About Eczema

Eczema is generally a term for several different types of skin swelling. People with eczema tend to have a hyper-reactive immune system that produces inflammation in response to a trigger such as a substance outside or inside the body. As of 2007, there were 31.6M people in the United States that had some form of eczema [1]. The most common form is atopic dermatitis, a skin condition where dry skin becomes irritated, red, and inflamed before developing patches that itch and take time to heal. About 18M adults in the United States have atopic dermatitis [2]. It tends to occur in the same place such as behind the knees, on the wrists, knuckles, and ankles, and in the bend of the arm. Scratching can cause the skin to tear and an infection can set in. Scratching should be avoided because it can disrupt the skin barrier, making symptoms worse. In people with pigmented skin, the areas become dark and can take months to fade.

Some people with eczema have a mutation of the gene responsible for maintaining the skin barrier by producing a protein called filaggrin [3]. Filaggrin helps our bodies maintain a healthy protective barrier on the very top layer of the skin. Without enough filaggrin to build a strong skin barrier, moisture can escape and inflammatory triggers can enter. This is why many people with eczema have very dry and infection-prone skin.

In order to prevent development of eczema symptoms or worsening symptoms, it is important to know potential triggers. They may be different for different people. What makes them difficult to identify is that there is a lag time between when you may have been exposed to the trigger and when symptoms appear. Some common triggers are dry skin, irritants such as metals (e.g. nickel), cigarette smoke, soaps, household cleaners, fragrances, fabrics (e.g. wool or polyester), antibacterial ointments, formaldehyde (can be found in household disinfectants, some vaccines, glues, adhesives), isothiazolinones (antibacterials found in personal care products), cocamidopropyl betaine (shampoo and lotion thickener), and paraphenylene-diamine (e.g. in leather dyes and temporary tattoos). Other triggers are stress, sweating, weather that is too dry or too humid, long hot showers or baths, infection (e.g.staphylococcus aureus, viruses), allergens (e.g. seasonal pollen, dust mites, pet dander, mold), and hormones [4].

Eczema may result from an autoimmune condition. Thus, some find that sun exposure subdues the hyperreactivity of the autoimmune response. However, sun exposure will increase wrinkling and dryness, compounding eczema symptoms.

For some who suffer from eczema, moisturizing and skin care is not enough. They should see a dermatologist.

For more information and resources, see the National Eczema Association.

References

  1. Hanifin J, Reed M. A Population-Based Survey of Eczema Prevalence in the United States. Dermatitis. 2007;18(2):82-91. doi:10.2310/6620.2007.06034
  2. Silverberg, J. I. Public Health Burden and Epidemiology of Atopic Dermatitis. Dermatologic Clinics. (2017);35 (3), 283-289. doi:10.1016/j.det.2017.02.002
  3. Furue M, Chiba T, Tsuji G, Ulzii D, Kido-Nakahara M, Nakahara T, Kadono T. Atopic dermatitis: immune deviation, barrier dysfunction, IgE autoreactivity and new therapies. Allergology International. 2017;66:398-403.
  4. National Eczema Association, https://nationaleczema.org/eczema/causes-and-triggers-of-eczema/ accessed on 6/10/2018