WHAT CAUSES ECZEMA?
One of the predominant theories is that someone with eczema has a short-circuited immune response, where the skin reacts abnormally when a substance comes in contact with it. In severe cases of eczema, the substance can be as benign as water; for others, the trigger can be anything from clothing, detergents, soaps, grass, food products, allergens (including dust mites), a lack of humidity, or a combination of things. Even more frustrating is that the reaction can be intermittent, with no real rhyme or reason for why or when.
There also appears to be a strong hereditary component to eczema. For example, children whose parents suﬀer from eczema run an 80% chance of developing it themselves. Further, in both children and adults, stressful situations tend to trigger, prolong, or worsen eczema ﬂare-ups.
Regardless of the source, eczematous skin reacts to a substance or substances or to environmental conditions by spinning out of control and generating mild to severe inﬂammation, which leads to itching and subsequent scratching that damages skin’s critical barrier function.
There are several types and varying degrees of eczema, which, as you can imagine, makes diagnosis and treatment a bit tricky! The following are the most common types of eczema:
- Atopic eczema (also referred to as atopic dermatitis): Perhaps the most pernicious and painful type of eczema, it’s characterized by its severity and the intolerable sensation of itching and irritation, leaving skin raw, fssured, and vulnerable to infection. This is the type of eczema that many infants experience between the ages of two and six months. In infants, symptoms appear on the face, scalp, feet, and hands; in older children and into adulthood, symptoms appear in the fold of the arm and behind the knees, though particularly bad outbreaks can appear anywhere on the body.
- Allergic contact dermatitis: This specifc form of eczema often stems from a subset known as irritant contact dermatitis. It occurs when a specifc substance comes in contact with the skin and causes the immune system to overreact. The result is inﬂamed and sensitized skin. Most typically, allergic contact dermatitis is caused by fragrance, nickel, detergents, wool, grass, citrus, household cleaning products, and vinegar. Once you’ve identifed the specifc substance, avoiding it often solves the problem.
A subset of allergic contact dermatitis is eyelid dermatitis. Typically mild to moderate redness is present, as well as scaling, ﬂaking, and swollen skin. This is extremely common and almost exclusively aﬀects women in relation to their use of hairstyling products, makeup, and nail polish (even once it dries) when your manicured nails come in contact with the eye area. The best way to solve the problem is to stop using the oﬀending product(s) and find options that don’t trigger a reaction.
- Infantile seborrheic eczema: Better known as cradle cap, this form of eczema generally aﬀects only babies and children. The crusty, thick, sometimes reddened lesions may look problematic, but this disorder is rarely itchy or even felt by the child. If you want to treat this, and success is limited, consider a 1% hydrocortisone or a 2% topical ketoconazole cream, which are available from your infant’s pediatrician.
- Adult seborrhoeic eczema: This shows up for most people between the ages of 20 and 40, and is estimated to aﬀect 5% of adults. It’s usually seen on the scalp as mild dandruﬀ, but can spread to the face, ears, and chest. The skin becomes red and inﬂamed and starts to ﬂake. It’s believed to be caused by yeast, but its precise cause remains unclear; stress may be a factor. If the area becomes infected, treatment with an antifungal cream, topical steroid creams, or immunomodulators may be necessary.
- Nummular eczema: Typically localized on the legs, nummular eczema is characterized by coin-shaped patches of pink to red skin that may take on an orange cast if crusting or scaling is present. Left untreated, the dry, scaly spots typically darken and thicken. This type of eczema is most common in adolescent girls and in women between the ages of 30 and 60, and the condition tends to occur in winter.
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