Eczema: Types, Symptoms, Treatment

What is eczema?

Eczema refers to a group of inflammatory skin conditions that lead to itchiness, dry skin, rashes, scaly patches, blisters, and skin infections.

What are the types of eczema?

Atopic dermatitis (eczema)

Skin feeling itchy, dry, and inflamed.
Typically starts in childhood but can begin at any age in life.
Eczema is not contagious.

Contact dermatitis

An allergic skin reaction when the skin comes in contact with something that irritates it.
Symptoms include itchiness, rash, and blisters.
Contact dermatitis is not contagious.

Seborrheic dermatitis
- An inflammatory skin condition characterised by a papulosquamous appearance in regions abundant in sebaceous glands, especially the scalp, face, and body creases.
Dyshidrotic eczema
- A form of eczema that leads to small, extremely itchy blisters (pompholyx) on the hands or feet.
- These blisters may persist for as long as three to four weeks before clearing.
Neurodermatitis (lichen simplex chronicus)
- A form of eczema that starts with an itch, which can then result in a rash once scratched.
- Most individuals develop one or two of these itchy patches, and they rarely improve without treatment.
Nummular eczema (discoid eczema)
- A form of eczema that results in coin-shaped spots on the skin that may be itchy with red or brown patches.
- There may be oozing or crusting in severe cases.
- Can be triggered by dry skin, insect bites, or injury.
Stasis dermatitis (venous eczema)
- Occurs due to venous insufficiency, which is characterised by poor circulation in the lower legs. This happens when the valves in leg veins that help push blood back to the heart weaken and leak fluid.

What are the risk factors of eczema?

Genetics
- Research indicates that some individuals with eczema has a mutation of the gene responsible for producing filaggrin.
- Filaggrin is a protein that maintains a healthy protective barrier on the outermost layer of the skin.
- Insufficient filaggrin levels can cause loss of moisture, causing the skin to be prone to bacteria, viruses, and allergens entering the body.
- This exposed or “leaky” skin barrier cause intensely itchy skin, dry scaly patches of skin, blisters, skin infections, red spots or bumps and other symptoms.
Immune system
- Eczema is not classified as an autoimmune disease, which means the immune system does not directly cause the disease.
- However, the immune system can be a cause of flare-ups. During a flare-up, the skin barrier is weakened, making individuals more vulnerable to other skin conditions.
Environmental triggers
- Individuals who stay in intensely cold, damp or hot, swampy places may be at an increased risk of developing eczema.
- Sweating due to warmer weather, outdoor allergens, and increased exposure to sunlight can provoke itching, rashes, and other symptoms.
Emotional triggers
- Anxiety and stress are common triggers for eczema flare-ups, which then increases anxiety and stress in turn, creating a cycle that leads to further eczema flare-ups.

What are the symptoms of eczema?

In babies, signs of eczema commonly include itchy, dry, and scaly skin, along with redness and swelling. Small bumps develop as well, which can open and weep when scratched. Eczema in infants and young children usually shows up on the face, elbows, and knees.

Eczema in older children and adults typically shows up on the hands and feet, arms, and back of the knees. Do remember that all patches of dry skin are not indications of eczema. Children prone to dry skin can develop dry patches due to factors like the sun, air conditioning, and pool and salt water.

What are the triggers of eczema flares?

Triggers may be different from person to person, which include:

Irritants like soaps, detergents, shampoo, washing-up liquid, bubble baths
Environmental factors like cold and dry weather, humidity that may cause sweating
Allergens like house dust mites, pet fur, pollen, moulds
Food allergies like cows’ milk, eggs, peanuts, soya, wheat
Specific materials worn against the skin like wool, synthetic fabrics
Hormonal changes
Skin infections
Stress

How is eczema diagnosed?

Diagnosing eczema involves a combination of a thorough medical history, physical examination, and, in some cases, additional tests.

Your doctor may ask:

Do your blood relatives have atopic dermatitis, asthma, or hay fever?
What are your (your child’s) symptoms?
When did the symptoms start?
Which part of your (your child’s) skin does the atopic dermatitis appear?

Additional tests to support the diagnosis or rule out other conditions:

Patch testing to identify contact allergens.
Skin prick testing to identify immediate allergic reactions to specific substances.
Blood tests to measure levels of IgE and eosinophils, which can be elevated in allergic conditions, including atopic dermatitis.
In rare cases, skin biopsy may be done to confirm the diagnosis or exclude other skin disorders.

How is eczema treated?

There is no known cure for eczema. However, there are available treatment options that can help you manage and/or reduce symptoms. Consult a dermatologist to know the most effective treatment for you.

Topical treatments
- Medication: Topical corticosteroid applied on your skin to decrease the inflammation within a few days.
- Emollients: Moisturising treatments applied on the skin to decrease water loss and cover it with a protective film.
- Colloidal oatmeal: It has direct antioxidant and anti-inflammatory properties, which may provide the mechanisms for observed dermatological benefits.
- Calamine lotion: Primarily consists of calamine, zinc oxide, and glycerine. It has astringent, antipruritic, antiseptic, haemostatic, antibacterial, moisturising, and protective qualities beneficial to manage skin exudation, rashes, and itching.
- Coal tar: An antibacterial medication applied on the skin and scalp to treat itching, irritation, and dry patches (scaling and flaking). It is available in various forms such as a cream, ointment, scalp lotion, shampoo, or a liquid additive to your bath (emulsion additive).
- Wet wraps: In certain cases, your doctor may recommend medicated bandages, clothing, or wet wraps to wear over parts of skin impacted by eczema. These can be used over emollients or with topical corticosteroids to stop scratching, allow the skin underneath to heal, and prevent the skin from drying out.
Oral medication
- Oral corticosteroids: Short-term use for severe flare-ups to reduce inflammation.
- Oral immunosuppressants: To control moderate or severe eczema cases that are not responding to other treatments.
- Antihistamines: To help control itching, especially at night.
- Biologic drugs: Injectable medication to target specific pathways in the immune system to reduce inflammation for moderate to severe atopic dermatitis.
Relaxation techniques
- Engage in light exercises like yoga, tai chi.
- Go outside, even a stroll around the neighbourhood can be therapeutic.
- Indulge in a relaxing and rejuvenating bath.
- Other self-care strategies aligned with your interests.

How to prevent eczema?

For most types of eczema, you can take these steps for prevention and management:

Understand what your triggers are so that you can avoid exposure to them.
Incorporate a daily bathing and moisturising regimen into your routine.
Consistently take medications prescribed by your doctor.

Make an appointment at Pantai Hospitals

Consult your doctor if your eczema symptoms worsen or if you notice new symptoms. A dedicated and expert team of dermatologists at Pantai Hospitals is available for consultation to provide the best care and assistance.

Pantai Hospitals has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.