposed to be on you for the rest of your life.

Can a tattoo affect eczema?

A tattoo always risks some sort of reaction, especially if you don’t look after it properly. So, while anyone who gets a tattoo has to think about it, it is definitely true that eczema sufferers have more of a consideration. Your skin is more susceptible to having a reaction than the majority of people who don’t have existing skin conditions. Getting a tattoo with eczema is risky at some times.

It should be said as well that you definitely can get a tattoo if you have eczema and there are so many examples of people getting inked and being totally fine afterward, even with this skin condition. Getting a tattoo with eczema is risky at some times.

Also, if you have eczema scars but you are thinking getting inked could be a really good way to cover them up, you might be in for a surprise. Sensitive areas where there are scars are often best avoided as they can cause you to get more flare-ups as a result.

Eczema and tattoos may have a reaction on skin and must be concerned with dermatologist before getting tattoos.

Are there risks of getting a tattoo if you have eczema?

It might help to think of the risks of getting a tattoo with eczema as the same as anyone else getting a tattoo, but more extreme. The actual sorts of issues you might experience are the same that anyone who gets inked could, but it is more likely, and often more severe if you have a pre-existing condition.

Getting a tattoo with eczema includes the below risk.

Risks include:

  • This is something you don’t want to happen, and it is essential that you practice good hygiene to keep the area in the best possible condition.
  • Flare-ups. Your eczema could simply get worse making it redder and definitely more annoying. You might find yourself scratching a lot as a result.
  • This can be caused in areas where you have had eczema and then decide to get a tattoo.
  • Allergic reactions. Some ink can give you a reaction, and while it isn’t common, it is definitely possible.
  • Open wounds and scarring. If your eczema should cause your tattoo to take longer to heal then you might find that you get scarring that takes a lot longer to deal with than some other people getting their ink.

 

Keep in mind, too, that if you have any skin lesions that have occurred as a result of your skin condition or from previous flare-ups you shouldn’t be getting a tat at this point, it might be worth waiting until your skin is in a better condition.

Is there special ink for sensitive skin?

There are inks that may be more kind to sensitive skin and skin that has conditions like eczema. When you have your tattoo consultation or chat online with your tattoo artist, try to make a point of discussing this with them, it could be that they have to source this specifically, but it is worth it if you are going to get a tattoo and you are worried that the ink could irritate some areas of your body.

Healing and Maintenance of the New Tattoo

So how do you look after the tattoo once you have it? Tattoos are effectively just wounds for the first couple of weeks as the needles make marks in the skin and leave the color desired inside.

The wound hurts, but it also needs you to take good care of it to stop it from becoming dry or getting infected. If you have eczema this is even more vital.

The initial care is done by the tattoo artist who will send you home with a bandage around it and a nice clean wound. They’ll tell you how long to leave the bandage on for.

Your tattoo needs to be cleansed with a wet cloth, but not totally put in water, such as in the bathtub. You can also get ointments, but make sure they are proper tattoo ointments and not ones that will stop the wound from quickly healing.

After 3-4 days of ointment, you can use certain types of moisturizer, as long as they don’t have any irritant ingredients. This helps the tattoo to stay moist and not scab up too badly.

If you feel like you’re getting any sort of complications then you can go to the doctor as they may be able to give you other ointments. There are also a lot of people who think an oatmeal bath is the ideal way to alleviate the itchiness you are probably going to experience in the first week.

One must take above precautions if they have eczema and tattoo.

Things to Consider When Choosing a Tattoo Artist

Being able to find a reliable tattoo shop is a big part of the battle. Someone who is experienced and can either use more sensitive inks, or is simply able to advise you better on the care of your tattoo is best.

On top of that, you need to know you enjoy their style and that they are likely to provide you with the type of ink you want. That’s why we look at portfolios before we choose to work with a tattoo artist, after all.

While having eczema, one must choose a better artist as the tattoo on eczema create flareup.

Eczema in babies, children and teenagers

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Introduction

Eczema is a common chronic skin condition that makes the skin inflamed, red and itchy. There are several types of eczema affecting all age groups. Infants and children commonly get atopic dermatitis and seborrheic dermatitis. Eczema, especially atopic dermatitis often appears in the first 6 months to 5 years of a child’s life. Eczema affects up to 25% of children worldwide. It is estimated that 60% of people with eczema develop it during the 1st year of their life. Eczema, commonly atopic dermatitis may change on how it looks and acts as your child grows older.

Often Eczema have various age groups. Eczema in a child can be treated accordingly.

As parents of children affected with eczema, it is good to know the following facts for better understanding of this skin condition;

  • Eczema is not contagious. Therefore, your child cannot ‘catch it’ from someone or give it to another.
  • It is better to identify the particular triggers that causes flare ups in your child in order to prevent exposure and a subsequent flare. Common triggers include; irritants like soap and detergents, allergens like dust mite and animal dander, overheating, various irritant fabrics like coarse fibered wool, stress, food allergies, bacterial and viral infections etc.
  • Implement a daily bathing routine and proper moisturizing to protect your child’s skin and to lock in the moisture.
  • You have to use prescription medication consistently to control symptoms.
  • There is no cure for eczema and it can be controlled only.
  • Discuss with your dermatologist and get a proper diagnosis of the type of eczema that your child has. So that it will be easy to manage symptoms and flares while preventing further flares by avoiding triggers.
  • It is helpful to maintain a diary on your child’s eczema flare ups and possible triggers that led to them.

Why do children develop eczema?

The exact cause of eczema is unknown. Children who develop eczema has a combination of genes and environmental triggers. Something outside the body (extrinsic triggers) or something within the body (intrinsic triggers) may switch on the immune system leading to an eczema flare. Children who come from eczema families (families with a history of atopic triad – eczema, asthma or hay fever) has an increased tendency to develop atopic dermatitis.

Eczema in various age groups

Eczema looks and acts differently in children of various age groups. The appearance of eczema and the location in the body the rash appears, change as your child grows.

Below mentioned are Eczema age groups:

Eczema in infants (1st 6 months)

Eczema usually appear on your baby’s face, especially cheeks, chin, forehead and scalp. Scalp eczema is mainly due to seborrheic dermatitis which is commonly known as the cradle cap. The eczema in face can spread to other areas of the body.When seborrheic dermatitis affects the diaper region in the body, the area becomes red and inflamed. Eczematous skin in infants, tends to look more red and weepy.

Eczema in babies (6 – 12 months)

Eczema often appears on your baby’s knees and elbows rather than the face. Because these are places that are easy to rub as they crawl and easy to scratch. The eczema rash can get infected. Then there will be pustules (small pus filled bumps) or form a yellow crust on the skin. Babies with nappy rash may have seborrheic dermatitis in their nappy region.

Eczema in toddlers (2- 5 years)

Atopic dermatitis commonly occur in elbow creases and knees. Your toddler’s hands, wrists and ankles can get affected too. Frequently the face is affected. Red patches with small bumps may appear on your toddler’s face – around the mouth and the eye lids. Your toddler’s skin may look dry and scaly. Toddlers and preschoolers commonly have patchy eczema on their elbows, wrists, knees and ankles. Sometimes lichenification (thick lesions with deeper lines) can occur due to scratching.

Eczema in children (5 – 12years)

Eczema usually appears in the back of elbows and knees. Sometimes hand eczema can be common. Itchy patches and redness may develop behind your child’s ears, scalp and feet.

Eczema in teenagers

Teenagers can have patches of eczema anywhere on their bodies. These areas include; around their necks, eye lids, ears, hands, folds of their elbows and behind their knees. These patches can be inflamed, thickened and bumpy. Lichenification can occur because of frequent scratching.

When should you take your child to a doctor or a dermatologist?

  • If your child developed the rash for the first time and if you are not sure whether it is eczema
  • If the eczema is very itchy and your child scratches uncontrollably
  • If the lesions are oozing (weeping) or bleeding
  • If your child has trouble sleeping because it is so itchy
  • If the eczema does not respond after a few days, although you have been treating as usual
  • If the rash is painful
  • If there is pus oozing from the lesions or pustules (pus filled bumps) formed on the lesions
  • If your child is having fever, feeling tired and ill

How is eczema in a child treated?

Eczema in a child is not curable. It is managed by treating flare ups as they appear and preventing future flares. If your child’s eczema is mild, local application of a mild corticosteroid cream or ointment will help to control the lesions. Ex: 1% hydrocortisone. This can be bought over the counter as well.

If your child’s eczema is severe, you will need a prescription for a stronger corticosteroid. For children with mild to moderate eczema on face and body folds, a non – steroidal cream like pimecrolimus or tacrolimus may be prescribed.

Antihistamines like cetirizine or fexofenadine are prescribed to reduce itching and to prevent your child from scratching the rash. Scratching can worsen an eczema rash. Corticosteroids and antihistamines will settle the flare within a few days in many children. An oral steroid course will be prescribed for children with severe eczema. Oral antibiotics will be prescribed if your child’s rash is infected, when pus is present or if your child has fever because of the infected rash.

What can you do to help your child with self- care?

As parents you have a big role to play in ‘at home treatment’ of eczema.

  • Get your child to use a moisturizer regularly. A good, thick moisturizer which is fragrance free is ideal to use twice a day. Your child can apply the moisturizer soon after a bath or shower, while the skin is still damp. It will help to absorb the moisturizer in to skin well. For babies and younger children, it is your duty as parents to keep them well moisturized.

If your child’s skin is very dry, ointments are better as they are greasier than creams.

  • Bathing routines – Make sure that your child have short baths or showers. Water can be lukewarm but not hot, because hot water can strip the moisture from the skin. A simple fragrance free moisturizing bath oil is better than using soap or body wash.

Bathing helps to get rid of dirt and other irritants from your child’s skin. When bathing your baby, wash your baby’s smelly and dirty body parts using a mild fragrance free cleanser. Avoid scrubbing your baby’s skin. Limit the bath time to 5-10 minutes. Apply moisturizer soon afterwards.

  • Keep your child cool. Avoid keeping them near heaters or fire places.
  • Avoid dressing them with too many layers of clothing. Cotton clothes and underwear are better. Avoid clothes made with polyester and coarse fibered wool.
  • If your child scratches often, try to distract them. Keep their finger nails short and clean. You can put cotton mittens to cover your baby’s hands.
  • Identify and avoid triggers and allergens that can irritate their skin.

It is important to start treating your child’s eczema as soon as you notice it. This can prevent the skin condition from worsening. Delayed seeking of treatment makes it more difficult to treat and control eczema.

Children with eczema become more prone to skin infections. Eczema further weakens the skin barrier making it easier for viruses, bacteria and other germs to get inside the body. If you notice any skin infection on your child such as sores, yellowish crusts on skin or pus filled blisters seek help without delay.

Summary

Eczema is a common chronic skin condition which has no cure. It is quite common in babies, children and teenagers.  Eczema can be controlled with a customized skin care routine. This includes moisturizers, prescription medications and eliminating triggers to prevent future flare ups. As parents and caregivers you have a big role to play when it comes to managing your child’s eczema.

 

References:

https://nationaleczema.org/eczema/children/

https://www.aad.org/public/diseases/eczema/childhood/treating/treat-babies

Calculating EASI (Eczema Area and Severity Index)

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Introduction

Atopic dermatitis, commonly known as eczema is a common chronic skin condition. Therefore, it is important for doctors or dermatologists to assess its severity and to measure the extent or the area involved in order to manage this condition, as well as to assess the response to treatment in their patients. EASI score is a tool which is used for this purpose. Once you learn how to calculate eczema severity index accurately, it will take only a few minutes to assess an eczema patient. EASI is actually easy!

The Eczema Area and Severity Index (EASI) is a validated scoring system which grades the physical signs of eczema (atopic dermatitis). EASI is a core outcome for measuring the clinical signs of eczema in all clinical trials. However, EASI score includes only the inflamed regions in the body and it does not include a grade for scaling and dryness.

Calculating Eczema Area and Severity Index score

When calculating EASI, 4 body regions are considered. They are;

  1. Head and neck
  • Scalp – 33%
  • Face – 17% each side, occupies 33%
  • Neck – 17% front and back, occupies 33%
  1. Trunk including the genital region
  • Front – 55%
  • Back of trunk – 45%
  1. Upper limbs
  • 50% right arm
  • 50% left arm

Front of each arm is 25% and back of each arm is 25%

  1. Lower limbs including the buttocks
  • R/leg – 45%
  • L/leg – 45%

Front of each leg is 22.5% and back of each leg is 22.5%

For each of the 4 regions of the body, the area score is recorded. Area score is the total percentage of skin affected with eczema for each body region.

Area score Percentage of skin affected by eczema in each region
0 No active eczema in this region
1 1–9%
2 10–29%
3 30–49%
4 50–69%
5 70–89%
6 90–100%: the entire region is affected by eczema

 

Severity score

The severity score is also recorded for each region of the body. It is calculated as the sum of the intensity score using 4 different signs. These 4 signs include;

  1. Scratching and excoriation
  2. Redness of skin (erythema and inflammation)
  3. Thickness of skin (swelling and induration in acute eczema)
  4. Lichenification (lined skin with furrows and prurigo nodules in chronic eczema.

Half scores are permitted. It is difficult to assess redness in patients with a dark complexion. Therefore, if you are in doubt, you can increase the average redness score by 1 level.

Score Intensity of redness, thickness/swelling, scratching, lichenification
0 None, absent
1 Mild (just perceptible)
2 Moderate (obvious)
3 Severe

 

How are the calculations done?

You have to record the intensity of each 4 signs for all 4 regions separately and calculate the severity score.

  • Severity score = scratching intensity + thickness intensity + redness intensity + lichenification intensity

For each region, multiple the area score by the severity score and by a multiplier. Note that the multiplier is different for each of the body region and is also different in children.

  • Head and neck: severity score x area score x 0.1 (in children from 0–7 years the multiplier is 0.2)
  • Trunk: severity score x area score x 0.3
  • Upper limbs: severity score x area score x 0.2
  • Lower limbs: severity score x area score x 0.4 (in children from 0–7 years the multiplier is 0.3)

To determine the final EASI score, add up the total scores for each region. The minimum EASI score is 0. The maximum EASI score will be 72.

How do you record the EASI score?

Body region Redness Thickness Scratching Lichenification Severity score Area score Multiplier Region score
Head/neck _______ +_______ +_______ +_______ =_______ X_______ X 0.1 (If ≤7 yrs, X 0.2) =_______
Trunk _______ +_______ +_______ +_______ =_______ X_______ X 0.3 =_______
Upper limbs _______ +_______ +_______ +_______ =_______ X_______ X 0.2 =_______
Lower limbs _______ +_______ +_______ +_______ =_______ X_______ X 0.4 (If ≤7 yrs, X 0.3) =_______
The final EASI score: add up the 4 region scores =_______ (0-72)

 

All regions has to be added up separately to get each region score. Then the values of each region score in all 4 regions must be added together. Then you will be able to calculate the final EASI score which will be between 0-72.

To help you understand better, let us look at an example of a child with an acute flare of eczema and calculate the EASI score.

Ex: A 5 year old girl has developed an acute flare up of eczema. This flare up has affected all her limb flexures. The trunk of this child is reddish and dry.

Now let us calculate the region scores.

  • Since the head and neck is not affected, the score in this region is zero. (severity score = 0 and area score is also 0)
  • The trunk is mildly red which gets 1 point. Since it is not scratched and not lichenified no points are given. Skin is thickened only mildly, therefore, can give 1 point. When the points are added thee severity score is 2.

The trunk is affected around 60%, therefore the area score is 4.

  • Skin in both elbow flexures are affected by eczema and it is moderately red (2), moderately scratched (2), only mildly thickened (1) but since it is not lichenified it is 0. The severity score adds to 8.

Area score is 1 because less than 10% of both upper limbs are affected.

  • Eczema behind both knees are extremely red and is quite severe. 3 points are given. They are severely scratched (3), with severe thickening (3) and mild lichenification (1) is seen. Therefore thee severity score is 10.

Area score is 2, because around 20% of the legs are affected.

Now let us calculate the region score for each of the regions.

Severity score X Area score X Multiplier

  • Head and neck = 0
  • Trunk = 2 x 4 x 0.3 = 2.4
  • Upper limbs = 5 x 1 x 0.2 = 1
  • Lower limbs = 10 x 2 x 0.3 = 6.0

EASI score = 2.4 + 1.0 + 6.0 = 9.4

The 5 year old girl with an acute flare of eczema was found to have an EASI score of 9.4.

What are the advantages of calculating EASI?

EASI (Eczema Area and Severity Index ) is a tool or a scale used in clinical trials to assess the extent and severity of eczema. The highest score is 72 which indicates worse severity of eczema. It has been suggested that severity of eczema based on EASI score can be categorized as follows;

  • 0 = Clear
  • 1 – 1.0 = Almost clear
  • 1 – 7 = Mild atopic dermatitis
  • 1 – 21 = Moderate severity of atopic dermatitis
  • 1 – 50 = Severe atopic dermatitis
  • 1 – 72 = Very severe atopic dermatitis

In the example stated above, the 5 year old girl who had an acute flare of eczema falls to the category of moderate severity.

EASI score can also be used to assess the response to treatment.

Summary

The Eczema Area and Severity Index (EASI) is a validated scoring system which grades the physical signs of eczema. The body is divided in to 4 regions and the calculation is done by adding up scores of each region.

EASI score = Severity score X Area score X Multiplier

The severity and extent of eczema can be assessed by calculating thee EASI score and it is an important tool used in clinical trials.

References:

https://dermnetnz.org/topics/easi-score

https://journals.sagepub.com/doi/10.1177/1203475420923644

https://www.ncbi.nlm.nih.gov/books/NBK539234/

Eczema vs. Atopic Dermatitis

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Eczema vs. Atopic Dermatitis: What is the difference?

Eczema is a common chronic skin condition. Eczema is the name given for a group of skin conditions that cause your skin to become inflamed, red and itchy. The lighter skin tones usually become red, while darker skin tones become brown, gray or ashen. Eczema is not a contagious skin disease and you cannot ‘catch it’ from someone. However, the exact cause is unknown, but there is a combination of genes and environmental factors that play a role. When an allergen or an irritant which may be from outside (extrinsic) or even inside (intrinsic) your body activates your immune system so that inflammation can set in. The symptoms occur because of this inflammation and it is common to almost all the different types of eczema.

What are the different types of eczema?

There are 7 different types of eczema. They are;

  • Atopic dermatitis
  • Seborrheic dermatitis
  • Contact dermatitis
  • Stasis dermatitis (varicose eczema)
  • Nummular eczema (discoid eczema)
  • Dyshidrotic eczema (pompolyx)
  • Neurodermatitis (lichen simplex chronicus)

The above different types of eczema has its own effects on the skin and should be treated accordingly

Although atopic dermatitis is commonly referred to as eczema, it is only a type of eczema. This is probably because atopic dermatitis is the commonest form of eczema. It is the reason why many people simply refers to it as eczema. Research suggests that atopic dermatitis affect 15- 20% of children and 1-3% of adults worldwide.

It is possible to get more than one type of eczema at the same time. However, each type of eczema has its own triggers and the treatment methods can be different. Therefore, it is important to consult a dermatologist who specializes in eczema in order to diagnose the exact type or different types of eczema you have. He or she will be able to formulate a management plan accordingly so that you will be able to prevent future flare ups.

We should be aware about these different types of eczema and take precautions accordingly.

What is atopic dermatitis and how does it differ from other types of eczemas?

Atopic dermatitis is the commonest type of eczema which makes your skin dry, itchy and cracked. It is commonly seen in children and it develops often before their first birthday. However, atopic dermatitis can develop in adults for the first time.

The difference is that other types of eczemas are commonly seen in adults than in children.

Just like other types of eczemas atopic dermatitis is a chronic (long term) skin condition. In some children it can clear completely or improve significantly as they grow older. This type of improvement with age is seen in atopic dermatitis and not usually in other types of eczemas.

The symptoms of atopic dermatitis may vary. Some will have dry, itchy skin in small patches while others have wide spread inflamed skin throughout their bodies. Atopic dermatitis commonly affects hands, insides of elbows and backs of knees. Although it can affect any part of your body. Face and scalp are affected especially in younger children. Atopic dermatitis may come as flare ups. These are periods when symptoms become more severe.

Like other types of eczemas, atopic dermatitis does not have a clear or an exact cause. ‘Atopic’ means sensitivity to various allergens. Therefore, atopic dermatitis occurs often in people who are prone to get allergies. Atopy runs in families and can associate with other allergic conditions like hay fever and asthma.

Certain triggers like soap, detergents, hot and humid weather and stress can lead to symptoms or flares. Especially in young children even food allergies may play a role.

Here is a brief overview of other types of eczemas.

  • Seborrheic dermatitis – also known as seborrheic eczema. It is a type of eczema where red and scaly patches develop on your eye brows, sides of the nose, scalp and ears. Seborrheic dermatitis commonly affects the hair growing areas and areas where oils (sebum) are secreted. It has a scaly, dry appearance and may be caused by a reaction to yeast, which is a commensal organism on our skin.There is an associated over production of Malassezia yeast. This leads to an over reactive immune response that causes skin inflammation. Cradle cap is seborrheic dermatitis seen in infants, and it typically develops within a few weeks after birth and disappears after some time on its own.
  • Contact dermatitis – When your body comes in to contact with a certain substance, skin will start to react and this type of eczema can occur. Ex: metals like nickel in watch straps, rubber, certain perfumes, poison ivy, bleach, detergents and other irritants.

This rash is typically red and can itch and burn. Blisters can be seen when severe.

  • Stasis dermatitis (varicose eczema) – This type of eczema commonly affects your lower legs. It is caused by problems with blood flow through your leg veins. Gravity causes stasis of venous blood. When there is reduced blood circulation in elderly and in those with varicose veins the blood can seep out. Skin discoloration can occur along with ankle swelling. Chronic venous eczema can associate with non-healing varicose ulcers.
  • Nummular eczema (discoid eczema) – in this type of eczema, circular or oval shaped patches occur on skin. There can be triggers like insect bites, chemical burns, skin trauma and dry skin to develop discoid eczema.
  • Dyshidrotic eczema (pompolyx) – This is a type of eczema which causes tiny blisters to erupt especially in the palms of your hands. These blisters are often painful. Dyshidrotic eczema can develop in the soles of feet too. It is commonly seen in adults under the age of 40 and in females. Occupational exposure to certain metals, stress, moist hands and hot weather can be common triggers.
  • Neurodermatitis(Lichen simplex chronicus)– This is a skin condition that starts with an itchy patch of skin. Scratching makes the lesion itchier. This itch – scratch cycle causes the skin which is affected to become thick and leathery. Several itchy spots may develop typically on the wrists, forearms, neck, legs and anal region. These lesions are very itchy most of the time. Scratching can cause bleeding and even scarring.

What are the features that are common to all types of eczemas including atopic dermatitis?

  • The rash occurs due to an inflammation of the skin and sometimes irritation.
  • The exact cause is unknown
  • Eczema is not contagious.
  • All types of eczemas are almost always itchy, including atopic dermatitis.
  • Family history is commonly seen
  • Treatment commonly includes antihistamines, topical steroids and emollients and especially adhering to self-care measures. However, atopic dermatitis where there are trigger factors removal of such triggers are helpful.
  • Eczema is not curable and it can be controlled only.

What are the differences between other types of eczemas and atopic dermatitis?

It can be challenging to differentiate the various types of eczemas because symptoms can be common such as dry skin and inflammation. However, there are a few differences. Taking a proper history and examination will help the dermatologists to differentiate between atopic dermatitis and other types of eczemas.

  • Age – Atopic dermatitis commonly affects infants and young children. Other types may occur at any age, but more prevalent in adults.
  • Location of the rash – Atopic dermatitis typically present in cheeks or inner aspect of elbows and knees in infants and young children. In adults atopic dermatitis can occur in other areas like back of elbows and around eyes.

Seborrheic dermatitis occur in scalp and other hair growing, oil secreting regions.

Dyshidrotic eczema occur in palms and soles.

Varicose eczema typically occur in lower legs.

  • Type of lesions – Distinct characteristics are found in certain types of eczema.

Ex: Discoid eczema – round shaped distinctive lesions

Contact dermatitis – lesions appear typically in areas exposed to the irritant. There can be clear borders with a visible edge.

Dyshidrotic eczema – small painful blisters in palms and soles

  • Associated comorbidities – Atopic dermatitis is often associated with other atopic conditions like asthma, hay fever and allergic conjunctivitis. Other types of eczema are not associated with atopy.

Summary

Eczema is a common term for a group of chronic skin conditions that cause skin inflammation and irritation. Atopic dermatitis is the most common type of eczema and many individuals often refer to it as eczema. However, there are many other types of eczema. While they have similar features and symptoms, each type differs in its causes and progression of the condition. Being able to identify the type of eczema in a person is crucial for treatment and prevention.

 

References:

https://nationaleczema.org/eczema/types-of-eczema/

https://www.nhs.uk/conditions/atopic-eczema/

Steroid cream for Eczema

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Introduction

Topical steroids are medicated creams that can be applied on skin to treat eczema. It is a very effective treatment in addition to emollients (moisturizers). A short course of prescription steroid cream for eczema is enough to clear up an eczema flare. If you use it for short periods, side effects are uncommon. Steroids reduce skin inflammation which occurs in eczema.

Eczema or atopic dermatitis is an inflammation of the skin leading to red, itchy rash.

What are topical steroids?

Steroids also known as corticosteroids belong to a group of medications known as glucocorticoids. Topical steroid is an anti-inflammatory preparation. Apart from being anti-inflammatory, it also acts by being immunosuppressive, anti-proliferative and vasoconstrictive. Steroid containing topical products include creams, ointments and lotions. Creams work best in treating moist or weeping areas of eczematous skin. They are usually white. Ointments are best to treat dry and thickened areas of skin. They are usually clear. Lotions are used to treat hairy regions such as scalp. They are thin creams.

Steroids work by reducing the inflammation of your skin. They are used for many skin conditions and eczema is one of them. Prescription steroid cream for eczema is effective in treating eczema.

There are several types of topical steroids and they are categorized according to their strength. Greater the potency or strength, more effective it will be in reducing inflammation but on the other hand side effects will be more with continued use.

  1. Mild – Ex: 1% Hydrocortisone
  2. Moderately potent – Ex: Prednicarbate
  3. Potent (strong) – Ex: Betamethasone valerate, Mometasone furoate
  4. Very potent – Ex: Clobetasol propionate

How topical steroids are prescribed?

When there is one or more patches of an eczema flare-up, a course of topical steroid is used. Once the flare-up is cleared, the topical steroid treatment can be stopped. The aim is to use the lowest strength of topical steroid to minimize the side effects, but strong enough to clear your flare up.

Ex: 1% Hydrocortisone is used to treat eczema in children

Usually topical steroids must not be used for prolonged periods on large areas of the body. This rule is important especially for children. For severe inflammatory eczema, a very potent topical steroid will be used such as Clobetasol propionate. A small amount should be applied on affected areas while gently massaging into skin.

Sometimes your doctor or the dermatologist will use 2 or more preparations of different strengths at the same time.

Ex:

  • Mild topical steroid for eczema lesions on the face
  • Moderately potent steroid for lesions on arms and legs where your skin is thicker
  • A very potent steroid is needed for eczema on your palms and soles as the skin is thick in these areas.

Usually a short course of topical steroids for 7 -14 days is enough to clear a flare-up although sometimes longer courses are required. Some dermatologists will try a short course of a strong topical steroid usually for 3 days to treat a mild to moderate flare. This method is quick and quite safe. How often a steroid course is necessary will depend on how often you get a flare and it greatly varies from person to person. Once the steroid topical course is over, emollients must be continued daily to prevent further flares of eczema. Therefore, prescription steroid cream for eczema for a short period usually gives relief.

For people with frequent flares of eczema, a steroid can be applied on the usual sites where you get a flare up for 2 days every week. This is known as weekend therapy. It helps to prevent a flare up from occurring.

How to apply topical steroids?

Topical steroids can be applied once or twice a day according to your doctor’s advice. A fingertip unit is the correct dose and it is a small amount that has to be gently rubbed on the areas of inflamed skin until it disappears. Although moisturizers are applied liberally, topical steroids must be applied carefully.

First apply your emollient and wait for 10-15 minutes, before applying the prescription steroid cream for eczema. Wash your hands after application.

What is a fingertip unit (FTU)?

A fingertip unit is the amount of steroid that is squeezed out from a tube (standard size with a 5mm nozzle) along an adult’s fingertip. 1 FTU is enough to treat an area, twice the size of an adult palm with fingers together.

Pros and cons of topical steroids

Topical steroids are especially useful in treatment of any inflammatory skin condition. It is very effective to treat a flare-up of eczema. However there are certain side effects which you have to know.

What are the side effects of topical steroids?

A short course (less than 4 weeks) of topical steroids is generally safe and side effects are rare. Problems arise when you continue to use topical steroids for prolonged periods or if strong steroids are used frequently. Side effects are common if strong topical steroids are used long term. The side effects can be local or systemic.

Local side effects (affecting the area treated and a bit of surrounding skin)

  • Burning or stinging sensation – This is common when you apply a topical steroid for the first time. Once your skin gets used to the treatment, this feeling will subside.
  • Skin atrophy (Thinning of skin) – although uncommon with normal regular use, it occurs especially if a potent steroid is used under occlusion (air tight dressing).
  • Worsening or triggering other skin conditions like acne, Rosacea and perioral dermatitis.
  • Develop striae (permanent stretch marks), telangiectasia (thin spidery blood vessels), easy bruising and discoloration. These are common with long term use of topical steroids.
  • Changing of skin color – This is noticeable more in people with dark complexion.
  • Growth of hair will increase in the treated area of skin
  • Allergic reactions – This may occur usually to the preservatives used in the steroid product. It can irritate your skin and worsen inflammation.

Systemic effects (affecting your whole body)

This is rare with topical steroids but can occur when strong steroids are used for long periods. The steroid can get absorbed in to your blood stream.

  • Affecting the growth of children – If children need repeated doses of strong topical steroids, their growth must be monitored.
  • Increase of blood pressure
  • Increase of blood cholesterol levels
  • Fluid retention (Collection of fluid in legs)
  • Baldness (thinning of hair in scalp)
  • Features of Cushing syndrome – weight gain, skin thinning, mood changes, buffalo hump in the neck, purple color striae, moon face etc.

Although there is a common fear of treatment, the risk of side effects is lower than most of us think, as long as it is applied as prescribed and not used longer than necessary.

What is topical steroid withdrawal?

This can occur when treated with a moderate strength or potent steroid which is stopped suddenly. The symptoms of topical steroid withdrawal include red skin, stinging, burning pain, itching, excessive sweating and peeling of skin. The severity of symptoms may vary from mild short lived to severe long term. The symptoms will gradually settle, sometimes leaving your skin dry and itchy for prolonged periods.

What should you be careful about when using steroids?

  • Do not undertreat because you are too cautious – always apply as prescribed to clear your flare up.
  • Avoid using too much – you might want to continue topical steroids daily, even after your eczema has cleared, in order to prevent a future flare. You should not use steroids for long periods without close supervision by a doctor. However, you can apply moisturizers liberally every day which will help you to prevent a flare up of eczema.

In order to prevent side effects, the strength or potency of the topical steroid needs to be adjusted to the sensitivity and thickness of the skin area which needs to be treated.

Steroids become more potent in your face, eye lids, genitals, inner sides of joints and arm pits because the skin is thin and sensitive. Therefore, steroids of low or medium potency is enough to treat eczema in these regions. Higher potency steroids are needed for scalp, palms and soles as the skin here is thick and the medication should reach deeper layers of skin.

The effect will be stronger when topical steroids are applied to wet skin. It acts better when applied after taking a bath when your skin is damp rather than applying steroids to dry skin. If you cover the area with a wet wrap or a bandage, it will help to absorb the medication more. It is important to keep this fact in mind when applying steroids to diaper (nappy) covered skin regions in babies.

Topical steroids can be combined with other active ingredients such as antibiotics, antifungal agent or calcipotriol. Topical Antibiotic/ steroid preparations should be used rarely, short term only. This is to reduce the risk of antibiotic resistance.

Prescribing topical steroids in pregnancy – Mild and moderate potency steroids can be safely used in pregnancy. But if using strong steroids in to large areas or under occlusion, caution should be used because it can get absorbed.

There can be potent steroids illegally present in some cosmetic products sold over the counter or via internet. These can give rise to side effects unknowingly. Always read the label before you try out any new products on your own.

References:

Probiotics for Eczema

Table of contents

Introduction

Eczema is a chronic inflammatory skin condition commonly suffered by many people. It affects between 5-20% of people at some point in their life. Numerous clinical trials are on the way and probiotics are thought to be an effective eczema treatment. Although many doctors are using them increasingly to treat eczema, according to a research review published in Cochrane Database of systemic Reviews,it is suggested that probiotics may not be an effective eczema treatment and the use of probiotics is not evidence based. However, there is no harm in using them and evidence do not show an increase of adverse events. Future research is needed to know the exact benefits of probiotics in treating eczema.

The symptoms of eczema can be annoying. Apart from dry sensitive skin, the itching can be severe, especially at night. You may suffer from loss of sleep due to this. Thickened, scaly, crusty skin with red patches can be unsightly. Sometimes these lesions become raw, swollen and ooze pus. Having lesions on hands and visible areas of the body can affect your job and relationships. Having eczema can severely affect your quality of life. Eczema is not a curable disease and it can give rise to many flare-ups during your life time.

Dealing with eczema can be challenging. Can probiotics be the answer?

What are Probiotics?

Our bodies are full of good and bad bacteria. Probiotics are considered as good bacteria, because they keep our gut healthy. Probiotics are live microorganisms taken by mouth. Mostly probiotics include Lactobacillus bacteria and yeast. They are naturally found in yogurt and unpasteurized milk. Kefir, miso, kombucha, Kimchi, dark chocolate, raw cheese and apple cider vinegar are also rich in probiotics. So, depending on the diet, you may be eating foods that contain probitocs already. Probiotics are known to provide healthy digestion.

Probiotics are available as supplements that commonly contain Lactobacillus and Bifidobacterium. These live bacteria in probiotics protect the gut wall by attaching to it and control the growth of undesirable bacteria. This promotes a healthy balance of gut bacteria while improving the function of your gut.

Although the exact impact on eczema by probiotic use is not clear, there are other proven benefits. Probiotics are known to;

  • Boost your immunity
  • Improve your digestion and improving the gut health
  • Help in preventing urinary tract infections

Research suggest that if a pregnant mother takes probitocs prenatally, the incidence of eczema in children will be reduced. However, supplementing probiotics in pregnancy must be done with caution by a doctor.

Why consider probiotics in eczema patients?

Eczema gives rise to dry skin with red, itchy rash with or without oozing. Scratching can make the lesions bleed and your skin can become thick and crusty. Eczema can greatly affect your quality of life.  Research has found that patients with eczema have different bacteria in their gut when compared to people who do not have eczema. Sometimes there is associated inflammation in their guts. Research suggests that if this mix of gut bacteria is changed or inflammation of the gut is reduced, eczema symptoms can be reduced too.

Evidence shows that bacteria colonies living on the skins of eczema patients are also different from those who don’t have it. As with the gut, the skin’s micro biome is not as diverse in people with eczema. This can leave it vulnerable for the bad bacteria to grow and proliferate. Staphylococcus is an example for a bad bacteria which proliferates on skin especially in people with eczema. Staphylococcus is a bacteria that is linked with flare- ups of eczema. It can trigger inflammatory response on their skin. Those who have eczema tend to have larger populations of this bacteria on their skin.

The aim of topical probiotic therapy is to build a healthier and more diverse skin micro biome in people with eczema. This is done by introducing the right strains of good bacteria on to the skin of eczema patients. This multitude of good bacteria will help to keep the harmful bad bacteria strains in check.

Eczema is associated with your immune system and the immune response is faulty. Probiotics are known to boost the immunity. So they may work in controlling eczema by reducing the immune reaction. Treatment with probiotics should be continued for at least 6 weeks to 3 months to see results.However, currently available probiotics show minimal difference in reducing eczema symptoms especially itching and loss of sleep.

Emollients (moisturizers) and topical steroids are found to be effective in controlling eczema along with antihistamines to reduce itching. Using these treatments in combination with probiotics will provide the best benefit for eczema. Adding probiotics to your diet or taking them as supplements can reduce the number of eczema flare-ups you get.

How should you start probiotics?

If you think of adding probiotics to your diet or take it as a supplement discuss with your doctor or a dermatologist first. Your doctor will help you in prescribing the best combination of probitocs and where to find it.

There are over the counter probiotic supplements. If you decide to use them, make sure to read the instructions and follow them accordingly. Always take the supplement with food because taking them on an empty stomach can give rise to side effects. Before going for supplements try to consume probiotic rich natural foods.

It is best to consult your doctor before starting probiotic supplements if you suffer from bowel conditions, other chronic diseases or a compromised immune system. If you take a probiotic supplement for the first time or change to another brand, you might experience certain symptoms like gas, diarrhea and heart burn until your body adjusts to the supplement. It will be beneficial if you start with a lower dose and gradually increase to full dose.

Topical probiotics for eczema

Research have also been done on topical probiotics to see how it affects the skin. Although this concept is still new, the research has so far been promising towards eczema. Topical probiotic strain namely Roseomonas mucosa can be helpful in treating eczema. This bacteria is found naturally on our skin. There are topical probiotic lotions produced using this bacteria. A study published in 2018 found that using Roseomonas mucosa containing lotion has been effective in reducing the amount of staphylococcus on the skin. Those who applied this lotion regularly, claimed that their severity of eczema was improved.

Another study published in Clinical, Cosmetic and Investigational Dermatology found that a lotion containing the probiotic Lactobacillus johnsonii significantly improved eczema clinically. Therefore various strains of Lactobacillus are found to be effective as topical probiotic treatment as they have the ability to reduce the staphylococcus bacteria on skin.

Small sample size is one of the main drawbacks in these studies. More research is needed to understand the impact of topical probiotics on eczema; whether there is actually a benefit.

Conclusion

Since the effectiveness of probiotics in treatment of eczema is not proven yet, it is important to note that we should not rely solely on probiotics alone as eczema treatment. As there are no increase of adverse effects, it can be used as complementary treatment for eczema. You may also benefit by strengthened immune system and improvement of your gut health by using probiotics. Research offers promising results.

References:

 

 

Eczema Allergy Test

Table of contents

Introduction

Allergic disorders are increasing across the world and currently affects up to 40% of the population. Eczema is a chronic skin condition which is associated with allergies. Many parents think that knowing the allergens through allergy testing will help to prevent eczema flares. Will it be actually beneficial? Read on to find our more on eczema and eczema allergy testing.

What is eczema?

Eczema also known as atopic dermatitis is a chronic, inflammatory skin condition. Symptoms of eczema include dry, itchy skin with red rashes. You may have several flare ups of eczema throughout life. It can immensely affect the quality of life. Eczema is a common skin condition worldwide. According to research, it may affect up to 30% of children and some of them will continue to have eczema in to adulthood. Eczema is found to be caused by an interaction of your genes and many environmental factors. Most of you will have a family history, but not everyone with eczema has a genetic link. But, if you have a sibling or a parent with eczema, there is a higher chance for you to develop eczema. So, allergy testing for eczema in adults is what needed.

An eczema flare is triggered by environmental factors. These triggers include;

  • Irritants and chemicals – soap, detergents, cosmetics, perfume, cleaning products, formaldehyde
  • Cold air
  • Cigarette smoke
  • Hot weather and heat
  • Airborne allergens – dust, pollen
  • Out- door pollutants
  • Certain fabrics – polyester, wool
  • Certain metals –nickel

You may notice that only some of these triggers are allergic substances.

What is an allergic reaction?

An allergic reaction is an immune response that occurs in our body to a substance to which we are already sensitized. This allergic substance causing the allergic reaction is known as an allergen. An allergen can be anything such as dust, pollen, animal dander, chemicals and certain foods. An allergen which can sensitize certain individuals to cause over reaction by their bodies, may be harmless to others who are not sensitized. It is strongly recommended for allergy testing for eczema in adults.

Why do only some people develop allergies?

It is still unclear why some people get allergies and others don’t. Having a family history may make a child more prone to develop allergic diseases, although not all allergies of parents are passed on to the offspring. But you as parents may pass on the predisposition to allergic diseases. So your child may develop an allergic reaction of some sort such as eczema or hay fever. These genetically predisposed people are known as atopic individuals. The families are called atopic families. These allergic disorders may even coexist. We should also consider allergy testing for eczema in adults.

Ex: babies with eczema have a higher chance of developing food allergies

Our skin is a protective barrier which keeps germs (bacteria, viruses and fungi) and allergens away from our bodies. If you have eczema, your skin barrier is disturbed. This will create a route for allergens to enter the body and sensitize.

Allergy test

If your child is getting frequent flares of eczema, you may wonder whether the flares would stop, provided you know what causes the eczema and the allergens responsible. Many parents inquire about eczema allergy testing for children with eczema. However, only some children with eczema will benefit from allergy testing.

Dermatologists believe that all children with eczema do not need allergy testing. This is because;

  • The most effective way to clear a flare up of eczema is to adhere to the eczema management plan given by your doctor. This will include how the child should be given baths, applying emollients (moisturizers) and using eczema medicines like topical steroids when needed. There are many factors which trigger an eczema flare and not only one allergen. You should help your child to avoid these triggers that leads to his or her eczema.

Triggers can be allergic in nature but most often they can be non-allergic and include irritants, stress, heat, soap, sweating, weather changes, tiredness and a respiratory infection. So, it is only sometimes that eczema allergy tests will help to improve your child’s eczema.

  • You should not limit yourself to avoiding allergens because doing only that will not clear a flare up of eczema.
  • Although allergy shots can be given, they are not proven to help an eczema flare. However, allergy shots given to treat lung allergies may have an effect on reducing eczema.

Here are some signs you should discuss with your child’s dermatologist about allergy testing.

  • Despite following the eczema management plan given by the dermatologist for few weeks, still the eczema remains the same or the improvement is seen only slightly.
  • The growth expected in your child is not happening satisfactorily.
  • If you notice that each time your child is given a certain food, the eczema gets a flare up. However you should remove these foods from your child’s diet only if the reaction is severe or if the dermatologists requests.

Types of allergy tests

  1. Patch test

Substances that your child is allergic to are applied to discs. Each disc will contain a different allergen. These discs are taped to your child’s skin at the back. The skin should be free from eczema before the test. Your dermatologist will examine your child’s skin at specific times to look for reactions.

  1. Skin prick test

Small amounts of the substances that your child is allergic to will be placed on your child’s skin. It can be done on the skin of the forearm or back. Then the skin is pricked or scratched. Your doctor will check for reaction on the skin at specific times.

  1. Food challenge test

A blood test or a skin prick test will tell what food allergies your child doesn’t have.

The blood test will tell whether your child has antibodies in their blood which may react to common substances and lead to allergic reactions. Blood test will help to confirm a suspicion of an immediate air borne or food allergy.

During one of these tests, if your child has a positive reaction to a food, the results need to be confirmed with another type of test. This is referred to as a food challenge. There are many different types of food challenges. If this test is decided for your child, your dermatologist will discuss what to expect.

Conclusion

Allergies are more common in children with eczema than in children who do not have it. So, if you think whether your child is reacting to something, an allergic test may be helpful. An eczema allergy test can be performed to determine allergens. Although parents believe that removing the allergic cause would clear their child’s eczema, unfortunately it is not that simple. It is quite rare for childhood eczema to clear even after removing or reducing the exposure of the possible allergen.

 

References:

 

 

Hand Fungus and Eczema

Table of contents

Introduction

Just like you can get fungal infections on your feet, it is possible to develop fungus in your hands. Hand fungus is called ‘Tinea manuum’ but commonly known as ring worm infection. In Tinea manuum, there is a red, scaly rash with a slightly raised border which is shaped like a ring. Commonly you can get it by touching your groin or feet if they are also infected with Tinea or by touching fungus contaminated objects, soil or infected persons. also infected with Tinea or by touching fungus contaminated objects, soil or infected persons. So it is important and get hand fungus treatment.

Sometimes you may falsely identify a hand fungus as hand eczema as they may have certain similarities. Sometimes both these conditions can be associated with each other.

When eczema arises in your hands it is called hand dermatitis or hand eczema. It is a chronic long- lasting skin condition which is also as common as fungal infections. Hand eczema may lead to severe negative effects on the quality of your life and even on your social status. Hand fungus treatment is therefore mandatory.

Eczema or fungus on your hands will be visible as it is difficult to hide, that may be quite embarrassing when you are among others. It will especially affect negatively on people who use their hands for the occupation such as the chefs, attendants and salon workers. Eczema is not contagious, but hand fungus is. Both these skin conditions can be quite severe, but they are not life threatening.

Hand eczema versus hand fungus

Fungal infection and hand eczema may seem similar as both are red, itchy rashes. Hand fungus typically has a raised border commonly with central clearing. The appearance is like a ring. Hand eczema doesn’t have a raised border and middle of the rash does not clear as the rash spread. So there is difference between hand fungus and hand eczema.

Commonly hand fungus affects only one hand, although you may develop it on both hands. Hand eczema is commonly bilateral and symmetrical. Hand eczema can get several flares and remissions while not responding to over the counter antifungal medications. Even after treatment, eczema can only be controlled and can reappear. However, hand fungus will respond to OTC antifungals and may clear off completely if you treat it properly. If partially treated hand fungus can reappear too and if you develop resistance to treatment, the future treatment of the rash will be difficult.

Hand eczema can be genetic and may run in families. Hand fungus is not familial, but often family members can get infected by close contact as it is contagious.

Although hand fungus can sometimes have associated nail involvement, in hand eczema nails are not involved.

What are the risk factors to develop hand fungus?

  • Those who do sports that involve close skin contact
  • Those using public showers like in gyms etc.
  • Sharing things with infected people such as towels, tools
  • Those who handle or be around animals as Tinea can spread from animals including cats, dogs and cows.
  • Those who wear tight fitting gloves
  • If you sweat too much on your hands

What are the causes of hand eczema?

Hand eczema may be related to occupational exposure or house hold activities. It often affects people who are in to catering, cleaning, hair dressing, mechanical work and health care as they frequently come in to contact with chemicals and other irritating substances.

It is a chronic skin condition which is multifactorial. Contact allergens and irritant substances play a role in triggering hand eczema. The exact cause of hand eczema is unknown. There can be a genetic association for hand eczema and it can run in atopic families. Atopy is the genetic tendency to develop allergic conditions like eczema, asthma and hay fever. Stress can be a risk factor for hand eczema.

As hand eczema is not contagious you cannot ‘catch it’ from another person or spread it to others.

What are the symptoms of hand fungus?

  • The infection usually starts on your palm and may spread to other areas like the back of your hands and fingers.
  • The rash may start small and get larger gradually with time.
  • Itchy, red rash with raised border and the outer surface appears scaly
  • Peeling and flaking of the area
  • Sometimes the fungus can affect your nails which is called onychomycosis or Tinea unguium. Then your nails can get brittle. They appear discolored, thickened and your nail may get separated from the nail bed.

Sometimes a blistering rash on the edges of your palms and fingers may be caused by the fungi. They appear as crops and will contain a sticky clear fluid. They may have a peeling edge. This rash can itch and burn. The reason why hand fungus treatment is necessary.

What are the symptoms of hand eczema?

  • Itching which may be severe – this is a common symptom in almost all hand eczemas.
  • If you scratch continuously the rash can become raw, sensitive and swollen.
  • Skin lesions are red and inflamed. Swelling can occur due to inflammation.
  • The skin of your hand is usually dry and sensitive.
  • There can be small raised bumps that may leak fluid.
  • Oozing and crusting especially when scratched
  • Red or brownish grey dark patches may appear on your hands
  • Long standing hand eczema can give rise to leathery, scaly, cracked and thickened lesions.

Treatment of hand fungus

If your hand fungus is mild, you can use an over the counter anti-fungal cream such as micanazole or clotrimazole. If your rash does not respond, seek help from your doctor or a dermatologist. He or she may prescribe a stronger topical anti-fungal agent. A course of oral antifungal medicine will be added if your lesions are severe or when the rash does not respond to topical treatment alone.

You have to make sure that you stick to the treatment regime as incomplete treatment can lead to resistant forms of fungi.

To prevent further fungal infections avoid touching contaminated objects, soil or animals unnecessarily. Do not share towels or other personal items. Avoid using common tools unless it is necessary. Avoid using public showers if possible. All these things comes under hand fungus treatment and therefor important to apply.

Treatment of hand eczema

Unfortunately there is no cure for hand eczema, but you can successfully control it. Try these home remedies to soothe your lesions.

  • Avoid scratching as it can worsen hand eczema.
  • Identify and avoid triggers that worsen your hand eczema – triggers like pollen, dust, certain foods, strong soaps and detergents,excessive sweating and smoking can worsen hand eczema.
  • Avoid strong soaps and detergents. If you must use them, wear gloves to protect your hands. Use cotton gloves when doing chores.
  • Use a mild soap or a fragrance free cleanser when bathing and washing hands. Pat dry your hands using a soft towel. Do not rub or wipe hard.
  • When you need to clean your hands use lukewarm water instead of hot water.
  • Moisturize your hands well with a good emollient. Get a good hand cream to apply frequently in order to prevent them from drying. Make sure to use an emollient that is alcohol and paraben free with minimal fragrance. If you need help to select the best moisturizer that is suitable for your skin, discuss with your doctor or a dermatologist. Apply moisturizer after a bath and soon after washing hands while your skin is still damp. It helps to absorb and lock in moisture.
  • You can use cold compresses to help soothe your skin especially if it is raw.
  • Over the counter creams like Hydrocortisone can be applied over your lesions. Hydrocortisone is a mild steroid and an anti-itch cream. More potent steroid creams and ointments may be prescribed by your doctor if your lesions are severe (Betamethasone, Mometasone, clobetasol).
  • You can try over the counter antihistamines like Fexofenadine, Cetirizine,Chlorpheniramine, or Loritidine to reduce your itching. Read the instruction leaflet prior to taking any OTC medication.

If your hand eczema does not respond to over the counter medications and home remedies, seek help as stronger medications need to be prescribed. If you think that a certain substance at work or home is the culprit behind your eczema, your doctor will do a ‘patch test’ to identify which irritants or allergens are responsible. Your doctor will also discuss the practices and behaviors that may be contributing to your hand eczema and ways to avoid or modify them.

In summary

Hand fungus is clinically differentiated from hand eczema by following signs.

  • Most hand fungus affect only a single hand.
  • If both your hands are affected, the involvement is not symmetrical.
  • Skin markings become white because the surface is scaling. But in hand eczema skin markings will be increased.
  • The Tinea rash has a raised border
  • Nearby nails can get affected (Tinea unguium)

 

Hand eczema can get complicated with skin infections. This is because of repeated scratching that destroys your skin barrier leading to cracks and open sores. Skin infections can occur with bacteria, viruses and fungi on a hand with eczema.

When your hand eczema gets a superadded fungal infection, it may give a mixed picture.

The itching will be more as both conditions are known to itch. Scratching can lead to erosions and even oozing. Fungal infection can occur especially when you have wet eczema. Fungus thrives on warm moist skin. Treatment will be difficult as the steroids which are used to treat eczema can worsen the fungal infection. Therefore, oral antifungal medications like Itraconazole or Terbinafine may be needed. Sometimes treatment will take a course of 4-6 weeks to eradicate the fungus. Then the eczema can be controlled with local application of steroids.

References:

https://dermnetnz.org/topics/tinea-manuum

https://pubmed.ncbi.nlm.nih.gov/9884898/

https://nationaleczema.org/eczema/types-of-eczema/hand-eczema/

 

 

Is Eczema Hereditary?

Table of contents

Introduction

Eczema which is also referred to as Atopic dermatitis is a chronic, inflammatory skin condition. Hallmarks of eczema include dry, itchy skin with red rashes that may come in flares. It is a common skin disease worldwide. According to research, it may affect up to 30% of children and in some of them, eczema will continue in to adulthood. Although eczema usually appear during infancy and childhood, it can arise in adolescents and adults too, who never had eczema in their childhood.

Eczema is now found to be caused by an interaction of your genes and environmental factors. Most will have a family history, but not everyone with eczema has a genetic link. If you have a sibling or a parent who has eczema, then there is a higher chance for you to develop eczema too. Is this because of the role that genetics play in eczema? So the question arises if eczema is hereditary. Let us find out.

Scientific evidence is strong in supporting the genetic predisposition for development of eczema. Multiple research done worldwide proves that the evidence of gene mutations in several genes may play a role in causing eczema. In this article we will further discuss how eczema becomes hereditary and the research evidence for the relationship between eczema and genetics.

Does research, point towards a relationship between your genetics and eczema? Eczema, is it hereditary?

Birth cohort studies are ideal to assess the health outcome from birth in to childhood with regards to eczema. Given the age specific emergence of eczema, it provides that eczema can be in fact hereditary.

Research data indicates that several genes may be associated in developing eczema. A research review done in 2010 analyzed the whole human genome. Several genes were found to significantly alter the function and composition of skin in patients with eczema. There is an allergic or an inflammatory response in eczema. Some genes affect the immune system leading to this inflammatory response. The other genes will impact specifically on the eczematous skin.

Genes coding for the function of our skin

Our skin has 3 layers – the epidermis, dermis and hypodermis. Epidermis is the outermost layer which is responsible in maintaining the barrier function of our skin. If your skin barrier is healthy, it will support retention of moisture as well as protecting your body from foreign substances that can harm us, such as allergens, bacteria and toxins.

A gene called the FLG gene, instructs the skin cells to make a large protein named ‘Filaggrin’ in the epidermis. Filaggrin plays an important role in barrier function of our skin. It connects the structural proteins in the outermost skin cells and form tight bundles. Filaggrin strengthens the skin cells and create a strong barrier for protection. Research shows that the FLG gene has a mutation in the DNA sequence in about 50% of patients with eczema. Therefore, specific instructions are not given by this defective gene to cells to make filaggrin. Filaggrin is not produced properly when the message is defective. Less Filaggrin will make your skin barrier weak. Epidermis will become dry and unhealthy which will be prone to allergic reactions and infections. When the filaggrin forming gene is mutated and defective, the protective barrier function is lost. This will make you prone for eczema and we can link here if eczema is hereditary.

When there are anomalies in the FLG gene, these people will also be prone to develop asthma and hay fever. This is a classic triad. It is known as atopy. The classic triad of atopy includes eczema, asthma and allergies like hay fever and allergic conjunctivitis. Atopy refers to this genetic tendency to develop allergic diseases and they run in families. These families are known as atopic families. Atopy is typically associated with heightened immune response to many common allergens such as inhaled allergens and food allergens.

In another study, a gene called SPINK5 is also found to be mutated in patients with eczema. This gene is known to instruct skin cells to make proteins. How this mutation in the SPINK5 gene affects to develop eczema is still not clear.

Genes coding for the function of our immune system

The genes that are associated with our immune system include genes forming IL (interleukin) 4, 5 and 13. These genes are found to promote allergy and inflammation. They can cause a reduction in the immune response towards pathogens as well as affecting the skin barrier function.

Interleukin 33 is an inflammatory cytokine that is over expressed in the skin cells of patients with eczema. IL 33 gene stimulates many cells to produce cytokines and create inflammation. It is mainly associated with the itch – scratch cycle of eczema.

Can Eczema be a feature of a separate genetic disorder?

Eczema can be associated with some genetic disorders that have many signs and symptoms including skin abnormalities and immunodeficiency. Examples of such disorders include;

Immune dysregulation, X- linked (IPEX) syndrome, Netherton syndrome, Poly-endocrinopathy, Enteropathy, severe dermatitis, metabolic wasting syndrome (SAM) and multiple allergies.

Are genetics the only reason to get eczema?

Although genetics increases your risk of developing eczema, this is not the only cause. There are many causes that are associated with developing eczema. Usually it is a combination of several causes and risk factors. As mentioned earlier, both genetics and environmental factors play a role in developing eczema.

Here are some of the identified causes and risk factors of eczema;

  • Exposure to cigarette smoke during infancy – smoking indoors and maternal cigarette smoking
  • If the mother went through high levels of psychological stress during the pregnancy, the offspring can be affected
  • If your immune system is defective or over reactive
  • If your skin is very dry and unhealthy
  • Dysfunction of the skin barrier – dysregulation of the immune system may be a cause
  • Certain endocrine disorders like thyroid dysfunction

Now that we know that eczema has a genetic tendency, we will learn more on how an eczema flare occurs.

An eczema flare up is triggered by environmental factors. Once our skin is already at risk to develop eczema because of our genes, many factors can act as triggers to develop a flare.

Environmental triggers for eczema flare-ups include;

  • Irritants such as soap, detergents, cosmetics, perfume, cleaning products, formaldehyde – irritants are found in everyday products we use. One chemical which may act as an irritant to a particular individual to trigger an eczema flare may not be so for another person.
  • Cold air
  • Hot weather and heat
  • Cigarette smoke
  • Airborne allergens
  • Out- door pollutants
  • Fabrics like polyester, wool
  • Certain metals like nickel

You may be having eczema because of your genes, or you still may not have developed any symptoms although you have a strong family history. Naturally you will be worried because of this hereditary tendency, whether you will be a victim of eczema. But if we are careful and we look after our skin well, we should be able to delay onset of eczema or prevent a flare up. if eczema is hereditary we should also not forget environmental triggers could also be the reason.

What can we do to prevent an eczema flare up, even if we are genetically prone?

  • Moisturize and hydrate your skin well
  • Use a humidifier at home when using heaters during winter to prevent dehydration of your skin
  • Manage your stress well by practicing relaxation techniques such as yoga and meditation
  • Identify and avoid irritants which can trigger a flare such as wool, certain chemicals and other irritants
  • Avoid using harsh soaps and detergents

Conclusion

Eczema can affect up to 30% of children worldwide. It often afflicts infants in the 1st few months of life. This can be the first indicator of this atopic tendency. Research indicates that eczema or atopic dermatitis has a strong genetic link, so eczema is hereditary. Several genes that affect our immune system and skin function may play a role while environmental factors and stress can trigger eczema. There are many things you can practice to prevent getting a flare. However, once you are genetically prone towards eczema, you may get a flare at some time in your life. Do not get disheartened. Seek treatment early. Although there is no cure for eczema you can successfully manage flares and keep your condition under check, if you stick to your treatment plan and follow up regularly with your dermatologist.

 

 

 

References:

https://medlineplus.gov/genetics/condition/atopic-dermatitis/

https://www.aaaai.org/Tools-for-the-Public/Allergy,-Asthma-Immunology-Glossary/Atopy-Defined

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957505/

https://pubmed.ncbi.nlm.nih.gov/31455506/#:~:text=Interleukin%2D33%20(IL%2D33,for%20the%20development%20of%20AD.

 

 

Top eczema triggers to avoid

Introduction

Although eczema is one of the commonest chronic skin diseases, we still don’t know what exactly causes eczema. Researchers believe that a combination of genetic causes and trigger factors play a role in most types of eczema. You may be born with an increased likelihood of developing eczema because of the genes you inherit from your parents.

Those of you with eczema tend to have an over reactive immune system. It can get triggered by both intrinsic (inside the body) and extrinsic (outside the body) substances. The response to the substance is inflammation. Inflammation leads to red, itchy skin lesions common to most types of eczema.

How does eczema skin differ from normal skin?

Normal skin provides a healthy protective barrier which prevents skin from drying out and fights off infections. This barrier is made by a protein called filaggrin. Research shows that there is a mutation in the gene which creates filaggrin in some people with eczema. As filaggrin is not there to build a strong skin barrier, the moisture from your skin can escape outside leading to very dry skin. Because of the defective barrier, bacteria and viruses can enter in, making your skin infection prone.

The goal of eczema management is to keep your symptoms under control. You have to feel comfortable and stay healthy while living with eczema, because eczema has no cure and it can cause flares from time to time. Prevention of getting a flare can be challenging. To prevent a flare we have to identify the potential triggers which causes a flare.

What are the common eczema triggers?

It may be difficult to detect a trigger because a flare can occur sometime after exposure and not directly after. This time lag can make it difficult to detect some of the triggers which causes our eczema flare.

We have to keep in mind that eczema affects everyone differently. What triggers a flare in you is not the same for another. You may experience the symptoms of eczema in different regions in your body and at certain times of the year.

Common eczema triggers are;

  • Dry skin – If your skin gets very dry, it becomes scaly, rough and brittle easily. You may get a tight feeling. These features can lead to an eczema flare.
  • Irritants – some substances can act as irritants to our skin. These can be found in the everyday products we use and even in natural substances that come in to contact with our skin. We use most of these products on our body and in our homes in our day to day lives. These irritants can make our skin itch and burn or become red and dry further. Because in eczema we already have a sensitive skin with a defective barrier.

These irritants can be;

  1. Hand and dish soap, shampoos, body wash, bubble bath
  2. Laundry detergents, surface cleaners, disinfectants and other household cleaners
  3. Some natural liquids such as juice from fresh fruits, vegetables and meat.
  4. Metal ex: Nickel (found in watches, kitchen ware, jewelry, batteries etc.)
  5. Fragrances and perfumes
  6. Cigarette smoke
  7. Antibacterial ointments ex: Bacitracin, Neomycin
  8. Certain fabrics such as wool, polyester and other synthetic fabrics

Here are some potential chemicals which can irritate our skin and cause an eczema flare up.

  • Isothiazolinone – it is an antibacterial product found in some personal care products ex: baby wipes
  • Formaldehyde – it is found in glues, adhesives, household disinfectants and some vaccines
  • Paraphenylene-diamene – found in temporary tattoos and leather dyes
  • Cocamidopropyl betaine – found in shampoos and lotions

These substances can irritate your skin when it comes into contact with them or when you touch them.

  • Environmental factors – cold or dry weather conditions, humidity and dampness, house dust mites, molds, pollen and pet dander may act as triggers to give a flare.

Most of these are air borne allergens. Allergens are substances which cause an allergic reaction.

  • Food allergies – allergens in certain foods can trigger eczema.

Ex: Cow’s milk, pea nuts, soya, eggs, wheat, gluten, shell fish

As each one with eczema is different, whether you are allergic to such food items and to what food items, differ from one patient to another. Some eczemas are not related to food allergies at all. Be mindful of what you eat if you know that certain foods can trigger your eczema.

  • Stress – emotional stress is found to be a trigger for eczema flares. The exact cause of how stress affects eczema is not sure. Symptoms may worsen when you are feeling ‘stressed’. Knowing that you have eczema which is a chronic skin disease can also stress you which can lead to a flare up. Living with eczema can be challenging and it can affect our emotional wellbeing. The appearance of the skin rash is not only embarrassing but it can lead to severe itching and sleepless nights.

Stress and anxiety are well known triggers of eczema because when we experience a stressful situation, our body switches to a ‘fight or flight’ mode which increases the production of stress hormones such as cortisol and adrenaline. They can suppress our immune system and cause an inflammatory response in our skin, leading to a flare.

  • Hormonal changes – Eczema flares can occur and symptoms may worsen during certain times in women because of their hormonal changes.

Ex: prior to the periods, during pregnancy and breast feeding

  • Skin infections – when germs get in to your skin, it can trigger an eczema flare. Eczema skin may develop fissures and small cracks on the surface. These act as entry points to various bacteria (staphylococcus, streptococcus), viruses (HSV) and even fungi. Infection can make eczema worse and treatment becomes more difficult. Your skin will get more damaged which leads the way to further infection. Therefore, breaking this cycle of infection is a key to successful management of eczema.
  • Heavy workouts and exercise can lead to increased sweating leading to eczema flares. For people with eczema, heavy exercise can dry out their skin through loss of fluids. Sweat has sodium which further can dehydrate your skin while irritating and making it sting. As the skin surface temperature soars with exercise, it can trigger frenzied scratching in people with eczema. This can damage your skin and lead to a flare.

If you have symptoms that worry you, seek help from your doctor or a dermatologist. It is best to maintain a diary, so that you can discuss what the possible triggers are and the ways of avoiding these triggers with your doctor. Apart from complying with the treatment regime, it is a must to identify what triggers a flare up and try your best to avoid them.

Some tips to avoid triggers

  • Identify the triggering foods and avoid them in your diet

Maintaining an eczema friendly diet is the key to keeping your symptoms under control. There are certain foods which help to reduce eczema symptoms. They are known to be anti-inflammatory foods. Studies have demonstrated that these can fight inflammation.

  1. Fatty fish – Fatty fish contain long chain omega 3 fatty acids, EPA and DHA and are a rich source of protein. EPA and DHA can reduce inflammation.

Ex: Salmon, Mackerel, Anchovies, Herring

  1. Berries – Berries contain antioxidants called anthocyanin which have anti-inflammatory properties.

Ex: Blue berries, Black berries, Raspberries

  1. Avocados – rich in vitamins, minerals, monounsaturated fats, carotenoids and tocopherols which are good anti-inflammatory agents.
  2. Cruciferous vegetables – They are rich in antioxidants which fight inflammation.

Ex: Broccoli, Kale, Cauliflower, Brussels sprouts

  1. Green tea – it is a healthy beverage with anti-inflammatory properties
  2. Peppers – They are rich with antioxidants and strong anti-inflammatory properties.

Make sure to avoid foods like fried foods, junk foods, processed meats, refined carbohydrates and Trans fats because they are linked with increased levels of inflammation. They may play a role in worsening your eczema.

  • Keep your home allergen free, vacuum regularly, wash your bed linen at least once a week, replace carpets with hard wood floors so that you can mop your floor to keep it dust free and clean.
  • To avoid your skin becoming too dry during winter months, use a humidifier at home. Moisturize your skin more than usual in cold months to prevent drying.
  • Manage your stress well – practice yoga, meditation and other relaxation techniques
  • Use gloves when using detergents and house hold cleansers. Avoid touching chemical irritants unnecessarily.
  • Use hypoallergenic scent free body products
  • Choose fabrics which doesn’t trigger symptoms such as itchiness and redness. You can wear an extra layer of non-irritant garment like cotton, under your wool garments.
  • You can do low intensity work outs in cooler times of day such as early morning or evening. Keep a fan nearby to evaporate the sweat.

Managing your eczema can be challenging. Keep track of your day to day activities. Identify what worsens your symptoms. Take necessary steps to reduce exposure to these triggers. With time you may notice an improvement in your skin and flares will be much less.

References:

  • https://nationaleczema.org/eczema/causes-and-triggers-of-eczema/
  • https://nationaleczema.org/eczema-emotional-wellness/
  • https://www.nhs.uk/conditions/atopic-eczema/causes/