Dermatologist Gives Eczema Insights
As a dermatologist, I see patients with eczema many times a day because there are so many types, and some are really common. The word “eczema” is used to describe a type of inflammation of the skin that has different causes. All of the types of eczema look different on the skin and occur in different parts of the skin.
Atopic dermatitis is the type people often think of when they hear the word.
It is genetic and runs in families with allergies, asthma, hay fever, and very sensitive skin. It is a form of hypersensitivity though the rash often seems to worsen for no reason. The most common sites for the rash are (and occurs first) around the inner elbows and behind the knees.
When severe, it happens on any part of the skin. The skin is itchy, red and crusty. Patients scratch, and the skin often gets infected because people with atopy are more likely to be carriers of the Staph bacteria that is a common cause of impetigo.
Atopics are hypersensitive to many things that touch their skin like ingredients in moisturizers, laundry soap, wool, etc. so they need really hypoallergenic skin care. They also need to moisturize daily because their skin gets really dry which can trigger the eczema.
Contact dermatitis is eczema caused by allergic reaction to something that touched the skin.
Poison oak and ivy are classic causes. Perfumes, essential oils, metal, and many other things can cause it, too. Atopics are more likely to get it, but it can happen to anyone.
The skin is red, itchy and often blisters form. The blister water does not contain the allergen (like poison oak oil) and is not contagious so it will not spread the rash.
Dyshidrotic eczema happens on the hands and feet.
It is intensely itchy and shows up as little dots on the sides of fingers or toes as well as palms and soles. We don’t know why, but seasonal allergies or internal allergic reactions may play a role.
It can be very debilitating because we use our hands all the time, and the skin is fragile and forms painful cracks if it gets irritated from too much use, like doing house cleaning chores.
Nummular means “coin shaped” in Latin and the eczema is seen as red, dry, scaly itchy patches often on parts of the skin prone to dryness like the lower legs and arms.
It can occur on the trunk, too. It happens more with age as skin dries. It can be prevented with good moisturizing skin care and by avoiding harsh soaps. Often, a little injury like a bug bite will start it off, and then the eczema develops.
Once the skin is making eczema in one spot, it seems to make it in other areas, too, though it is not contagious. I describe it as putting a match to dry hay, and the fire takes flight across the entire surface.
Seborrheic dermatitis is dandruff.
It usually occurs on the scalp, eyebrows, along the sides of the nose and mouth, and behind the ears. Chest and back skin can be involved, too. The term “seborrhea” means the running of sebum, and early physicians thought it was due to excess skin oil.
Skin is dry, red and flaky with some itching. Treatment involves using anti-seborrhea medicines in shampoos and soaps and anti-yeast creams because a skin yeast plays a role, though is not the entire cause.
We don’t know exactly why the eczema happens, but we do know that pityrosporum yeast plays some part.
Stasis dermatitis is due to poor vein circulation in the legs.
Over time, the circulation problem damages the skin, and it breaks down in eczema. Like other forms of eczema, there is redness, scale and itch.
Serious skin infections can result in cellulitis. Treatment is to elevate legs to help circulation, moisturize skin to help it stay healthier, wear support stockings to help prevent edema, and treat stasis dermatitis early with cortisone creams so infection does not happen.
Each type of eczema has specific treatment “pearls” that address the underlying skin problems.
That said, the basic problem is inflammation and weakening of skin barrier. That is always improved by hydrating, gentle and hypoallergenic skin care.
What this means is that we use only mild skin cleansers and cool-to-tepid water so we don’t overly dry skin when bathing. Moisturizers are applied right after toweling skin dry and often at other times during the day to help repair the skin barrier.
Products need to be fragrance-free and hypoallergenic. Eczema should not be irritated by use of harsh products. This is tricky with dyshidrotic hand eczema where hands are used all day for working. Rubber gloves need to be used to protect hand skin from things like dish soap.
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