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ECZEMA FAQ

What is eczema?
Eczema is a common, relapsing (appearance of symptoms after a period of improvement) chronic inflammatory skin condition. Eczema is a form of dermatitis, which is a group of diseases that cause inflammation of the skin. Another common form of dermatitis is known as contact dermatitis.
What is eczema?
Eczema is subdivided into two forms known as atopic eczema or dermatitis and non-atopic eczema or dermatitis.

  • Atopic eczema is a form of eczema that is triggered by an allergic reaction to either food or airborne allergens. People suffering from atopic eczema present some of the hallmarks of an allergic reaction such as an increase in the levels of specific immune cells, antibodies and inflammatory proteins. The skin of people with atopic eczema is more easily irritated than people not suffering from eczema.
  • Non-atopic eczema is a form of eczema that is triggered by environmental irritants such as
    chemicals, stress, temperature and h
Who is affected by eczema?
The symptoms of eczema often begins in early infancy or early childhood (before the age of five). Children can either outgrow eczema or it can persist into adolescence or adulthood.
What are the symptoms of eczema? What does eczema look like?
The symptoms of eczema are an ill defined area of redness, dryness and scaling known as a rash. The rash can be itchy. There may also be open sores that are crusted and can discharge a thin, clear, watery fluid. Additionally, there is skin thickening, known as lichenification, due to persistent scratching and inflammation in the chronic (long term) phase of the disease. The symptoms may appear after a period of improvement. This is known as a flare.
Is eczema itchy?
Eczema can be very itchy. Scratching or rubbing itchy areas can cause eczema symptoms to worsen. This is known as the “itch-scratch cycle”.
Does eczema hurt?
Eczema can be painful or uncomfortable since there may be open sores. The sores can bleed because of persistent scratching or rubbing. People suffering from eczema have dry sensitive skin, which can also cause discomfort.
Where can you get eczema? Where does eczema usually appear?
Eczema can appear on any skin surface. Typically, eczema affects the skin flexures (the areas of the body that bend such as the area behind the knees or the inside of the elbows). Eczema can also appear on the face including the lips and eyelids, neck and hands. The area of the skin affected by eczema is dependent on age.

  • In infants and children, the rash can appear on the face and extensor areas of the body such as the elbows and behind the knees.
  • In adolescents and adults, the flexural areas of the body such as the area behind the knees and the inside of the elbows, as well as the ankles, wrists, hands and neck are affected by
    eczema.
What causes eczema? How do you get eczema?
Eczema is a complicated disease, which is caused by the interaction of a variety of factors that are not fully understood. Research has shown that eczema is caused by genetic factors, a dysfunctional skin barrier, environmental factors and a overactive immune system.

Eczema is hereditary meaning that the disease can be passed down from parents to their children.

  • Children with parents who have a history of eczema, hay fever or asthma have a higher risk of developing eczema.
  • Concordance studies with monozygotic or identical twins (twins share the same genetic material) shows that eczema has a concordance rate of 0.8. This means that 80% of the identical twins both had eczema

Unaffected skin of people with eczema differs from people not suffering from eczema.

  • Research has shown that the skin of people suffering from eczema is hyperreative (easily irritated) to environmental triggers.
  • Also, some people with eczema may have a deficiency in a protein found on the skin known as filaggrin. Filaggrin is important in maintaining skin moisture, integrity and barrier function. Therefore, people with eczema have dry skin even in unaffected skin areas.

The level of immune cells and proteins associated with inflammation, such as specific types
of T cells associated, are elevated and found in the skin at the site of rash, as well as
systemically (whole body).

What triggers eczema?
The triggers that can cause a flare, meaning the symptoms of eczema to appear or worsen, are different for each person. Sometimes, people may be exposed to the trigger before the symptoms of eczema appear making it difficult to determine the trigger. However, the most common triggers include:

  • Dry skin
  • Irritants such as perfumes, metals, soaps and other chemicals
  • Stress
  • Sweating (warm or cold weather)
  • Staphylococcus infections
  • Allergens (food or airborne)
  • Hormones
Is eczema contagious?
Eczema is not contagious, therefore you can’t catch eczema by touching the affected skin area and you can’t pass it on to other people if you have eczema.
How is eczema diagnosed?
There is no clinical test to diagnose eczema. Therefore, a doctor will diagnose eczema based the shape and location of the rash, as well your medical history. Sometimes, the doctor may take a skin biopsy to rule out other diseases that look like eczema
How are the severities of eczema determined?
The severities of eczema are determined based on frequency of itching and the impact on daily activities:

  • For mild eczema, there is infrequent itching and the symptoms don’t have an impact on
    daily activities.
  • For moderate eczema, there is frequent itching and the symptoms have a moderate impact
    on daily activities, including sleep disturbances.
  • For severe eczema, there is incessant itching and the symptoms have a severe impact on
    daily activities, including frequent sleep loss.
Am I at risk of any other diseases if I have eczema?
Research has shown that people with atopic eczema are at a higher risk of developing asthma, hay fever and food allergies. Also, people with eczema are at risk of other inflammatory conditions such heart disease, obesity and diabetes due to chronic inflammation.
Am I at risk of any other diseases if I have eczema?
Research has shown that people with atopic eczema are at a higher risk of developing asthma, hay fever and food allergies. Also, people with eczema are at risk of other inflammatory conditions such heart disease, obesity and diabetes due to chronic inflammation.
Is there a cure for eczema? Does eczema go away?
There is no cure for eczema, however there are treatments that are available that can manage the symptoms of eczema. Since there is no cure for eczema, the symptoms may reappear after a period of improvement (i.e. after discontinuation of treatment).
How is eczema treated?
In general, the main goal of the treatments used to manage the symptoms of eczema are to reduce the dryness of the skin and to reduce inflammation of the affected areas. It is also important to avoid the triggers that cause your eczema symptoms to appear or worsen. The treatments for eczema may be topical (i.e. cream) or oral (i.e. pill) depending on the severity of the disease. The treatments differ for people suffering from mild, moderate or severe eczema.
How is mild to moderate eczema treated?
For mild to moderate eczema, a combination of the following non-prescription and prescription treatments are used:

Non-prescription

  • Emollients to treat dry skin
  • Physiologic moisturizers to treat dry skin
  • Bleach baths to reduce inflammation and prevent infection
  • Coal tar to reduce inflammation
  • Cold compresses to reduce inflammation

Prescription medicine

  • Topical steroids to reduce inflammation of the affected area
How is moderate to severe eczema treated?
For moderate to severe eczema, the following treatments are used in addition to the treatments for mild to moderate. These treatments are strong and are only used if the treatments for mild to moderate eczema don’t work. The treatment for moderate to severe eczema includes a combination:

Prescription medicine:

  • Topical calcineurin inhibitors to reduce the inflammation of the affected area
  • UV phototherapy
  • Systemic immunosuppressants (as a last resort)
What are the best creams or ointments for eczema?
The best creams and ointments for eczema are creams that will help moisturize the skin and reduce inflammation. These creams often contain ceramide and other fats that are naturally found on the skin. It is important to use creams that are not perfumed or contain other chemicals that could irritate the skin.
What are the complications of suffering from eczema?
If the symptoms of eczema go untreated, then there is a risk of developing a skin infection such as Staphylococcus and herpes infections since the pathogen is able penetrate the broken skin barrier and cause an infection.
If it is not eczema, then what is it? What are the other types of dermatitis?
Eczema is a form of dermatitis. Another common form of dermatitis is known as contact dermatitis. The symptoms of contact dermatitis are similar to eczema. Contact dermatitis is also subdivided into two forms known as allergic contact dermatitis and irritant contact dermatitis.

  • Allergic contact dermatitis is a delayed (48 to 96 hours) immune reaction following direct
    skin contact with an allergen. The first exposure to the allergen doesn’t trigger a response
    but causes the immune system to be sensitized meaning that subsequent exposure will
    cause an immune reaction. The immune reaction is limited to the area that was in contact
    with the allergen.
  • Irritant contact dermatitis is triggered by repeated exposure to chemicals that remove the
    moisture and oil from the skin resulting in damage and inflammation.

There are several other forms of dermatitis such as dyshidrotic eczema, nummular eczema,
stasis dermatitis and seborrhoea dermatitis.

  • Dyshidrotic eczema is a form of dermatitis that causes water blisters to form on the palms, fingers, toes and soles of the feet.
  • Nummular eczema is a form of dermatitis that causes round coin-shaped lesions to form on the hands, arms and legs.
  • Stasis dermatitis is a form of dermatitis that is associated venous insufficiency and forms on the lower extremities (lower legs).
  • Seborrhoea dermatitis is a form of dermatitis that occurs in areas with a large number of sebaceous glands such as the scalp, eyebrows and nose.

Additional Resources
1. Canadian Dermatology Association: https://dermatology.ca/public-patients/skin/eczema/
Eczema Canada: http://www.eczemacanada.ca/en
2. National Eczema Association: https://nationaleczema.org/eczema/types-of-eczema/atopicdermatitis/
3. American Academy of Dermatologists: https://www.aad.org/public/diseases/eczema/atopicdermatitis#overview



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