An itch has been described as an irritating sensation that produces a desire to scratch. Once in a while, everybody has experienced the itch but for some people it goes beyond this and becomes a disease called eczema. Eczema (also called dermatitis) describes any inflammation of the skin which is characterized by itching, redness and an outbreak of lesions. It is non-contagious in nature i.e. does not spread from one person to another.

Alternative Names of Eczema are: Infantile eczema; Atopic dermatitis; Dermatitis – atopic.

Complications of Eczema
The list of complications that have been mentioned in various sources for Eczema includes:

• Lichenification (leathery skin) - from excessive rubbing.
• Atopic pleat (Dennie-Morgan fold) - extra fold of skin under eye.
• Hyperpigmented eyelids.
• Allergic shiners (dark rings around the eyes).
• Recurrent skin infections
  • Staphylococcal skin infections.
  • Streptococcal skin infections.
  • Warts.
  • Cold sores (herpes simplex).
  • Molluscum contagiosum.

Causes of Eczema
Numerous factors have been suggested as a cause for eczema (dermatitis/ skin allergy) but no exact origin and mechanism has been pin-pointed for this condition. Most of the studies simply speculate as to what can trigger this condition and a combination of genetic as well as environmental factors has been strongly implicated.
An abnormal function of the immune system (allergy/ allergic response) is seen in most cases where the body reacts abnormally to external impressions which otherwise don’t have an impact on healthy individuals.

Some of the triggers for eczema include but are not limited to:

• Environmental allergens: House dust, sand, smoke, animal dander, pollen, molds, etc.
• Dietary allergens: Milk & milk products, soy, fish, eggs, peanuts, etc.
• Contact with irritant substances such as soaps, detergents, cleaning products,    cosmetics, perfumes, etc. Even contact with certain forms of clothing, rubber, watches, jewelry, some metals such as nickel, etc, can trigger it off.
• Changes in temperature and humidity
• Dry climate and excessively cold temperature
• Psychological stress - This has been advocated as a cause in a large number of cases. How stress triggers off the altered immune response is not clearly understood.
• Impaired blood circulation especially in the legs - leads to stasis dermatitis
• Genetic factor: This has been strongly implicated as a cause for developing eczema. Often, patients with eczema are seen to be having some form of family history of allergies, asthma, hay fever or other forms of allergic diseases.
• Unknown factors trigger certain forms of dermatitis such as seborrheic dermatitis, atopic dermatitis, etc.

Signs & Symptoms of Eczema
Varied in its presentation, eczema can show up in diverse forms in different individuals. Some key features that are common to most forms of eczema are as follows:

• Dry itchy skin
• Redness, heat and swelling of the affected part
• Skin eruptions - usually multiple small ones
• Occasionally there may be oozing of thin watery fluid from the eruptions
• Chronic scratching may lead to thickening of the skin in the affected area
• Darkening of the skin in long standing cases
• Crust formation may be seen
• Scaling

The lesions may appear on any part of the body but are commonly seen to affect:

• Knees, elbows, ankles - especially inner sides
• Face and neck
• Arms and legs
• Folds of skin

Diagnosis of Eczema
The typical signs and symptoms of an eczematous patch are usually enough for an experienced physician to make the diagnosis. Supportive past and family history of the patients further aid him in diagnosis of eczema / dermatitis. In some cases however, the physician may need to take a small scraping from the eczema lesion to examine it under microscope for ruling out fungal infection. Skin biopsy may be required to rule out certain other skin diseases that mimic eczema / dermatitis.

Allergy tests may be required to determine the allergens or the irritants that are causative factors in a particular case.

Patch testing is also commonly done by physicians to pin-point what substances are capable of inducing eczematous reactions especially in cases of contact dermatitis.

Treatments of Eczema
Children are unique patients because it may be difficult for them to resist scratching their eczema, thereby making the condition worse. Fortunately, for mild to moderate cases,

• The application of moisturizer on a regular basis can be very helpful. And, in most cases, the eczema will disappear as the child ages.
• In the meantime, avoid as many eczema triggers as possible. Keep your child’s skin moist.
• After bathing, apply moisturizer within three minutes to retain the moisture in the skin
• Avoid sudden temperature changes.
• Keep your child’s bedroom and play areas free of dust mites (a common trigger).
• Use mild soaps – both on your child’s skin and on your child’s clothing.
• Dress your child in breathable, preferably cotton, and clothing.

Prevention of Eczema
Eczema outbreaks can usually be avoided with some simple precautions. The following suggestions may help to reduce the severity and frequency of flare-ups:

• Moisturize frequently.
• Avoid sudden changes in temperature or humidity.
• Avoid sweating or overheating.
• Reduce stress.
• Avoid scratchy materials (e.g., wool or other irritants).
• Avoid harsh soaps, detergents, and solvents.
• Avoid environmental factors that trigger allergies (e.g., pollens, molds, mites, and animal dander).
• Be aware of any foods that may cause an outbreak and avoid those foods.

When to seek Medical Advice
See your doctor if:

• You're so uncomfortable that you're losing sleep or are distracted from your daily routines.
• Your skin is painful.
• You suspect your skin is infected.
• You've tried self-care steps without success.