Atopic Eczema: Causes, Symptoms, Pictures & Treatment

Eczema or dermatitis is a chronic skin condition most common in childhood but settles spontaneously by the teenage years. In some patients, atopic eczema starts from adulthood for the first time and persist throughout adult life. Asthma and hay fever are commonly related with atopic eczema or may be found in the first degree relatives. Atopic eczema presents condition of allergic contact dermatitis.

Causes of Atopic Eczema

What are the causes of Atopic Eczema?

The main causes of atopic eczema include

• A positive family history of atopy is often present which includes eczema, asthma, and allergic rhinitis that causes atopic eczema.
• It may also be caused due to primary genetic defect in skin barrier function i.e. loss of fuction variant of the protein flaggerin.
• Exacerbating factors such as infections, allergies (chemicals, food, pet, dust, fur) sweating, heat, occupation and severe stress can also be the cause of atopic eczema.

Clinical Presentation of Atopic Eczema

• Itchy papules and vesicles which are often weepy appear on the skin.
• Chronic lesions appear on the skin are dry scaly itchy patches that are erythematous in paler skin and grey or brown in richly pigmented skin.
• In infants it is more common on the face and extensor aspects of the limbs but in children and adults it is on the flexor aspects.
• Eczema may be present as brown, purple or grey bumps i.e. popular eczema or follicular eczema are more common in richly pigmented skin.
• In eczema chronic scratching or rubbing results in lichenification.
• Eczema lead to pigmentary changes that leads to hypopigmentation(reduced pigmentation) and hyperpigmentation(increased pigmentation).
• Patient’s nails show pitting and there is a ridging of the nails.

How to diagnose Atopic Eczema?

The most crucial differential diagnosis is contact dermatitis. All patients with facial eczema should be considered for patch testing to look forward for contact allergen. Psoriasis and seborrhoeic dermatitis may cause confusion in the diagnosis of atopic eczema.

Management and treatment of Atopic Eczema

• Irritants and soap should be avoided.
• Emollients should be applied frequently.
• Topical steroids and topical calcineurin inhibitors are used for the treatment.
• Treatment with mild steroids(1% hydrocortisone) should be used initially.
• Cream can be used cosmetically.
• Moderate steroids such as clobetasone butyrate, aclometasone dipropionate, may be necessary but used for limited periods of time.
• Steroids should be used regularly. Avoid from applying on eyelids.
• The medicines such as calcineurin inhibitors, tacrolimus ointment and pimecrolimus cream are very useful on the skin of the face as these medicines do not cause the thinning of the skin.

Medication for Atopic Eczema

What are the medicines for Atopic Eczema?

• Topical steroids for active infected areas and topical immunomodulators such as tacrollimus, pimecrollimus are used for maintainance therapy as they are used as stroid-sparing agents.
• Antihistamines for symptomatic relief.
• Antibiotics(e.g. flucloxacillin) are used for secondary bacterial infections.
• Antivirals(e.g. aciclovir) are used for secondary herpes infection.
• Immunosuppressents(azothioprine, ciclosporin, methotrexate) are used for sevete non-responsive cases and biologic therapy.
• Phototherapy is also used as a best treatment.

Complications in Atopic Eczema

There may be secondary bacterial infection on the skin that may be crusted weepy lesions.

Secondary viral infections are also common that includes molluscum contagiosum(pearly papules with central umblication). Viral warts and eczema hepaticum can be seen.

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