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About Eczema and diagnosis , Classification of steroids by strength, Characteristics by age

The term eczema is used for a variety of skin conditions characterised by epidermal inflammation. Sometimes dermatitis is used synonymously, although dermatitis may describe any skin inflammation.

Categorised as exogenous (of external origin) or endogenous (originating within a structure, organ, or organism) depending on the cause.
Examples of exogenous eczemas include allergic, irritant, and photosensitivity eczema.
Endogenous eczemas include atopic, discoid (coin-shaped), gravitational, and seborrhoeic eczema.
However, this classification is not always helpful, as there may be many different causes of eczema, both endogenous and exogenous in an individual patient.

While the areas of skin affected vary in different types, skin lesions share certain common features. In acute eczema the skin is typically red and inflamed with boils,papules and blisters. In chronic eczema the skin may show the same but be more scaly, pigmented and thickened. Two of the most common forms of eczema are atopic eczema and seborrhoeic dermatitis.

Atopic eczema predominantly affects infants and children although adults may also suffer. The skin is itchy and there is chronic or relapsing dermatitis in which the face and neck and flexures of the elbows and knees are involved most often and are excoriated and lichenified.

Cure of atopic eczema is said to be unrealistic, but good control can be achieved with proper management. The Surestop synergy gives relief upto 60-75%, sometimes even upto 90% where only slight flareups can be seen in future recurrences, but not a complete elimination.

Surestop also helps to reduce Seborrhoeic dermatitis, which is a common eczematous skin disorder in which erythematous pruritic patches of skin may become either scaly or exudative and crusted. Scaling lesions are the type most commonly observed. In some cases, known as seborrhoeic folliculitis, there may also be follicular papules or pustules.

Seborrhoeic dermatitis occurs in regions of the body where sebaceous glands are plentiful, such as the scalp, face, and chest, although the condition is not associated with increased sebum production. The cause of seborrhoeic dermatitis is unknown, although it might be related to overgrowth with Pityrosporum ovale, a normal commensal yeast. Treatment is suppressive rather than curative. Dandruff due to normal shedding of scalp skin is treated similarly to seborrhoeic dermatitis of the scalp.

Echinacea preparations are used for the external treatment of hard-to-heal wounds, eczema, burns, psoriasis, herpes simplex, etc.

Diagnosing Eczema

Hanafin and Rajka’s diagnostic criteria for eczema:
> Itching
> Dryness of the skin
> Skin Inflammation
> Secondary infection of the skin
> Frequent flare-ups of eczema activity
> Family history of eczema, hay fever or asthma

A UK working party in 1994 refined and developed further based on a validated set of epidemiological data. They suggested the following:

Eczema is an itchy skin condition ... plus three or more of the following features:

> Involvement of skin in front of the elbows, behind the knees, the side of the neck or on the cheeks of children
> Personal history of asthma or hay fever, a history of atopic disease in first degree relatives in those under the age of 4 years
> General dry skin in the previous year
> Eczema present in the folds of skin in front or the elbows or behind the knees of on the face or outer aspects of the limbs in the under 4 year olds
> Eczema starting before the age of 2 years

Steroid strengths

The human body makes it own steroids in the adrenal gland, vital for the body's normal function and are essentially hormones.
Synthetic steroids are anabolic steroids (build muscle mass and cause liver damage) and catabolic steroids or glucocorticoids used to treat eczema. These have anti-inflammatory and immunosuppressive properties -they damp the activity of various immune cells that cause inflammation. They have been a very useful medicine, even lifesaving, in conditions like severe asthma or rheumatoid arthritis.

The down side is that if they when used at a high dose for a prolonged period, side-effects include fluid retention, suppression of adrenal glands, weight gain, bone thinning, decreased growth in children, high blood pressure and loss of muscle mass and hence used in treating very severe flare-up of eczema, and for the shortest period of time to minimise serious side-effects. Topical creams were developed to try to produce the same anti-inflammatory properties without the systemic side-effeccts on the rest of the body.

Topical steroids classified by strength -

*once-daily use only
From various sources, this table is a reference only.

Eczema varies by age

Baby/ Infant Eczema
Usually on the face, upper chest, scalp and neck. Forearms and shins may be involved later.

Symptoms
Tiny blisters may occur which open and may leak fluid.
Dry skin: The skin overall is very dry.
It is unusual to have involvement around the mouth or nose.
If the condition is severe, it may involve the whole skin.
The diaper area is usually free of eczema.
Between the ages of twelve and eighteen months, there is a tendency for the skin to become thickened particularly on the forearms and shins due to crawling.

Childhood Eczema
Between 4-10 yrs, eczema is usually more localized than in the infant.

Symptoms:
Usually in flexures -like sides of the neck, folds of the elbows, and back of the knees
The skin is often dry and red
There are often excorations and thickening or lichenification of the skin from scratching
The skin may have light or dark discoloration

About 10-15% continue to have active eczema as they grow older, while most others will have ongoing dry skin issues.

Teen/ Adult
Less acute than in children. Commonly, hands, feet, aound the eyelids and ears. Sometimes flexures of elbows and knees.

Any of the following conditions may occur:
Xerosis - dry scaly skin with no obvious inflammation, poor skin barrier function is a feature
Keratosis Pilaris - horny plugs in hair follicles especially on the outer arms and thighs
Dennie-Morgan lines - a single or double line or fold under both lower eyelids
Palmoplantar Hyperlinearity – prominent and increased creases on the palms and soles
Ichthyosis Vulgaris - a genetic condition of increased scaling especially on the lower legs
Pityriasis Alba - hypopigmented, whitish slightly scaly patches on the face especially in darker skin
Chelitis - chapped lips of cracks in the corners of the mouth
Lichen Simplex Chronicus - thickend leathery lined skin from chronic rubbing
Nodular Prurigo - itchy, often multiple nodules especially on the forearms and lower legs

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