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Skin care: eczema SKIN CARE: ECZEMA
Eczema and dermatitis are often regarded as being synonymous. Dermatitis, however, simply means inflammation of the skin, of which there are various forms; whereas eczema is a distinctive pattern of inflammatory response with distinctive microscopic changes, and internal, rather than external, associations.
The word eczema comes from the Greek ekzeo, to boil over. In an acute case of eczema, the skin becomes red and swollen, with surface oozing and/or blistering which results in crusting and scaling. The chronic cases end up with thickened skin, evidence of scratch marks, and increased pigmentation. In infancy the most common form, but by no means the only form of eczema, is atopic eczema. The term 'atopic' indicates an inherited tendency to develop one or more of a related group of common conditions, such as asthma, hay fever, urticaria or eczema. It is estimated that 10 per cent of the population are atopics, and that hay fever is the most common manifestation. Eczema affects about 3 per cent of infants, and these have a one-in-four chance of developing asthma or hay fever some time later.
Atopic eczema usually appears in the infant between the age of three months and two years. The initial site of inflammation is commonly the face and scalp, with subsequent spreading to the limbs. Individuals with this condition manifest certain abnormalities, particularly of the skin, which are thought to be the reason for them developing atopic eczema.
These abnormalities include impaired oil gland function, which results in a dry and hence itchy skin. This is why so many of these infants also suffer from a 'fish-scale' condition, known as ichthyosis. Accompanying this is also impaired sweat gland function, which results in a poor response to temperature or climatic changes, and an increased tendency to overheat. This combination also results in a more itchy skin. They also have what is termed a lowered itch-threshold, which means that they feel itchy in response to stimuli which would not cause itching in the normal individual. In other words, their skin is hypersensitive to itch stimuli.
A further abnormality in children who suffer from atopic eczema is that they have an increased level of a certain protein in the blood known as IgE. This is the reason they exhibit positive reactions to most skin tests. Consequently, these skin tests are of little value in assessing the relevance of food stuffs in the causation of eczema. Furthermore, they exhibit defective T lymphocyte function, which results in an impaired cell-mediated immunity. With this, there is an abnormal blood vessel response to touch. Instead of the red line one normally sees on the skin after light stroking, these children develop a white flare due to capillary constriction rather than dilation.
Various factors may trigger an attack of eczema. These include external irritants, climatic changes or psychological factors. The type of eczema that develops varies from individual to individual. Rather than the classical flexural eczema in the creases of the skin, some people develop coin-like spots, mainly over the limbs, known as discoid eczema. Alternately, the eczema may simply affect the fingers or toes, with small water-filled blisters forming underneath the skin, known as dyshidrotic eczema. Some cases, however, only show white, rounded patches, mainly over the shoulders or on the cheeks, and this is known as pityriasis alba. Others may simply exhibit rather dry, irritable skin, without any redness or oozing, known as asteatotic eczema.
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