Eczema, also known as atopic dermatitis, is a common chronic skin condition marked by itchy and inflamed skin. Often developing in early childhood, it presents as patches of dry, red, and itchy skin, typically on the face, inside the elbows, behind the knees, and on the hands and feet. The severity and symptoms can vary widely among individuals. While the exact cause is unknown, eczema is believed to result from a combination of genetic predisposition and environmental triggers.

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Key Points

What is eczema/atopic dermatitis?

Eczema, or atopic dermatitis, is a chronic condition that causes the skin to become itchy, dry, and inflamed. It’s one of the most common skin conditions, especially among children.

Who gets eczema/atopic dermatitis?

Eczema is most common in children but can also affect adults. It often appears before the age of 5 and may persist into adulthood or occur for the first time later in life. Individuals with a family history of eczema, asthma, or hay fever are at higher risk.

Clinical features

Eczema is characterised by patches of dry, itchy skin that can become red and inflamed. These patches often appear on the face, inside the elbows, behind the knees, and on the hands and feet. The skin may also become thickened, cracked, and scaly.

Diagnosis and differential diagnosis

Diagnosis of eczema is typically based on the patient’s history and physical examination of the skin. Skin patch testing might be used to diagnose or exclude co-existing allergic dermatitis. Eczema is differentiated from psoriasis, seborrheic dermatitis, and other skin conditions.

Impact and complications

Eczema can significantly impact quality of life, causing discomfort and sleep disturbances due to itching. It can also lead to skin infections and emotional distress. In children, severe eczema may affect growth and development.

Causes and triggers of eczema/atopic dermatitis

Genetic Factors –  Family history of eczema, asthma, or hay fever.

Environmental Triggers –  Allergens, irritants, weather changes, stress.

Skin Barrier Dysfunction –  Impaired skin barrier leads to moisture loss and vulnerability to irritants.

Subtypes and variants

  • Dyshidrotic eczema – Also known as pompholyx, this type of eczema is characterised by small, itchy blisters on the edges of the fingers, toes, palms, and soles of the feet. It can be triggered by stress, moisture, and exposure to nickel, cobalt, or chromium salts. The condition is more common in warmer months and in individuals with a history of atopic dermatitis.

  • Discoid eczema – This variant presents as distinct, coin-shaped spots or patches on the skin. These lesions can be very itchy and may become crusted or ooze. The exact cause of discoid eczema is unknown, but it can occur in individuals with no previous history of atopic dermatitis. It tends to affect adults and can be exacerbated by dry skin, cold weather, and stress.

  • Contact dermatitis – This subtype is caused by direct contact with irritants or allergens, leading to skin inflammation. It can be divided into irritant contact dermatitis, which is more common and occurs when the skin is damaged by irritants like soaps and chemicals, and allergic contact dermatitis, which is a result of an allergic reaction to a substance such as nickel, rubber, or certain plants. Symptoms include redness, itching, and sometimes blistering of the skin.

Treatment Options for eczema/atopic dermatitis

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