Eczema overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Edzel Lorraine Co, DMD, MD[2]
Overview
Eczema, also known as atopic dermatitis, or [atopic eczema]], is a dermatologic problem which is commonly seen in children. It is a relapsing-remitting skin problem that is predominantly manifested as pruritus, with accompanied swelling, redness, and dryness of the skin. Flaking, cracking, oozing, blistering or bleeding may occur as a result of excessive scratching of the skin.
Historical Perspective
It was in the 20th century when eczema came into existence, and later on, concepts on this had evolved including major insights on the nature of the disease.
Classification
Eczema is classified according to location, appearance, or etiology.
Pathophysiology
The mechanism of disease of eczema involves a complex interplay of abnormalities of skin microbiomes, a dysfunction in the epidermal barrier, and an immune dysregulation. There are two main theories on the existence of atopic dermatitis, also known as atopic eczema - the inside-out hypothesis, and the outside-in hypothesis.
Causes
The etiology of eczema is multifactorial and complex. This involves aberrations in genetic component, adverse effect of certain medication and some environmental factors.
Differentiating Eczema from other Diseases
Eczema has various mimics with regards to the clinical presentation, severity, and course of disease. A strong clinical evaluation by the physician based on the presenting signs and symptoms is needed to come up with the correct diagnosis. Differential diagnoses of eczema include infectious disease, inflammatory disease, immunodeficiency problem, or a nutritional deficiency.
Epidemiology and Demographics
In the United States, eczema has a prevalence of 10.7% in children and 7.2% in adults. Eczema has more predilection in males.
Risk Factors
Risk factors of eczema include family history and FLG gene mutation.
Screening
Hanifin and Rajka criteria are the gold standard for diagnosing eczema.
Natural History, Complications, and Prognosis
Eczema has regarded as a medical condition with a natural history that occurs consistently. It is characterized as a disease with an early onset, mostly during the childhood period, and remits during the adolescence period. If left untreated, eczema can lead to viral, bacterial and fungal infections. Psychological problems could also arise brought about by constant itching.
Diagnosis
History and Symptoms
Family history, dietary habits, lifestyle habits, and allergies should be elicited whenever considering eczema as the primary diagnosis. This is important because eczema can be based on the patient's history and evolution and distribution of the skin lesion.
Physical Examination
Eczema is a [dermatologic disease]] and pruritus is the hallmark feature of this disease.
Laboratory Findings
Levels of IgE are associated with allergy, aside from parasitic infections, autoimmune diseases, and certain carcinomas.
Other Diagnostic Studies
No particular biomarker is reliable to diagnose eczema. However, the current practice is by using the laboratory levels of IgE, which when elevated, can also be associated with allergy, aside from parasitic infections, autoimmune diseases, and certain carcinomas.
Treatment
Medical Therapy
Topical corticosteroids are the mainline treatment for eczema. Different potencies of steroids are rendered specifically for the severity of eczema. Other drug treatments oftenly used for eczema include topical calcineurin inhibitors,crisaborole, antimicrobials, and antifungals.
Surgery
Surgical treatment is not commonly used as a means of management for eczema.
Primary Prevention
Primary prevention is the most effective means to avoid complications of eczema. Emolients and consumption of prebiotics and probiotics can prevent the occurrence of this condition.
Secondary Prevention
Prevention of further trans-epidermal water loss is the cornerstone of management of eczema. Since dysfunctional skin barriers could lead to water loss, daily replenishment of skin moisture is needed. This can be achieved through different modalities such as emollients, occlusives, and humectants.
Cost-Effectiveness of Therapy
The economic impact of eczema causes a burden to patients suffering from this disease. A recent study showed that an average of $274 ($199 indirect cost, and $75 direct cost) is spent by each patient for eczema.
Social Impact
Pruritus and constant scratching of the skin can significantly affect the social life of patient. Sleep disturbances, attention-deficit/hyperactivity disorder, headaches, daytime fatigue, and stunted growth are commonly seen in these patients and could lead to embarrassment and poor self-esteem.
Future or Investigational Therapies
Future trends will focus more on genetic studies in eczema.