Health Care and Life Sciences : Anatomy Eczema.
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Health Care and Life Sciences : Anatomy
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Eczema is defined as an inflammatory, chronically relapsing, non-contagious, and extremely pruritic skin disease (Ring, Eyerich, & Darsow, 2013). This disease is known by the name atopic dermatitis. According to the World Allergy Organization 2003 Nomenclature Task Force, eczema is the agreed term to replace the transitional term atopic dermatitis syndrome (Ring, Eyerich, & Darsow, 2013). In some cases, eczema represents a group of conditions that make the skin to become red, itchy, and even inflamed. In children and babies, it is very common to develop eczema on the face. However, it can appear anywhere on the body and the symptoms can differ from one child to the next. From this description, eczema can be termed as a complex disorder with genetics, immunity, barrier functions and environmental factors (McPherson, 2016). Of these pathological mechanisms, many of them interact and are seen to work so as to progress or even maintain Atopic Dermatitis (McPherson, 2016).
Eczema is known to have a prevalence of 2-5% in children and approximately 10% in young adults (Ring, Eyerich, & Darsow, 2013). Its exact cause is unknown, but it is believed that its development is as a result of a combination of genes and environmental triggers. That is, when an allergen turns on the immune system, skin cells don’t behave accordingly bringing up the eczema flare-up. Eczema is inherited in a polygenic fashion where many genes are involved. This gives evidence for genomic imprinting since the maternal influences are more than the paternal ones. A breakthrough in the genetics of eczema was achieved in the year 2006 and it identified a loss of function mutations within the gene filaggrin. This ends up causing ichthyosis vulgaris and it confers a potential risk to develop eczema and especially early in persistent sensitization (Ring, Eyerich, & Darsow, 2013). Filaggrin is an important protein in the formation of the epidermal barrier through the binding and aggregation of the keratin cytoskeleton. It is these results that put forward the importance of the skin barrier when it comes to preventing allergic responses. They also gave rise to the concept that the primary defect in eczema is a failure of skin barrier function that allows the abnormally enhanced presentation of antigens, allergens, and chemicals to the immune system (Ring, Eyerich, & Darsow, 2013).
The symptoms of eczema are known to vary depending on the age, and the disease condition of a particular person. In infants, atopic dermatitis occurs with dry and scaly patches appearing on the skin. These patches are in most cases intensely itchy. For infants below the age of two years, these rashes will be evident on the scalp and cheeks, they bubble up before leaking fluid, and they can cause extreme itchiness. They will interfere with sleeping, and when they are continuously rubbed they can lead to skin infections. For the children aged from two years old to puberty, the rashes will appear behind the elbow and knee creases. They are also evident on the wrists, neck, ankles, and also the crease between the buttocks and legs. Over time these rushes can become bumpy, lighten or even darken in color. They can also thicken in a process known as lichenification. As a result, the rashes can develop knots and a permanent itch.
In adults, the rashes will appear increases of the elbows, knees, or at the nape of the neck. They cover much of the body and can cause very dry skin. In this case, they can be scaly than in small children. They can also lead to skin infections. For adults who’ve had atopic dermatitis as children, they can still have dry skin that is easily irritated, eye problems and even hand eczema. Additionally, the appearance of a skin that has been affected by atopic dermatitis will depend on how much a person scratches and on whether the skin is infected.
For prevention of eczema in children who are at high risk of breastfeeding to up to four months and a late introduction of solid foods is recommended. Allergens like mite and pets should be avoided although this is controversial. Factors that have been identified to trigger eczema should also be avoided, or avoidance strategies for specific allergens should be put into place. These strategies should include avoiding dietary changes, removing pets from home, protecting home beddings and others from dust and mite allergens among many others. For predisposed patients, prevention should be by avoiding the drying of the skin by using creams and emollients. This is helpful because it protects against relapsing of the disease.
Overheating is also a factor that can make eczema worse and it should be minimized. It is advisable to bathe in warm water rather than hot. Due to alkalinity, normal soap tends to dry out the skin. Therefore, soap and detergent based shampoos should be substituted. Ointments and creams that contain corticosteroids are used for the flare-ups that come with eczema. They relieve itching by reducing the inflammation on the skin and they are very effective when they are used correctly.
Management of eczema is based on the patient’s education. This is because its main aim is to get to constant cooperation between the patient and the physician when it comes to the treatment of this chronic disease. Symptomatic treatments include the frequent use of emollients so as to give back the restoration of the disturbed epidermal layer, oil baths, and the application of moisturizers. The anti-inflammatory treatments involve the use of topical steroids and calcineurin inhibitors, and antiseptics. Additionally, UV therapy has also been helpful in many cases.
For eczema, there is no lab test that is required. As a doctor, diagnosis is made by examining the skin and reviewing the medical history of the patient. Patch tests and other tests are used so as to rule out all the other skin diseases and also to identify the conditions that for hand in hand with eczema (Mayo Clinic, 2018). When examining the skin for eczema, there are things to look out for, for instance, the itchiness of the rash, the dryness of the skin and the presence of the scaly rash. A detailed medical history is the most important way of diagnosing eczema. It is followed by questions focusing on when the rash appears, where it appears and how often it does. Additional tests like the blood tests, skin biopsy, and allergy skin testing support the diagnosis for atopic dermatitis.
In conclusion, as a chronic disease, eczema calls for chronic care. Faithful attention to bathing and medication regimens and it also calls for a vigilant avoidance of the aggravating factors that can control the physical discomfort, and the significant emotional consequences that may come along with it. Good communication between the patient and their physician is important when it comes to an effective plan for chronic care.
Mayo Clinic, (2018). Atopic Dermatitis (eczema), retrieved from