Eczema & Science of Itch. What Research Says?

[dropcap]W[/dropcap]e’ve all experienced the discomfort of irritated, itchy, dry skin at some point. For some, however, this sensation is more than just the result of dry skin; eczema affects more than 31 million individuals in the United States (with 9.6 million children), as the National Eczema Association reported. Everything you need to know about the condition, from its causes and symptoms to its symptoms and treatment to its useful lifestyle modifications, is right here in one article.

What Is Eczema?

Eczema or dermatitis is a skin condition that makes the skin dry, red, itchy, and scaly.  In extreme circumstances, dermatitis-affected skin might crack, bleed, and discharge.

The National Eczema Society says it can appear pink or red on fair skin and brown, purple, or grey on darker skin. Scaling and a rough surface are common.

Science of Itch. 

Itchy skin can be annoying and distracting. However, have you ever considered the possible causes? The average person itches dozens of times each day.  They can be brought on by anything from an allergic reaction to dryness to disease.

Whenever an allergic reaction or contact occurs with any itch-causing substance, it releases an anticoagulant in your body. That prevents your blood from clotting. This compound we are mildly allergic to triggers the release of histamine (a chemical that swells our capillaries), causing an increase in blood flow. This results in the body’s immune response that perceives the threat explaining the swelling reaction. This also makes our nerves involved in itching, making us scratch. The whole mechanism of the itch isn’t understood in humans, but animal studies have discovered that itch signals in their skin are transmitted via a subclass of nerves associated with pain.

Eczema Types

Different forms of eczema manifest themselves in somewhat different ways. All is well researched and are described below.

1. Atopic Eczema.

Atopic eczema is the most prevalent form of skin condition affecting more than 26 million people annually in the United States. This is an allergic reaction, where the body’s immune system mistakenly attacks normally safe substances. Dry, itchy, red, painful, and cracked skin is a classic sign of atopic eczema. Hands, feet, arms, the backs of knees, and the insides of elbows are common areas affected in older kids and adults.

The onset of symptoms is typical during childhood and might vary in severity. When one parent has atopic dermatitis, the risk of their child developing the condition is increased.

Hand Eczema.

If dermatitis is only on your hands, you have hand eczema (both palms and backs). Multiple factors usually combine to generate this problem. Frequent fractures and splits impair the hands. It can also be a sign of atopic dermatitis or brought on by irritating or allergic contact dermatitis. Multiple factors contribute to its complexity of it.

2. Irritative & Allergic Contact Dermatitis.

The skin condition known as “contact dermatitis” can be caused by an irritant or an allergen. Over 80% of cases of contact dermatitis are caused by irritation. When the skin’s protective barrier is compromised in some way, this can happen even in persons who don’t have atopic dermatitis. It is not related to hay fever or seasonal allergens in the same way that other kinds of eczema are. In addition, studies do not believe that genetics predispose some individuals to have contact dermatitis

Irritant contact dermatitis is caused by prolonged exposure to an irritating substance or material. Typically manifests on dry, cracked skin. A rash develops when an irritant, typically a chemical, penetrates the skin greatly. Again, this is most common where the irritant contacts the skin.

Allergic contact dermatitis occurs when the skin reacts more slowly (within 48-96 hours) following contact with a chemical that the immune system detects as foreign or to which you have developed an allergy.

3. Dyshidrotic eczema.

Also known as pompholyx, manifests as irritating blisters on the sides of the fingers and toes. The exact etiology of this type is unknown, but it most commonly affects adults younger than 40. Large, oozing blisters have been seen in some cases. Most cases of blister heal within two to four weeks. As a result, the skin typically gets dry and cracked, which can cause painful skin fissures.

It can be triggered by allergic reactions (to nickel, for example) and nonallergic factors (such as stress). Individuals with preexisting dermatitis or seasonal allergies are more likely to develop this condition. Those whose job entails them working with chemicals or whose hands are constantly wet are also at a higher risk of acquiring dyshidrotic eczema.

4. Numural Eczema.

Discoid eczema, also known as nummular eczema, is a chronic skin disorder characterized by coin-shaped patches of irritated or blistered skin, making them easier to spot. It’s common to see the discs on the arms, forearms, and lower legs. These patches will look red on fair-skinned people. In addition to being more common in men, discoid eczema tends to worsen in the winter because of the dry air. This dermatitis can occur alone or alongside another.

5. Seborrhoeic Dermatitis.

Seborrheic dermatitis frequently affects oil-producing skin regions, including your scalp, nose, and upper back. In adults, it is frequently termed seborrheic dermatitis.

Dermatologists speculate that a heightened immune response to the normal proliferation of yeast on human skin may be at the root of seborrheic dermatitis. In adults, the symptoms tend to come and go, getting worse when the weather becomes cold, or the person is under stress.

6. Neurodermatitis

Up to 12% of the general population suffers from neurodermatitis. The first symptom is generally a persistent itch, which appears at times of high stress or distress.

Unlike other types of eczema, Neurodermatitis tends to affect only one or two spots on the body at a time. They may experience discomfort everywhere on their body, including their toes, feet, hands, wrists, shoulders, cheeks, scalp, and even their genitalia.

Age-Related Eczema Types.

Changes in the skin’s structure happen naturally as we get older. For example, the rate at which epidermal cells are replaced, and collagen is made slows down, making skin drier and more prone to dermatitis. Types of dermatitis seen in older as mentioned below.

7. Gravitational/Stasis dermatitis. 

Cause in legs due to poor circulation in the legs as veins in the legs can become more fragile as people age and engage in less physical activity. This can cause both varicose veins and eczema. It can appear as dark, scaly patches on leg surfaces.  There might be as many as 20 million individuals over the age of 50 who are affected in the US alone.

Symptoms of varicose eczema, which most often appears on the lower legs, include:

• Blisters or itching, warm patches
• Flaky, scaly skin
• Red, crusty spots that occasionally ooze
• Skin rips and cracks

Pregnancy and the effects of female hormones make varicose veins more prevalent in females than males.

8. Asteatotic eczema

People over the age of 60 are disproportionately affected by asteatotic eczema, also known as xerotic eczema and dermatitis craquelé. A possible cause of this is how skin changes as we get older, getting drier. Shins are the most common target, although other body parts including the thigh, arm, stomach, and back may be affected as well.

The following table summarizes dermatitis and other signs with causes.

Causes of Eczema.

Although the specific origin of eczema remains unknown, researchers do understand what triggers it: a “getaway car” combination of genetic and environmental factors.

• Family History. Your risk of developing eczema increases if it runs in your family. A history of asthma, hay fever, and/or allergies increases your risk.
• Genetic Factors. According to research, dermatitis has a strong genetic relationship. According to a study published in Nature Genetics, some persons with dermatitis do not create enough proteins to form a strong barrier on the epidermis, the skin’s outermost layer.
• Extreme Weathers. An extreme in any environment can also be the cause. These can dehydrate the skin, making it more prone to cracking and flaking. Contrarily, the improper sort of moisture can also be a problem.
• Excessive sweating. Sweating can irritate the skin, particularly during a flare and in skin folds where sweat accumulates (elbows, knees, and the neck).
• Irritants. Soaps, detergents, fragrances, and cosmetics can all include chemicals that can aggravate sensitive skin and trigger an inflammatory reaction if used repeatedly or in large quantities.
• Emotional Triggers. Your mental health might impact the health of your skin, which can induce a flare-up of symptoms. Stress, worry, and sadness have all been linked to the increased frequency of outbreaks.
• Certain Foods. There is no convincing evidence between dermatitis and dietary allergies. But if you have any food allergy, it can flare up and cause a skin reaction. Learn more about what are food allergies here.

Complications.

Eczema manifests itself most obviously as red, irritated, and inflamed skin on the body’s outermost layer. But the effects of eczema may be felt all the way down to the bones. The possible risks include:

• Infections: You are more likely to contract staphylococcus and other skin infections because your skin may not have enough of the proteins that help fight off infections.
• Heart Problems: An increased risk of angina, heart failure, and myocardial infarction (heart attack) was observed in the recent 2018 study of people with severe dermatitis.
• Bone Fragility and Fractures: Recent studies have also shown an increased risk of hip, back, and spinal fractures in those with severe dermatitis. Consistent inflammation, which has been linked to dermatitis, is a contributing factor, according to experts
• Sleep Disturbances: About a third of persons with dermatitis have trouble sleeping. These problems include insomnia, lower sleep duration, daytime drowsiness, and exhaustion.

Diagnosing Eczema.

To diagnose eczema, a laboratory test is unnecessary. A skin exam and a review of your medical history might be all your doctor needs to diagnose. They may utilize patch testing or other diagnostic procedures to rule out other skin problems.  In a physical examination, a doctor will examine your skin in great detail to diagnose eczema.  Common questions that will be asked are,

• When did the itchy spots first appear, and where did they appear?
• In the instance that you get skin breakouts whenever you’re under pressure
• If you experience skin flare-ups in hot, dry, or cold weather, your skin is likely to dry.
• If you suffer from allergies, particularly those triggered by dander or pet hair,

Treatments.

Unfortunately, eczema cannot be cured with a single medication. It does go through cycles of worsening (flares) and remission. Although studies have indicated that 75% of children are dermatitis-free by age 16, there is no way to know if you will outgrow this chronic condition. Although there are remedies out there, nothing can completely do away with your symptoms.

• Emollients & Moisturizers. 

Emollients are topical skin moisturizers in products like lotions, creams, and ointments. It is the primary first-line treatment for eczema; emollients are essential for maintaining the skin’s moisture barrier. This is because itching leads to scratching, which causes more damage to the skin and additional itching. You may get emollients with or without a prescription. Thicker emollients are preferred as they provide more strong barrier against the trigger.

People with eczema have more sensitive skin, thus, moisturizers with food ingredients should be avoided. Oats, goat’s milk, almond oil. Using a moisturizer with the component may cause an allergy.

• Bathing Products. 

The skin can be dried out by using soaps, shower gels, and bubble baths. As an alternative to soap, you can use an emollient wash product or a leave-on emollient. Ointments, which are grease-based and hence beneficial for extremely dry skin.

• Corticosteroid. 

Topical steroids operate by reducing inflammation in the skin. In its early, or “acute,” stage, eczema manifests with redness, irritation, and itching, and it may even be oozing and flaking. In this case, topical corticosteroids an ideal first-line therapy for its flare-ups.

There are four strengths of topical corticosteroids: mild, moderately powerful, potent, and extremely potent. The severity of eczema and the affected area of the body should be considered while selecting the appropriate corticosteroid dosage. For instance,

• A low to moderate-potency corticosteroid is recommended for treating the face and genital eczema.
• Moderate to strong products may be used on the rest of the body.
• Extremely strong corticosteroids may be necessary for the palms and soles (as the skin is much thicker, so less prone to thinning). But since they might cause your skin to be thin, using them for more than two weeks at a period is not advised.

Use the fingertip unit technique to determine how much topical steroid to apply. Creams and ointments are measured by the amount needed to cover a fingertip. This much can treat two flat hands of eczema. An older adult’s trunk eczema may require seven fingertip units. A course of therapy lasting between 7 and 14 days usually suffices to alleviate a dermatitis flare. A longer course may be necessary for some situations.

If using both therapies, apply the emollient first. After 10 to 15 minutes, apply topical steroids over an emollient. Before applying a topical steroid, the emollient must be thoroughly absorbed.

• Oral Antibiotics. 

Infectious disease-causing bacteria are eliminated by these drugs. When you scratch an injury, you might introduce germs to the region. Antibiotics are commonly prescribed for eczema flares, even though only a few studies have shown they benefit.

• Injectables. 

When topical treatments fail to alleviate moderate to severe type, Dupilumab injection is used to treat eczema (atopic dermatitis) in adults and children 6 months of age and older who cannot take other drugs for their condition or whose eczema has not responded to previous treatments. It has been approved by FDA for dermatitis treatment recently. In the research published in 2016 in the New England Journal of Medicine reported that after 16 weeks of treatment, 75% of patients who took it had a reduction in their eczema symptoms.

• Immunosuppressants. 

Your dermatologist may prescribe an immunosuppressant or antihistamine medicine to help manage your immune system if your eczema is so severe that it affects a large portion of your body and causes significant inflammation (redness and itching). When taken before bedtime, their benefits are maximized. Indeed, some of the newest antihistamines on the market don’t have that drowsy side effect.

• Phototherapy. 

UV radiation or sunlamps are used in light treatment, also known as phototherapy, to help suppress the immunological reactions that cause dermatitis. The condition can be improved by a variety of therapies. Moreover, it helps protect against bacterial skin infections. Consistent phototherapy treatment for dermatitis may not yield noticeable results for up to two months. Like any treatment, light therapy comes with potential side effects and advantages. Consult your doctor as you weigh the benefits and hazards.

• Avoiding Triggers.

First, it’s important to recognize what sets off your eczema so you can modify your food and routine accordingly. Keeping track of what you consume, the weather, the items you use, and the activities you engage in might help you identify triggers.

• It is often encouraged to avoid fragranced products such as shower gels, detergents, and other cleaning supplies without added fragrances or dyes. To find products that are safe to use, check the labels of both lotion and laundry detergent.
• It’s common for those who suffer from atopic dermatitis also to be allergic to home dust mites. If you suffer from allergies, eliminating household dust mites is your best bet for alleviating your symptoms.
• Try as much as you can not scratch. Keeping your nails short will help.
• When possible, avoid wearing wool or other itchy materials close to the skin and instead choose cotton. The smoothness of the material, rather than the substance itself, is likely to be the key factor. Some silky synthetic textiles are perhaps just as wonderful as cotton.
• Don’t expose yourself to sweltering heat or cold, as either might cause skin irritation.

However, remember that each individual has a unique skin microbiome and a unique reaction to therapy, so what works for one person may not work for another.

•  Use Air Humidifier. 

A humidifier may be helpful in addition to routine moisturizing, using mild skin care products, and taking shorter, more frequent showers. It is a device/gadget that aids in restoring moisture to the air, reducing skin dryness and the associated itching and flaking. An up-to-date look at dermatitis therapy shows that using humidifiers during dry seasons can help reduce outbreaks.

• Bleach Baths. 

The danger of bacterial infections in people can be reduced by giving them regular baths with diluted bleach. Two or three times each week is ideal. Instructions for a bleach bath:

-A standard-sized bathtub filled halfway with water and a quarter cup of unscented washing bleach.
-Bathing soap: 1 tsp. Per 5 gallons of water.

• Exercise & Yoga. 

There are several reasons why exercise and yoga are beneficial for eczema. It maintains a healthy heart, muscles, and bones and increases the immune system’s vitality. Exercising as a treatment is highly effective in ameliorating symptoms and decreasing the frequency with which they recur. A study found that exercise is less likely to aggravate eczema.

Dermatitis cannot be cured. However, it may be treated successfully such that its symptoms are minimized. Alterations to one’s way of life and medical intervention may be necessary for treatment. Eating healthily and drinking enough water is also vital for healthy skin microbiota, moisturizing, and UV protection. Take care of your skin, so it doesn’t flare up when you’re out and about.