Eczema Treatment: What You Need to Know

Eczema is a medical term that refers to a group of conditions that cause the skin to become inflamed, itchy, red, and cracked. It is often used interchangeably with “atopic dermatitis,” which is the most common form of eczema. The word “eczema” is derived from the Greek word “ekzein,” which means “to boil over,” reflecting the inflamed, red appearance of the skin. The condition can range from mild to severe and can be chronic, meaning it persists over a long period, with periodic flare-ups.

Eczema Symptoms

Eczema, particularly atopic dermatitis, presents with a range of symptoms that can vary in intensity and appearance. Here’s a detailed breakdown of the symptoms associated with eczema:

1. Itching: This is often the most noticeable and distressing symptom for many people with eczema. It can range from mild to severe and is often worse at night. Persistent itching can lead to the “itch-scratch cycle,” where scratching due to itching can exacerbate the itchiness, leading to more scratching.
2. Redness: Affected areas of the skin become red or inflamed. This redness is a result of increased blood flow due to inflammation.
3. Dry, Sensitive Skin: The skin often becomes dry and may feel raw, especially after scratching.
4. Swelling: Inflammation can cause swelling in the affected areas.
5. Darkened Patches of Skin: Chronic scratching or the persistent nature of eczema can lead to areas of the skin becoming thicker and darker, a condition called lichenification.
6. Small, Raised Bumps: These may ooze fluid when scratched and can become crusted over.
7. Cracked Skin: In severe cases, the skin can become so dry and inflamed that it cracks, which can be painful.
8. Scaly or Leathery Skin: Over time, repeated scratching or rubbing can lead to the skin becoming thickened, leathery, and scaly.
9. Oozing or Crusting: Sometimes, the bumps or blisters can ooze pus or fluid, which can crust over when it dries.
10. Clear Fluid Discharge: When the skin is scratched or when the blisters burst, a clear fluid may be released.
11. Blisters: In some types of eczema, like dyshidrotic eczema, small blisters filled with fluid can appear, especially on the hands and feet.
12. Warmth: The inflamed area might feel warm to the touch due to increased blood flow.
13. Pain or Tenderness: Some people may experience pain or tenderness in the affected areas, especially if the skin is cracked or if there’s an overlying secondary bacterial infection.
14. Secondary Infections: Broken skin from scratching or from severe eczema patches can become infected when bacteria enter the open areas. Signs of an infection include increased redness, warmth, pus, yellow crusts on the surface, and sometimes even fever.

It’s important to note that the appearance and severity of eczema symptoms can vary widely among individuals. Additionally, symptoms can fluctuate, with periods of worsening (flare-ups) followed by periods of improvement (remissions).

Eczema Causes

Eczema, particularly atopic dermatitis, is a complex condition, and its exact cause is not fully understood. However, it’s believed to result from a combination of genetic, environmental, and physiological factors. Here’s a detailed breakdown of the known and suspected causes and contributors to eczema:

1. Genetic Predisposition:
   • Individuals with a family history of eczema, allergies, hay fever, or asthma are more likely to develop eczema. Certain genes have been identified that can make individuals more susceptible.
2. Skin Barrier Defects:
   • The skin acts as a barrier, protecting the body from external irritants and allergens. In people with eczema, this barrier is often compromised, allowing moisture to escape and letting irritants in. This leads to dryness and increased susceptibility to irritants and allergens.
3. Immune System Dysfunction:
   • An overactive immune response to certain triggers can lead to inflammation, which manifests as the redness and swelling seen in eczema.
4. Environmental Triggers:
   • Eczema can be triggered or exacerbated by various environmental factors, including:
     • Allergens such as pollen, dust mites, mold, and pet dander.
     • Irritants like soaps, detergents, perfumes, and certain fabrics.
     • Climatic conditions, especially dry or cold weather.
     • Infections caused by bacteria, viruses, or fungi.
5. Food Allergies:
   • For some people, especially children, certain foods can trigger eczema flare-ups. Common culprits include dairy products, eggs, nuts, soy, and wheat.
6. Hormonal Changes:
   • Women might experience eczema flare-ups at certain times, such as during menstruation, pregnancy, or menopause, due to hormonal shifts.
7. Stress:
   • While stress doesn’t directly cause eczema, it can exacerbate symptoms or trigger flare-ups in some individuals.
8. Microbes:
   • An imbalance in the natural bacteria found on the skin can influence the development and severity of eczema. The presence of certain bacteria, like Staphylococcus aureus, can exacerbate symptoms.
9. Infant Factors:
   • Infants who are formula-fed or introduced to certain solid foods early might have a higher risk of developing eczema. Breastfeeding may offer some protection.
10. Vaccinations, Infections, and Diseases:

• Some studies suggest certain vaccinations or childhood illnesses might be linked to the onset of eczema, though the evidence is not conclusive.

It’s important to note that while these factors can contribute to the onset or exacerbation of eczema, the interplay between them is complex, and multiple factors often coexist in individuals with the condition.

Eczema Types

Eczema is a general term that encompasses a variety of specific skin conditions. Let’s delve into a detailed description of the different types of eczema:

1. Atopic Dermatitis:
   • Description: The most common form of eczema, atopic dermatitis is a chronic, inflammatory skin condition that often appears in early childhood but can occur at any age.
   • Symptoms: Red, itchy patches, often on the face, inside the elbows, behind the knees, and on the hands and feet.
   • Causes: Combination of genetic predisposition, environmental factors, and a malfunctioning immune system.
2. Contact Dermatitis:
   • Description: This type arises when the skin reacts to a particular substance.
   • Symptoms: Redness, itching, and burning in the area where the skin has come into contact with an allergen or irritant.
   • Types:
     • Allergic Contact Dermatitis: Caused by exposure to a substance or material to which one has become specifically sensitized.
     • Irritant Contact Dermatitis: Caused by direct contact with substances that damage the outer layer of skin.
3. Dyshidrotic Eczema/Pompholyx Eczema:
   • Description: This type specifically affects the fingers, palms of the hands, and soles of the feet.
   • Symptoms: Small, itchy blisters filled with fluid.
   • Causes: Stress, exposure to certain metals (like nickel), or skin contact with specific substances can trigger it.
4. Nummular Eczema:
   • Description: Named for its distinct round or oval patches.
   • Symptoms: Coin-shaped spots that are itchy, red, and well-defined.
   • Causes: Often associated with very dry skin or skin injuries, such as burns or insect bites.
5. Seborrheic Dermatitis:
   • Description: Affects areas of the skin that are oily or greasy.
   • Symptoms: Redness, scaling, and dandruff; commonly seen on the scalp, face, and inside the ear.
   • Causes: The exact cause is unknown but may be related to the Malassezia fungus, which is naturally found on the skin.
6. Stasis Dermatitis:
   • Description: Occurs when there’s a problem with the flow of blood in the veins, leading to the pooling of blood in the lower legs.
   • Symptoms: Skin irritation, itching, and darkened skin around the ankles or shins.
   • Causes: Poor circulation, often as a result of venous insufficiency.
7. Neurodermatitis (Lichen Simplex Chronicus):
   • Description: Chronic itching skin condition where repeated scratching and rubbing lead to thickened, rough skin.
   • Symptoms: Thick, scaly patches on the skin, often on the neck, wrist, forearm, ankle, or genital area.
   • Causes: Triggered by insect bites, stress, or other factors, leading to an itch-scratch cycle.
8. Asteatotic Eczema (Eczema Craquelé):
   • Description: Occurs due to severely dry skin, especially in the elderly.
   • Symptoms: Dry, cracked, and scaly skin, often resembling a ‘crazy paving’ pattern.
   • Causes: Typically exacerbated by dry environmental conditions.

Each type of eczema has its unique triggers and requires specific treatments. However, the common thread among them is the presence of inflammation and itchiness. Proper diagnosis by a dermatologist is essential for appropriate treatment and management.

Eczema Treatment

Eczema, or atopic dermatitis, is a chronic condition, and while there’s no definitive cure, various treatments aim to control symptoms, reduce inflammation, and prevent flare-ups. Here’s a detailed breakdown of the treatments for eczema and their associated limitations:

1. Topical Corticosteroids:
   • Description: These are anti-inflammatory creams or ointments that reduce inflammation and relieve itching.
   • Limitations:
     • Prolonged use can cause thinning of the skin, discoloration, or the appearance of small blood vessels on the skin’s surface.
     • Overuse can lead to topical steroid addiction or withdrawal.
     • Not recommended for long-term continuous use.
2. Calcineurin Inhibitors:
   • Description: These are non-steroidal topical medications, such as tacrolimus and pimecrolimus, that reduce inflammation and itching.
   • Limitations:
     • May cause burning or stinging upon application.
     • There’s a warning about a potential link to skin cancer and lymphoma, although the risk is considered minimal.
3. Topical PDE4 Inhibitors:
   • Description: Eucrisa (crisaborole) is an ointment that reduces inflammation by targeting a specific enzyme (PDE4).
   • Limitations:
     • Can cause skin irritation or burning upon application.
4. Moisturizers and Emollients:
   • Description: These hydrate the skin, repair the skin barrier, and prevent moisture loss.
   • Limitations:
     • Need frequent re-application throughout the day.
     • Some people might experience irritation or allergic reactions to specific ingredients.
5. Antihistamines:
   • Description: These are taken orally to control itching and scratching, especially at night.
   • Limitations:
     • Can cause drowsiness, especially first-generation antihistamines.
     • Not always effective in relieving itching from eczema.
6. Phototherapy (Light Therapy):
   • Description: This involves exposing the skin to controlled amounts of natural or artificial ultraviolet (UV) light.
   • Limitations:
     • Requires multiple sessions per week and long-term commitment.
     • Potential side effects include premature skin aging and increased risk of skin cancer.
     • Not suitable for everyone.
7. Systemic Medications:
   • Description: Oral or injected medications, such as corticosteroids, methotrexate, azathioprine, or cyclosporine, are used for severe cases.
   • Limitations:
     • Can have significant side effects when used long-term, including potential damage to internal organs.
     • Regular monitoring through blood tests may be required.
8. Biologics:
   • Description: Dupixent (dupilumab) is an injectable medication that targets specific proteins to reduce inflammatory responses.
   • Limitations:
     • Expensive and may not be covered by all insurance plans.
     • Potential side effects include eye problems and allergic reactions.
9. Wet Wraps and Bandages:
   • Description: Moist bandages applied over topical medications to boost their effectiveness.
   • Limitations:
     • Time-consuming and can be uncomfortable.
     • Overuse can lead to skin infections.
10. Behavioral Therapies:

• Description: Techniques like habit reversal therapy to reduce scratching.
• Limitations:
  • Requires commitment and consistent practice.
  • May not be available everywhere.

11. Alternative Therapies:

• Description: Treatments like acupuncture, herbal remedies, or dietary supplements.
• Limitations:
  • Efficacy is often not well-established through rigorous scientific studies.
  • Potential interactions with other medications.

Eczema Ayurvedic Treatment

Ayurveda, the ancient holistic system of medicine from India, offers a unique perspective on eczema, viewing it as an imbalance in the body’s doshas. In Ayurveda, eczema is often referred to as “Vicharchika.” The condition is believed to be primarily due to an imbalance in the Kapha and Pitta doshas, although Vata may also be involved.

Here’s an overview of the Ayurvedic approach to treating eczema:

1. Dietary Changes:
   • Pitta Pacifying Diet: Since Pitta is associated with heat and inflammation, foods that cool and soothe are recommended. These include cucumbers, melons, and dairy products. Spicy, fermented, and acidic foods that aggravate Pitta should be avoided.
   • Kapha Pacifying Diet: To balance excess Kapha, light, and warm foods are suggested. Reducing heavy, oily, and cold foods can help.
2. Herbal Remedies:
   • Neem: Known for its anti-inflammatory and antiseptic properties, neem can be applied topically as an oil or consumed as a supplement.
   • Turmeric: Its anti-inflammatory properties can be beneficial. It can be applied as a paste on the affected areas or consumed internally.
   • Aloe Vera: Provides a cooling effect when applied topically and can reduce inflammation and itching.
   • Triphala: Often taken internally, it helps detoxify the body and improve digestion.
3. Ayurvedic Oils:
   • Oils infused with specific herbs, such as Mahatiktaka Ghrita or Panchatikta Ghrita, can be applied topically to soothe the skin.
   • Coconut oil can also be beneficial due to its cooling properties.
4. Detoxification (Panchakarma):
   • Procedures like Virechana (therapeutic purgation) can help eliminate toxins from the body and restore dosha balance.
5. Ayurvedic Baths:
   • Adding neem leaves or turmeric powder to bathwater can help soothe the skin.
6. Stress Management:
   • Practices like meditation, yoga, and pranayama (breathing exercises) can help manage stress, which can be a trigger for eczema flare-ups.
7. Lifestyle Changes:
   • Maintaining a regular routine, getting adequate sleep, and avoiding known triggers can help manage symptoms.
8. Ayurvedic Medications:
   • Formulations like Khadirarishta, Arogyavardhini Vati, and Gandhak Rasayana are sometimes prescribed to treat eczema from within.

Limitations:

• While many people find relief through Ayurvedic treatments, the results can vary from person to person.
• Some herbs can interact with other medications or have side effects, so it’s essential to consult with an Ayurvedic practitioner before starting any treatment.
• Ayurvedic treatments often require patience and consistency, as they aim to address the root cause of the condition rather than just the symptoms.

In managing eczema, it’s crucial to work closely with a dermatologist or healthcare provider to find the most suitable treatment combination. Individual responses can vary, and what works for one person might not work for another. Regular monitoring and adjustments to the treatment plan are often necessary.

In conclusion, Ayurveda offers a holistic approach to eczema treatment, focusing on balancing the body’s energies, detoxifying, and promoting overall well-being. As with any medical condition, it’s essential to consult with knowledgeable practitioners and consider integrating Ayurvedic treatments with other medical approaches for comprehensive care.

NOTE: 
“This article does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on this WebSite. If you think you may have a medical emergency, immediately call or visit your doctor.” 

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References

1. https://nationaleczema.org/eczema/
2. Nemeth V, Evans J. Eczema. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538209/
3. https://www.nhs.uk/conditions/atopic-eczema/