Eczema (Atopic Dermatitis) Quiz:

The word eczema comes from the Greek word for bubbling. It is a weeping, oozing itchy eruption that has many causes, the most common being atopic eczema. Other causes include allergic contact dermatitis, irritant contact dermatitis, seborrheic dermatitis, stasis dermatitis, pompholyx (dyshidrotic eczema), and xerosis. In addition, there are a number of other diseases that can present with an eczematous appearance, including scabies and fungal infections.

Atopic eczema is now thought to be related to defective production of skin protein called filaggrin in many cases.

Although a predisposition to atopic eczema can be inherited, it is not transmissible from person to person.

Environmental factors play an important role in triggering atopic eczema. It is not unusual for patients with atopic eczema to note that sweating during exercise, using harsh detergents, or wearing wool clothing can produce itching and trigger flares of atopic eczema.

Swelling, oozing, and crusting are all signs of atopic eczema. In a practical sense, all four characteristics (swelling, oozing, crusting, and itching) probably all occur simultaneously.

Pruritus (proo-RYE-tuss) is the medical term for itching. Itching sensations are carried by peripheral sensory nerves called C fibers. They are the same fibers that mediate the pain sensations. Anyone who has itched knows that is almost impossible to ignore the sensation. Scratching the itch probably changes the sensation to something akin to pain, which seems easier to tolerate.

Atopic eczema usually begins in infancy or early childhood. Since many children slobber at this age, the saliva will evaporate and dry out the skin of the face, producing dermatitis on the cheeks. Children in diapers also often have eczema on their elbows and knees. Eczema typically does not affect the diaper area. In adults, the pattern is somewhat different; eczema most commonly affects the skin folds opposite the elbows and knees. In addition, the neck, wrists, and ankles often have lesions.

Good skin care means that the skin should be kept moist. This is particularly important in children or adults who have atopic eczema. After a shower or bath, before towel drying, a thin layer of an emollient (a greasy substance which water cannot penetrate) should be applied to the wet skin to inhibit the evaporation of skin moisture.

If over-the-counter treatments fail to control atopic eczema, then it is time to see a physician. It may be necessary to prescribe topical steroids to control acute flares of dermatitis. Occasionally, other anti-inflammatory oral medications may be required for short-term control, and even ultraviolet light exposures can help manage serious persistent cases.

Most of the time, a competent physician is able to diagnosis atopic eczema with great accuracy by taking a medical history and then examining the patient's skin. Rarely, it may be necessary to draw blood and even take a sample of the patient's skin for microscopic examination to rule out other causes of weeping, oozing dermatitis.

Atopic eczema must be distinguished from a wide variety of other causes of weeping, oozing dermatitis. Many of these superficially similar conditions require very different forms of treatment.

Since the environment plays a very important role in skin hydration, the best answer to this question would be dry sand. Anything that tends to dry the skin would be likely to produce irritation in a patient with atopic eczema.

Itching usually prompts scratching, which can sometimes lead to a vicious itch-scratch cycle.

The urge to scratch can be so intense that it is done unconsciously. There is no question that scratching atopic eczema is counterproductive. Correct treatment will produce less itching, which can be tolerated without scratching.

Patients with poorly controlled atopic eczema should avoid being vaccinated for smallpox. Such individuals seem to be unable to control the vaccinia virus and may develop eczema vaccinatum, which can involve large areas of skin. Since it is no longer standard practice to vaccinate infants for smallpox in the U.S., this condition is rare. However, adults who have received recent vaccinia vaccinations can transmit the virus to others, so care must be taken to avoid close physical contact until the vaccine reaction has resolved.