Eczema

There are 7 different types of eczema: atopic dermatitis (the most common), seborrheic dermatitis (dandruff or oily scalp), stasis dermatitis (secondary to malfunction of the venous system in the legs), dyshidrotic eczema (secondary to an allergen, usually affecting the hands and feet), contact dermatitis (secondary to a contact allergy), nummular dermatitis (generally in the older crowd, round itchy areas), and neurodermatitis (aka lichen simplex chronicus, secondary to forming a habit or scratching a specific area(s) of the skin).

Let’s talk about them individually.  

 Atopic Dermatitis is “the itch that rashes”.  That’s right, this type of eczema doesn’t start with a rash.  The rash is a secondary development from the continued act of scratching.  Often, there can be a genetic cause for atopic dermatitis, although this is not always the case.  It is very common to find other “atopic” conditions affecting individuals who have atopic dermatitis.  These conditions are seasonal allergies/ hay fever and asthma.  Combined, these three conditions are considered the “atopic triad”.  Food allergies can also affect many of these individuals.  All of these conditions are secondary to the immune system malfunctioning.  

Specifically, in patients with atopic dermatitis, the skin barrier is not functioning as it should.  This leads to dry skin and itching.  Without a functional skin barrier for protection, this leaves these patients at risk for secondary infections, like bacteria (staph aureus, including MRSA), herpes simplex, and molluscum contagiosum (pox virus), to name a few.

So what does this all mean?  It means that these patients need to work extra hard to try to keep a normal skin barrier.  They need to use a non-fragranced hydrating emollient cream daily or even twice a day for the entire body.  They may also need prescription medications to help treat their flares and for maintenance of their condition.  Prescription medications may including corticosteroids (topical, oral, injectable), non-steroid topicals (calcineurin inhibitors, prescription emollients), antihistamines, antibiotics (topical and oral), injectable biologic medication (Dupixant), and light therapy.

These patients often need to be managed by several medical professionals like their Primary Care Physician, Dermatology, and an Allergist.  Sometimes, flares of one portion of the atopic triad can stimulate a flare of another, so it is important to control all aspects of this condition.  Sometimes young kids with this type of eczema can “grow out” of it as they get older, but this is not always the case.  The great news is that we have a fabulous team who is well-versed in treating atopic dermatitis and also have a solid referral base if another specialist is needed to help co-manage these conditions.

Seborrheic dermatitis

 This is a very common condition that can affect both children and adult.  Genetics, hormones, and yeast on the scalp can all play a role in causing this condition.  The most common site this involves is the scalp.  This condition can also affect the face, ears, neck, chest, and back, rarely the underarms and groin folds.  Seborrheic dermatitis can often manifest as loose scales, redness, itchiness, stuck-on yellow greasy scales, and/or an oily scalp.

 Seborrheic dermatitis is often a chronic condition, so unfortunately, there is no cure.  However, it can be treated to help control the signs and symptoms.  Often, treatment is aimed at decreasing the inflammation and itch, as well as targeting the yeast.  Over-the-counter options consist of ketoconazole, selenium sulfide, coal tar, and zinc pyrithione.  There are several different prescription  anti-yeast and corticosteroid shampoos and leave-on topicals, as well as some other non-steroid topical options.  

Stasis Dermatitis

Enlarged (varicose) veins, swelling, rashes and ulcers on the lower legs are all potential indicators of stasis dermatitis.  What causes this condition?  Well, this is a mechanical problem, all related to a faulty venous system (veins) in the lower extremities.  The valves in the veins that are only supposed to allow the flow of blood in one direction, back up the legs to the lungs, begin to malfunction and allow for the backflow of blood.  This results in leakage of blood components into the surrounding tissues and thus, results in swelling or edema.  This progression, over time, will lead to the development of rashes and ulcers on the legs.  

 It is important to treat this condition, because these patients can end up with secondary infections (bacterial and fungal), which can progress into cellulitis.  Treatment consists of controlling the swelling with the use of compression hose (may not be indicated with certain other medical conditions) and possibly oral medications (diuretics, prescribed by Primary Care Physician).  Treatment of the rash with OTC and prescription topicals.  Treatment of any infection (topical or oral). And, local wound care for any ulcers.

Dyshidrotic Eczema

This type of eczema usually affects the hands and the feet.  Often, this can be very itchy.  Sometimes, there is also underlying atopic dermatitis.  This is generally a result of contacting an allergen and results in developing small itchy fluid-filled (“tapioca-like”) bumps under the skin.  This can be a chronic problem unless the allergen(s) is identified and eliminated.  Sometimes, we recommend patch testing to investigate for potential causes if the cause is not obvious.  Usually, this can be treated with prescription corticosteroids (topical or oral), non-steroid prescription topicals, and emollient creams.

Contact Dermatitis

 This type of eczema is caused by contacting an allergen.  Like dyshidrotic eczema, this can also be chronic if the allergen is not eliminated.  Often the skin is very itchy, particularly in the areas that the offending contacts.  Patch testing may also be recommended for this type of eczema and the treatment is similar to that of dyshidrotic eczema.

Nummular Dermatitis

This type of eczema often affects the older population.  These patients may/may not have had eczema in the past.  This can affect any area on the trunk and extremities and is often, but not always, itchy.  The rash generally is red, scaly and round in shape.  There is often generalized dry skin.  Treatment consists of a daily emollient cream and corticosteroids (topical and oral).

 Neurodermatitis

 This is also known as lichen simplex chronicus.  These patients may start with an itchy lesion or patch of skin, so they scratch, which results in more itching, and thus more scratching, etc.  The result is a thickened area of skin.  To effectively treat this, the itch-scratch cycle needs to be broken.  We can usually achieve this by using emollient creams and prescription corticosteroid topicals or intralesional injection of a steroid.

 If you or anyone you know is suffering from any of these conditions, you are in luck!  We have skin experts that are able to treat all of these skin conditions.