Varied in its presentation, eczema can show up in diverse forms in different individuals. Some key features that are common to most forms of eczema are as follows:
- Dry itchy skin
- Redness, heat and swelling of the affected part
- Skin eruptions - usually multiple small ones
- Occasionally there may be oozing of thin watery fluid from the eruptions
- Chronic scratching may lead to thickening of the skin in the affected area
- Darkening of the skin in long standing cases
- Crust formation may be seen
The lesions may appear on any part of the body but are commonly seen to affect:
- Knees, elbows, ankles - especially inner sides
- Face and neck
- Arms and legs
- Folds of skin
In children, nappy region, scalp, face and neck and forearms are commonly affected.
Sometimes the symptoms may exist for a short period of time (less than 4 weeks) and then disappear completely, this is called acute eczema. However, in most cases, the features persist for a long period and tend to be recurring in nature leading to 'Chronic eczema'.
There are different kinds of presentations of eczema and it is important to know your type to understand the treatability of the same. Discussed here are some common types:
1) Atopic dermatitis:
This is also commonly known as infantile eczema since it develops during the first year after birth in most cases. 90% of atopic dermatitis patients develop symptoms before the age of five.
Symptoms largely include reddish, dry or oozing scaly eruptions at the bend of elbows, back of knees, neck, face, etc. The skin is extremely dry and very itchy. Infants usually find it very difficult to control the itching and excessive scratching may lead to secondary infection.
The condition develops as an allergic reaction to a number of things such as foods, environmental allergens, etc. (see causes of eczema for details). The condition tends to be hereditary and often family history of some form of allergy, asthma, hay fever, etc. is seen in such cases. Atopic dermatitis is often accompanied by other allergic and hypersensitive conditions like rhinitis, asthma, etc. In certain cases, the two conditions may alternate with each other i.e. one flares up when the other subsides.
2) Contact dermatitis:
As the name itself suggests, this type is marked by symptoms of eczema that develop in localized regions where the skin comes into direct contact with an allergen (allergic contact dermatitis) or an irritant (irritant contact dermatitis).
Irritants take longer period and increased amount of contact to trigger an eczematous reaction as compared to allergens (food allergens, environmental allergens). Even a brief exposure to a small amount of allergen can trigger a fast eczematous response.
One of the commonest forms of Contact dermatitis is the allergy that is caused by contact with nickel (which is a component of artificial jewellery). Contact with watches, ear rings, rings, chains or other items of this kind causes red, itchy rashes followed by tiny blisters and peeling of skin.
3) Seborrheic dermatitis:
Commonly seen to affect the scalp, margins of the head and area behind the ears, this condition is characterized by reddish rashes with yellowish, oily scales. This is common in people who have an oily skin and scalp and it varies according to seasons. When seborrheic dermatitis occurs in infants, it is known as 'cradle cap'.
4) Exfoliative dermatitis:
A great amount of scaling and flaking is typically seen in this type of eczema.
5) Stasis dermatitis:
This type of eczema occurs in the portions of the body where the blood circulation is poor (like the area around the ankles) and it has a tendency to form ulcers. It is often associated with some circulatory disorder like varicose veins, etc.
6) Nummular dermatitis:
The eruptions are coin shaped in this type of eczema.
This is characterized by eruptions which show close relation to psycho-somatic stress. The patient usually develops an intensively itchy skin especially when the person is resting or relaxed. A vicious itch-scratch-itch cycle develops. This type of eczema usually limits itself to areas that are easily accessible to the person such as lower legs, ankles, back and sides of the neck, wrists, forearms, and genitals.
8) Dyshidrotic dermatitis:
Small fluid-filled and itchy blisters appear on the hands and feet. These are most common along the edges of the fingers, toes, palms and soles and tend to appear during certain times of the year. The blisters cause intense itching and thickening of the skin after excessive scratching.