Eczema and Dermatitis: Diagnosis and Treatment

Eczema:

Acute eczema appears as rash. To differentiate this from psoriasis, this is less well demarcated and less scaly. Eczema can be caused by infection, allergy (atopia), various irritants and venous stasis. Different variety may co exist in a single patient. It is very important to know about the hobby, work or any other source of allergen exposure.

Causes of Eczema:

• Genetic: A family history of allergy (atopy) is common to find in about 70% of patients.

• Infection: Staphylococcus colonized lesions and toxins act as super antigens.

• Allergy: This is very common. Radioallergosorbent test (RAST) help to find out specific causative agent like house dust, mite etc. Food allergy is not also uncommon. Dairy products, eggs can exacerbate eczema. Infants may also suffer from eczema; but fortunately most of them grow out of it by the time they reach teen.

Treatment of eczema:

The patient must understand there is no specific cure available for this condition. Medicines can only control and lessen the symptoms. They tend to have dry skins (Xerosis). This skin gets irritated very easily and becomes itchy. Liberal use of emollients is the mainstay of the treatment. These should be used even when the disease is not active. Conventional soap is better to be avoided. Use emulsifying ointments instead. Emollients to be used at least twice daily. In severe type greasy emollients work best. For less severe variety less greasy products may be used. Topical steroids are also prescribed in a dose depending on the severity, site and patient's age to reduce inflammation and itching.

Dermatitis:

Irritant Dermatitis

We all are susceptible to various kinds of irritants. Most commonly palms are affected. It starts with a dry fissure, which is followed by weeping and itchy lesion.

Common irritants to cause this type of lesions are detergents, soaps, oils, alkalis, repeated use of water, and various solvents. Washing vegetables may also the culprit due the pesticides they contain.

Treatment of irritant dermatitis:

Avoid all the known irritants as far as practicable. Good car of hands by avoiding conventional soaps, liberal emollients, drying the hand properly after washing, using cotton or rubber lined cotton gloves for wet works and use topical steroids intermittently in case of flaring up.

Allergic contact dermatitis

This is often very easy to diagnose as the offending allergen leaves clue by the sharp cut off margins at the lesion. Though there may be secondary spread elsewhere (Auto Sensitization). The common allergens are nickel (watches, jewellery, key and coins); Lanolin (creams and cosmetics), chromates (cements, leather), colophony ( ink, glue, sticking plasters) foam in the furniture, plants (primulas) and medicinal ointments ( antibiotics, antihistamines, anesthetics etc.) This is Type IV type of allergic reaction.

Treatment of contact dermatitis:

Implicated allergen to be removed. To find out the allergen patch testing may be done. Topical steroids are used locally depending on the severity of the condition.

Adult seborrhoeic dermatitis

This is a very common condition. Dandruff being the commonest presentation. It also affect eyebrows, cheeks, and the flexures of the joints. This is caused by the overgrowth of skin yeast in the affected area. This condition can be fulminating in HIV positive patients.

Treatment of seborrhoeic dermatitis:

Use of topical antifungal and steroid ointment intermittently depending on the severity. Dandruff to be treated by Ketoconazole shampoo.

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