Category: Diagnosis

Table of contents

• Introduction
• Calculating EASI score
• Severity score
• How are the calculations done?
• How do you record the EASI score?
• Severity score X Area score X Multiplier
• What are the advantages of calculating EASI?
• Summary

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.

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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%

2. Trunk including the genital region

• Front – 55%
• Back of trunk – 45%

3. Upper limbs

• 50% right arm
• 50% left arm

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

4. 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

 

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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/

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Table of contents

• Eczema vs. Atopic Dermatitis: What is the difference?
• What are the different types of eczema?
• What is atopic dermatitis and how does it differ from other types of eczemas?
• What are the features that are common to all types of eczemas including atopic dermatitis?
• What are the differences between other types of eczemas and atopic dermatitis?
• Summary

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.

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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/

 

 

Table of contents

• Introduction
• What is eczema?
• What is an allergic reaction? 
• Why do only some people develop allergies?
• Allergy test
• Types of Allergy test
• Conclusion

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 eczema allergy test 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.

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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.

2. 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.

3. 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:

• https://eczema.org/information-and-advice/triggers-for-eczema/allergy-and-eczema/
• https://eczema.org/information-and-advice/triggers-for-eczema/allergy-and-eczema/
• http://www.nottinghameczema.org.uk/documents/allergy-tests-for-atopic-eczema.pdf

 

 

Table of Content

• • • Eczema Overview
    • Eczema Causes
    • The Link Between Eczema and Genes
      • FLG Gene
      • CADR11 Gene
    • Inheritance Pattern
    • Gene Testing for Eczema
    • Conclusion

Just Imagine if you and your spouse both develop or have a chronic skin condition like Eczema, one of the most common questions that will hit your mind while planning a baby will be what are the odds that kid will have it too? Is eczema hereditary

Unfortunately, it turns out that the odds are high because chronic skin conditions like Eczema have a strong basis in genes. The symptoms may or may not develop depending on the functionality of the gene.

Eczema an Overview

Before entering into the actual topic let us have an overview of what exactly eczema is? Also known as Atopic Dermatitis, Eczema is a chronic skin condition characterized by red, scaly, itchy, and inflamed skin when the symptoms are visible. It develops cracks and sometimes oozes at its peak. Its characteristic that tempts the affected person to incessantly scratch gives it its name an itchy rash.

Affecting around 15-20% of children and of 1- 3% of adults’ Eczema is not contagious but it has a characteristic of passing in a generation that is from parents to kids. Well, it is not compulsory that if a parent has eczema the kids will also have, but it increases the chances. For e.g. if both the parents have eczema then there is an 80 % chance that the kid may have eczema.

Causes of Eczema

Though the exact reason for the onset of eczema or the most common type of Atopic Dermatitis is not known, the current thinking is that it is caused by the combination of factors that may include.

• Environmental factors (Triggers)
• Irritants from day to day life
• Genetic mapping of the Individual
• Skin barrier dysfunction allowing foreign particles to breach the outer skin layer
• Other endocrine disorders such as thyroid

It is also found that certain geographic factors also play its part in eczema. For e.g. people living in cold climatic conditions and urban cities with high air pollution rates are more prone to this skin condition.

The link between eczema and genes

It is understood that the onset of Eczema is somehow related to the auto-immunity of an individual which also confirms the link between Eczema and gene mapping of the person. For a very long period of time, the exact cause of eczema was unknown. But the medical scientist has resolved it by stating that the combination of genetic and environmental factors are responsible for the development of the condition. In between environmental and genetic factors, genetics have more weightage.

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FLG Gene

In a normal individual, the skins outer layer forms a protective barrier that prevents it from invading foreign particles. This layer made up of a structural protein called Filaggrin “filament aggregating protein” which is encoded by a gene called FLG which constitutes a large segment of DNA that codes for the protein which we just came across.

It is found that the individuals lacking the functional copy of this gene FLG lack the protective layer of skin and often develop skin deficiencies that develop chronic skin conditions like Eczema. Many times, a mutation in the FLG gene can also lead to autoimmune conditions in people. This fact tells that eczema has something to do with the genes and can pass on to the next generation. In a whole population, around 10% of people inherit at least one version of the FLG gene from a big segment that has a slightly different DNA sequence2. These changes in the DNA sequence is unable to produce the amount of filaggrin protein that is required to form the protective skin barrier. As a result, the skin barrier is less able to prevent both water loss and the entry of pathogens.

CARD11 Mutation

The gene CARD11 provides useful information and instructions for making a protein that is involved in the function of immune system cells called lymphocytes. Certain types of lymphocytes particularly  T cells and B cells has a major role in supporting the immune system of the body. These cells identify foreign invaders such as bacteria, viruses, and fungi and defend the body against infection.

When T or B cells recognize a foreign substance, the CARD11 protein is turned on (or we can say it is activated) and attached to two other proteins named BCL10 and MALT1, to form the CBM signalosome complex. This complex in turn activates other protein complexes called nuclear factor-kappa-B (NF-κB) and mTOR complex 1 (mTORC1), which are important for cellular signaling. SO the chain continues to form a final signal and development to function the support the immune response against foreign invaders.

When this CARD11 gene gets mutated it doesn’t get activated when a foreign body invades and thereby the immune system gets compromised giving rise to various conditions one of them being atopic dermatitis.

Though till now we have mostly talked all about FLG mutations, which is one of the most predisposing factors to the eczema condition, other genetic variations can also be critical for the onset and severity of Atopic eczema. The presence of several susceptibility loci can be easily understood by the multi-factor symptoms of the disease that depends on the complex interaction between environmental factors like irritants, pollutants, weather, and microorganisms. To date, there are more than 30 known loci which are found to be associated with a higher risk of eczema.

The inheritance pattern of atopic dermatitis associated gene

Allergic disorders like eczema, asthma, or hay fever tend to run in families that is it may pass from one generation to the next. The transmission of genes from parent to child follows a certain pattern and this is called the inheritance pattern.

When the inheritance involves the CARD11 mutated gene, atopic dermatitis has an autosomal dominant inheritance pattern, which means one copy of the altered CARD11 gene in each cell is sufficient to cause the disorder.

Similarly, when it is associated with FLG gene mutations, the risk of condition follows an autosomal dominant pattern; a mutation in one copy of this gene is sufficient to increase the risk of the disorder.

Genetic Testing for Eczema

There is no common test that can tell you whether you have eczema, except a physical examination by the physician who can confirm the disease.

In today’s advanced world people are very keen to know how likely they or their child have a chance of developing eczema. That’s very well justified because knowing whether someone has inherited a mutant copy of FLG is important clinical information. Because if a mutation is present in a new-born, then early intervention with proper care and standard moisturizers could help to prevent or delay the onset of atopic eczema which is most common in children.

By doing this one can improve the quality of life of eczema sufferer and its caregiver. This will also delay or completely avoid exposing the young skin to topical and systemic immunotherapies which are ultimately strong on the skin and expensive to the pockets.

Currently, there are few DNA testing Companies like 23andMe, AncestryDNA, etc. Which can be used to predict your or your child’s risk of developing eczema based on the DNA. Remember these are just predictions and not an exact verdict and conditions in your environment still play a critical role.

Other Genes associated with Eczema In another new study led by Mariana L Stevens, published in the journal Nature Communications, researchers found and delineated the two variations of the gene KIF3A that is said to be responsible for the impairment of the skin barrier that regulates water loss resulting to the onset of Eczema.

The observation from the study by the team led by Mariana L Stevens could drive the researchers to come up with genetic tests that could be used to diagnose the risk of developing atopic eczema in Infants. This could help the early detection of the condition and which may lead the way to come up with therapies targeting water loss from the skin. Thereby a possible solution to prevent eczema in early childhood can be found, as mentioned by the National Institutes of Health.

Conclusion

So here’s the answer to your question, Is Eczema genetic? There is a link between Eczema and genes which solves the long-lasting mystery for the cause of Eczema. While there are studies and researches which direct us to narrow down the reason for the onset of eczema targeting non-functional or mutant genes. Gene FLG is the major gene responsible for encoding a structural protein called Filaggrin and profilaggrin which helps in building a mesh-like skin outer layer. This layer functions as a preventive barrier preventing foreign particles invade from outside and preventing water loss from inside. Recent findings and studies could propel researchers to come up with an Eczema genetic testing kit specifically for Eczema which shall help us to find out the susceptibility to the disease. Eventually, a solution to battle Eczema is making great strides.

References

• https://www.ibtimes.com/eczema-genetic-testing-risk-infants-could-be-possible-soon-3029083
• T. Lepre, R. Cascella, M. Ragazzo, E. Galli, G. Novelli, and E. Giardina, “Association of KIF3A, but not OVOL1 and ACTL9, with atopic eczema in Italian patients,” British Journal of Dermatology, vol. 168, no. 5, pp. 1106–1108, 2013.
• https://medlineplus.gov/genetics/condition/atopic-dermatitis
• L. Paternoster, M. Standl, J. Waage et al., “Multi-ancestry genome-wide association study of 21, 000 cases and 95, 000 controls identifies new risk loci for atopic dermatitis,” Nature Genetics, vol. 47, no. 12, pp. 1449–1456, 2015.
• M. Pigors, J. E. A. Common, X. F. C. C. Wong et al., “Exome sequencing and rare variant analysis reveals multiple filaggrin mutations in bangladeshi families with atopic eczema and additional risk genes,” Journal of Investigative Dermatology, vol. 138, no. 12, pp. 2674–2677, 2018.
• https://www.hindawi.com/journals/bmri/2019/3457898/
• https://www.karger.com/Article/FullText/370220#:~:text=Atopic%20dermatitis%20(AD)%2C%20also,%2D3%25%20of%20adults%20worldwide.

 

Table of content

• Eczema Infection
• Causes of Eczema Infection
• Signs and Symptoms of Infected Eczema Infection
• Complications in Eczema Infection
• When to approach a Physician?

Eczema Infection

Eczema, also known as Atopic Dermatitis, a term marked by Dry, Red, Itchy and inflamed skin, itself a chronic condition that requires proper management, But When Such condition is caught by an Infection it only worsens it. The routine Eczema Treatment will not be effective in such condition and requires special care.

Infection is more common in wet eczema than Dry eczema because the former provides the Infection causing germs (Micro-organisms) a favourable environment to survive, grow and multiply.

One of the other common reason for the infection is the habit of uncontrolled scratching. Continuous scratching damages the layer of the skin which acts a barrier causing bruises.

These Open bruises from scratching dermatitis permit germs and microbes resulting in infection.

Hence you might have noticed that the Eczema Infection is more common amongst the children because they don’t have control over scratching and also their skin has less resistance to germs.

Adults on the other hand somehow control the scratching, tempted by the itch in eczema. It is also common with the individuals who are currently on eczema treatment but have frequent sores and open wounds related to their eczema condition.

Atopic Eczema itself is not infectious or contagious (it cannot be spread to another person), but it can become infected if germs set in, which can pass on to person nearby as well. There are different kinds of infections that can develop with eczema also known as Atopic Dermatitis and these Infections can develop in or on eczema anywhere on the body right from the scalp to toe.

Causes of Eczema Infection

Infections in Atopic Eczema are caused by a variety of potential, bacteria, fungi or viruses. Coming up next are some of the common microbes which accounts for causing Eczema Infection.

• Bacterial – Staphylococcus aureus (Staph infection)
• Fungal – infections, such as ringworm(tinea)
• Viral – herpes simplex virus

• Bacteria – Staphylococcus aureus, Streptococcus

Staphylococcus aureus is a bacterium which is found in almost all people with Eczema. They cause colonization, although may not infect the lesions. In 20% of healthy adults without eczema, Staphylococcus aureus lives as a commensal organism (The microorganisms which live on the skin without harming the host). However, when eczematous skin gets damaged these bacteria can get in and cause infection.

• Viruses – commonly Herpes Simplex Virus 1 (HSV 1)

Presence of Eczema lowers the resistance to viral infections. HSV 1 virus spreads from skin to skin contact. HSV which commonly causes Cold sores can cause severe infection in eczematous rashes. This is also known as Eczema Herpeticum. It is an extensive skin eruption with vesicles which occur on eczema rash. Eczema Herpeticum commonly occurs in infants and children with severe eczema. These clusters of small blisters are itchy and painful.

• Fungal infections – Candida (Thrush) can develop in warm and moist skin folds. When the eczema is in flexures such as elbows, behind knees or around abdominal folds, candida can freely infect eczema especially when the skin is damaged by scratching. If the person lives in warm and humid climates, increased sweating can cause infection to spread.

Tinea (Dermatophytes) or Ringworm can also infect eczema rashes causing ring like reddish patches or infect in between toes leading to Athletes foot.

When Eczema rash is infected, it worsens Eczema and allowing it to spread more quickly and making the Treatment and healing process difficult.

Diagnosing infection in Atopic Dermatitis is not always straightforward. But there are a few signs and indications which you can look up to and take prompt actions once you notice them. It’s critical for people with eczema or caregivers of children with eczema to get familiar with the indications of infected eczema so you can look for the proper treatment. Proper treatment at the right time during the infection will help to avoid further complication.

The symptoms of infected Eczema will be very different from normal eczema which suddenly starts getting worst spreading the rash across the body in no time.

Signs and Symptoms of infected Atopic Eczema

• The skin area becomes more inflamed (swollen, hot and red)
• The eczematous lesions get blisters, ‘boils’ and cysts with red or yellow color spots with pus
• pus/weepy fluid (often yellow or green) coming out of the skin and crusts or scabs
• painful skin – “like you’ve got cuts everywhere”
• Very tired and unwell feeling drains the person
• Sudden flaring of eczema all over the body.
• Lesions become sore and painful with a tender to touch in Eczema Herpeticum.
• A person with infected eczema will also experience extreme Itching and burning
• In more advanced cases, a person may experience more severe symptoms including fever, chills, aches, and fatigue

Complications in Eczema Infection

Atopic Eczema Infection may also lead to more dangerous complications such as a serious staph infection that may cause a blood infection known as sepsis (A life-threatening condition) if left untreated.

Some of the other complications include

• Resistance to the topical steroids due to continuous and prolonged use
• Increase in blisters and Itching out of control
• Prolonged Eczema flare and Scarring
• It may cause a growth problem in some children’s too.

When to Approach a Physician?

Because it’s not always obvious if eczema is infected, it’s important to get help from medical professionals.

If an individual is suffering from chronic eczema, he should approach the physician immediately in case he develops a fever, experience chills, Experiencing tiredness/fatigue, or develop signs of infection, such as oozing blisters and excessive itchiness.

Infants and young children with infected Eczema should be taken for medical care as soon as possible and monitored for a clinical outcome more carefully when encountered with Eczema Infection.

Check your Eczema score to understand about your condition well. Manage your eczema by planning the eczema treatment that best suits you.