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  Types of Eczema

The following photographs and descriptions of the different types of Eczema illustrate typical characteristics, but a distinguishing fact about Eczema is its variability. Atopic dermatitis (also called eczema) is the name given to a stubborn itchy rash which occurs in certain people with sensitive skin.

Atopic Dermatitis

Atopic dermatitis is common in infants and small children (affecting about one in seven), but it usually clears before adulthood. Eczema may clear for years, only to reappear later at a different site.

The exact cause is unknown. It is probably the result of an inborn defect of the skin that tends to run in families; other family members often have asthma or hay fever. Atopic eczema is not contagious and does not affect one's general health. The skin is usually dry and easily irritated by soap, detergents and woolen clothing. Eczema may be aggravated by hot weather and a wide variety of environmental factors both at home and at work. These include dust, cats, emotional stress, and rarely foods. Teenagers and adults with eczema should choose their occupation carefully, in particular avoiding careers which involve wet work or handling detergents and solvents.

Atopic eczema rarely develops in babies before the age of four months (another type of eczema occurs before this). The face is often affected first, then the hands and feet. Sometimes dry red patches appear all over the body.

In older children the skin folds are most often affected, especially the elbow creases and behind the knees. In adults the face and hands are more likely to be involved.

Sometimes there is secondary infection with staphylococcal bacteria (impetigo). The result is oozing, crusting, with pustules, and usually causes the eczema to suddenly get worse. Infection with herpes simplex (the cold sore virus) may cause a severe blistering rash.

Hand Eczema

Hand dermatitis (also known as hand eczema) often results from a combination of causes.

Whatever sets hand dermatitis off in the first place, there are many aggravating factors which keep it going or prevent it clearing up.

Some people are more prone to hand dermatitis than others. They often have a personal or family history of Atopic dermatitis, asthma or hay fever. They may have had dermatitis on other areas, especially the feet.

Some have psoriasis, a common skin complaint best known for causing red scaly patches on elbows, knees and scalp.

Sometimes emotional stress make hand dermatitis worse, especially the type known as pompholyx.

Contact with irritants

Harsh chemicals such as solvents, detergents, acids, alkalis, even water and friction, strip the skin of its natural protective layer. Their effect is much more severe when the skin has already been damaged by dermatitis; a few minutes indiscretion can result in a nasty flare-up which can last for several months.

Allergy

Occasionally skin reacts abnormally to small amounts of substances that most people are unaffected by. There are a huge number of items that can cause allergic contact dermatitis, including nickel, perfumes and rubber. The dermatologist may arrange special patch tests to detect these. Contact with the causative material must be strictly avoided to result in total clearance of the dermatitis.

Gravitational Eczema

Gravitational eczema is an itchy rash occurring on the lower legs of patients with inadequate veinous drainage.

Affected individuals may have varicose veins or at some time had a clot in the deep veins of the leg. Clots in the deep veins of the calves and thighs (thrombosis or DVT) damage the valves and this prevents efficient upward pumping of the blood during walking. As a result a back pressure develops and this is reflected back to the capillaries where it produces a fluid build up in the tissues. The skin may feel hardened, known as lipodermatosclerosis (post-phlebitic syndrome). The leg tends to swell due to the back pressure. This results in inflammation of the skin, eczema. Varicose veins by themselves have a similar though milder effect.

The leg affected by gravitational eczema is usually swollen. The swelling is increased by prolonged standing and during hot weather. Gravitational eczema can involve the whole of the circumference of the leg or, more commonly, occurs in discrete patches. The eczema appears as a flat or slightly raised, red, scaly area which may ooze, have crusts, and cracks. It may be secondarily infected. It is frequently itchy. Rubbing results in the skin thickening up. Pigmentation of the skin and changes in the subcutaneous tissues may also develop. Ulceration of the skin of the leg can also occur.

Eczema

Dermatitis affects about one in every five people at some time in their lives. It results from a variety of different causes and has various patterns.

The terms "dermatitis" and "eczema" are often used interchangeably. Dermatitis can be "acute" or "chronic" or both. Acute eczema refers to a rapidly evolving red rash which may be blistered and swollen. Chronic dermatitis refers to a long standing irritable area. It is often darker than the surrounding skin, thickened and much scratched.

Contact Allergic Eczema

Contact allergic dermatitis to nickel may develop at any age. Once this nickel allergy has occurred, it persists for many years, often lifelong.

Nickel allergy is more common in women, probably because they are more likely to have pierced ears than men, although this is changing. The degree of allergy varies. Some people develop dermatitis (also called eczema) from even brief contact with nickel-containing items, while others break out only after many years of skin contact with nickel.

Some people develop intermittent or persistent eczema on their hands and feet. It is usually a blistering type of eczema, known as pompholyx. Sometimes it is due to contact with metal items containing nickel, but often there is no obvious reason for it.

It has been suggested that in some, dyshidrotic hand dermatitis is due to nickel in the diet. Unfortunately it is not possible to avoid ingesting nickel as it is present in most foodstuffs. A low-nickel diet is only rarely helpful.

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