Dr. Richard Scheerer
May 9th 2013 Eczema
The term ‘eczema’ is used for a group of conditions that show a similar pattern of changes in the skin, giving rise to speciﬁc changes on the surface. The word itself comes from the Greek and means ‘to boil or flow out’ . In acute (short-term) eczema, intense inﬂammation leads to the formation of little blisters (vesicles) in the skin, which soon burst or are scratched open, leading to weeping and the ‘ﬂowing out’ of fluid. Even if there are no vesicles, a section of skin affected by eczema looked at under a microscope shows fluid between the skin cells, tending to push them apart. This produces an appearance reminiscent of a sponge – hence the term ‘spongiosis’ that is used by doctors. All the different conditions called eczema would be expected to show this spongiosis, together with some degree of inﬂammation around superﬁcial blood vessels, which are dilated, producing the hot, red feeling and appearance. In eczema, it is the dermis and epidermis that are affected. The epidermis shows the most marked changes. The inﬂammation leads to leaky blood vessels, so ﬂuid collects between the keratinocytes, causing them to separate. The brick wall takes on a sponge-like appearance. As the eczema becomes chronic, the constant rubbing and scratching causes the epidermis to regenerate more quickly, so it becomes thickened. Finally, eczema causes changes in the upper part of the dermis.
This region becomes ﬂooded with white blood cells, which are part of the body’s immune system or defenses. They leak out of vessels and even pass up into the epidermis. Eczema is a condition that has a tendency to ﬂare up and settles. It will often seem manageable and tolerable, but there may well betimes when the skin becomes redder and inﬂamed, with weeping areas and general background dryness. Eczema can vary in severity from one individual to the next: some people will find that they have eczema affecting their whole body, whereas others may have it only on specific areas such as the hands, legs or scalp. A ‘flare’ describes a worsening of the eczema. An acute eczema flare can cause you to feel generally unwell, which may in some cases require hospitalization, but the majority of cases can be self-managed at home. The dryness results from a lack of moisture retention in the epidermis layers. Very similar to the surface of a dry riverbed, the skins surface often cracks creating lesions. This can be quite painful, bloody, and restraining on daily activities. Other symptoms include redness, scaling, thickening of the skin, swelling and weeping blisters. When symptoms become inflamed, a burning and itching sensation rushes through that particular area leading to scratching. Although the scratching can alleviate the burning and itching, it leads to opening/spreading the affected area and in the worst cases, infection. These symptoms often appear on the hands, feet, face, ears, legs, and the flexion areas of joints such as under knees and inside elbows. Triggers for inflamed symptoms can be internal and external. Environmental factors are the main external causes. Internal factors, besides stress, are allergic reactions to food, poor functioning liver, and a week immune system. Common food allergies for most eczema patients include eggs, dairy, wheat products (gluten), shellfish and corn. There are some triggers that can make existing eczema worse even though they do not cause it to start in normal