Eczema

Atopic_dermatitis_child
“Atopic dermatitis child” by The uploader was Eisfelder at German Wikipedia Licensed under CC BY-SA 3.0 via Wikimedia Commons

About

Eczema is an allergic skin condition also known as atopic dermatitis.It largly affects children with sixty percent of cases occuring within the first year of life, and up to 90% of cases occuring by age 5. Atopic eczema is a common health problem for children and adolescents throughout the world.

Causes

While there is no known cause of eczema doctors do have some theories that include:

  • Genetics
  • Abnormal function of the immune system
  • Environment
  • Activities that may cause skin to be more sensitive. Heat and sweating during the physical exertion of sports can cause increased itching in eczema patients.
  • Defects in the skin barrier that allow moisture out and germs in

Some children and few adults may have atopic dermatitis due to food allergies. It is unclear what the relationship to food allergies because people with Eczema tend to have other allergies such as asthma and anaphylaxis.
When food is diagnosed as the one of the triggers it may be due to by eggs, milk, wheat and soy.

Symptoms

Eczema can be mild, moderate, or severe. Symptoms appear as skin that is itchy, dry and sensitive that also flakes and scales. Areas affected in children are can be the scalp, face, chest arms and legs. Specifically children and adults tend to have the rashes in the folds of knees, elbows and neck. Eczema often becomes less severe as children grow into adults. The itch from Eczema has been known to be so severe that people have scratched their skin till it bleeds.

Sleep loss can affect people with eczema and there is a social stigma due to the rash being visible although it is not contagious.

Diagnosis

Eczema may be diagnosed by your doctor examining the skin and using patch testing to rule out other diseases of the skin. Diagnosis may also be determined with help by viewing the patient’s medical history.

Patients that have a sleep disturbance for 1 or more nights per week were considered to have severe atopic eczema.

Treatment

Treatment may require hydrating baths, topical medications and anti-inflammatory creams,topical steroid creams or ointments. When food is diagnosed as a trigger by removing those foods from the diet may lessen the severity of the rash. Probiotic-supplemented formulas have shown promise in one study.

Treatments have been done with sedative antihistamines but studies did not show any evidence of a clear benefit for itch or global improvements. Sedating antihistamines may be effective because of their central sedating effect rather than any action on peripheral histamine blockade.1

A small study in 2000 showed that after 2 months, a significant improvement in skin condition occurred in infants given probiotic-supplemented formulas.2 Another study showed probiotic supplementation has a positive effect on the prevention and treatment of infantile eczema.3

Oral evening-primrose oil has produced a significant clinical improvement when taken in high dosage.4

Allergen-specific immunotherapy against aeroallergens may be useful in selected cases.5

Other information

L0059449 Advertisement for 'Clarke's Blood Mixture', published Englan Credit: Science Museum, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org ‘Clarke’s Blood Mixture’ was advertised as a treatment for a number of skin and blood diseases, including gout, rheumatism, scrofula, eczema and scurvy. In 1909, the British Medical Association estimated the cost of its ingredients was the equivalent of half a penny (at today’s prices) compared to the sales cost, which was 14 pence in modern terms. The maker, Lincoln Midland Counties Drug Co, claimed all skin and blood diseases “can only be cured by purifying the blood”. The advert shows a picture of the packaging so customers knew which preparation was the genuine article. The advert claimed that the preparation had stood the test of time for fifty years – the treatment was available in the United Kingdom until 1968, although the original recipe had been altered. maker: Unknown maker Place made: United Kingdom made: 1925-1926 Published: - Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
Advertisement for ‘Clarke’s Blood Mixture’, published England
Credit: Science Museum, London.

The skin is prone to infection due to having a defective barrier.
A recent study has shown that breast-feeding did not protect against the development of atopic eczema.6 This contrasts with a 1984 study that showed in 1958 and 1970 there was a positive association between eczema and breastfeeding.7

There was a 2015 peer reviewed study published in the European Journal of Allergy and Clinical Immunology that concluded a delay in the first dose of the DTaP vaccination for children had less eczema and less use of eczema medication. This is new information that should be studied more and the information should not imply that parents should not vaccinate their children.7

Notes

Hoare C, Li Wan Po A, Williams H.Systematic review of treatments for atopic eczema. Health Technol Assess 2001;4(37)

Isolauri, E., Arvola, T., SÜtas, Y., Moilanen, E. and Salminen, S. (2000), Probiotics in the management of atopic eczema. Clinical & Experimental Allergy, 30: 1605–1610. doi:10.1046/j.1365-2222.2000.00943.x

Lin RJ, Qiu LH, Guan RZ, Hu SJ, Liu YY, Wang GJ. Protective effect of probiotics in the treatment of infantile eczema. Exp Ther Med. 2015 May;9(5) 1593-1596. doi:10.3892/etm.2015.2299. PMID: 26136864; PMCID: PMC4471811.

ORAL EVENING-PRIMROSE-SEED OIL IMPROVES ATOPIC ECZEMA Wright, S. et al. The Lancet , Volume 320 , Issue 8308 , 1120 – 1122.

Hong Kong Medical Journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine 2015, 21(3):251-260

The prevalence of childhood atopic eczema in a general population Kay, James et al. Journal of the American Academy of Dermatology , Volume 30 , Issue 1 , 35 – 39.

CHANGES IN THE REPORTED PREVALENCE OF CHILDHOOD ECZEMA SINCE THE 1939-45 WAR Taylor, Brent et al. The Lancet , Volume 324 , Issue 8414 , 1255 – 1257

The prevalence of childhood atopic eczema in a general population Kay, James et al. Journal of the American Academy of Dermatology , Volume 30 , Issue 1 , 35 – 39.

Allergy. 2015 Dec 28. doi: 10.1111/all.12830. (Epub ahead of print)
Timing of routine infant vaccinations and risk of food allergy and eczema at one year of age.
Kiraly N1,2, Koplin JJ1,3, Crawford NW4,2,5, Bannister S2, Flanagan KL6, Holt PG7,8, Gurrin LC1,3, Lowe AJ1,3, Tang ML9,10,5, Wake M11,12,5, Ponsonby AL13,5, Dharmage SC1,3, Allen KJ1,10,5,14.