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What is Eczema / Dermatitis / Pompholyx?

Eczema originates from the Greek word “Ekzein”, which means “to boil”. Eczema is a common, non-infectious skin disease, that is exacerbated by internal or external factors.

Dermatitis (derm-, derma-, dermo-, dermat(o)- Prefix denoting the skin)- is a much broader term used to describe “inflammation of the skin”, in general.

The terms eczema & dermatitis are used interchangeably. Demarcation between the conditions is difficult at times, however similar treatment protocols are used for both conditions. In the interest of the reader or patient, it has been considered best to address them both in the same section.

There are many forms or subtypes of dermatitis/eczema. These include atopic eczema/dermatitis, seborrheic dermatitis/eczema and contact dermatitis/eczema.
The different types occur in pattern according to age.

There are three basic stages of Eczema/Dermatitis- Acute, Subacute and Chronic.

ACUTE Dermatitis/Eczema:-
Skin lesions present as:
* Erythema:- redness of the skin. Present at the initial stage with lesions which have ill-defined borders determined by local swelling.
* Papules:- raised red spots. Clusters of raised red spots a few millimetres in diameter, these may be mixed with tiny vesicles, on a red background. Bloody crusts form after scratching.
* Papillovesicles:- raised red spots/blisters filled with a clear fluid (serum). Clusters of raised small “pointed” or “domed” blisters that are fluid filled on a red background. “Pinpoint” erosion occurs after eruption of the blisters. (Vesicles – blisters filled with a clear fluid)
* Pustular:- after a secondary infection i.e. staphycoccous (bacteria present on the skin) or staphylococcal (bacteria present in mucus membrane). The clear fluid present in the blisters turns putrid purulent. After rupturing, the weeping forms thick greenish/yellow “pus” crusts. Other symptoms include painful and swollen lymph nodes.
* Erosive:- Constant scratching of the vesicles or pustules results in severe and bloody weeping. Excoriations (“hole”) formations occur over the scratched area. The greater the scratching, the more severe is the erosion.
* Desquamative:- fine scaling may occur after the lesions have healed.

All of these can present at any given time but usually one is predominant.

As the condition progresses, larger areas of the body are affected. Continual scratching leads to further erosion of the skin with a corresponding increase in weeping. This causes the condition to worsen.

SUBACUTE Dermatitis/Eczema:-
This condition often evolves from recurring Acute Dermatitis/Eczema. It is less red in colour and swelling and presents with fewer vesicles. Papules are smaller but with a significant increase in scaling of the skin.

There may also be small areas of erosion due to scratching, some weeping of “clear” fluid, some crust formations and a significant increase and severity of itching.

Subacute Dermatitis/Eczema often goes on to develop into Chronic Dermatitis/Eczema, however given a new set of stimuli may regress and present the features of Acute Dermatitis/Eczema.

CHRONIC Dermatitis/Eczema:-
Often evolving from either Acute or Subacute Dermatitis/Eczema

Lesions present as very dry, rough thickened skin. Often flaking with deep and widening crease lines in the skin. The skin will also either be lacking pigmentation (hypopigmentation) or show excessive pigmentation (hyperpigmentation) of the skin.

The constant scratching and rubbing are done subconsciously leading to thickened skin which itches even more. Easily accessible sites or creased areas are mainly involved.

Associated Conditions:-
Approximately 50% of children with Atopic Dermatitis/Eczema, go on to develop asthma or hay fever.

Dry skin is common in all sufferers, but up to 20% are also afflicted with Ichthyosis Vulgaris. (See our Ichthyosis page).

Atopic Dermatitis/Eczema sufferers also appear to be susceptible to contact urticaria (hives/nettle rash). The urticaria usually represents an immediate response to certain foods, such as tomatoes, citrus fruits & marmite/vegemite. This reaction is often misleading and the “food allergy” is often incorrectly blamed for the dermatitis/eczema as well as for the resultant hives/nettle rash of the urticaria.

In medical terms, both conditions are a delayed allergic or delayed hypersensitivity reaction which can be provoked by the interaction of both external and internal factors.

External Factors
* Climate – heat, cold, dryness
* Environmental – animal fur, synthetic fibres, plants, chemicals & cleaners
* Sunlight/ultraviolet light
* Cosmetics – make up, soaps and shampoos, facial creams
* Foods

Internal Factors
* Chronic gastrointestinal disorders
* Stress/overexertion/emotional
* Disturbed sleep patterns/insomnia
* Infections
* Metabolic disturbances
* Endocrine dysfunction

This condition is largely confined to the palms, sides of the fingers and soles of the feet where deep seated blisters occur. The blisters become enlargened, occasionally turning pusy, before eruption occurs. It is then followed by scaling and peeling of the surface. The new exposed skin is considerable “thinner” and is usually tender or even painful to touch. People who sweat profusely are more inclined to be affected and the Summer heat tends to exacerbate the condition. It has been known to heal spontaneously with the onset of Winter, only to erupt again with the onset of Summer. This cycle can continue for years.

It is usually rare in a person under the age of 10 and has usually presented itself before the age of 40. In severe cases, secondary infections of the blisters can occur. This may result in Lymphangitis, causing red streaks to travel up the arm and/or legs. In these cases “anti-biotic” treatment may be required for the treatment of the infection.

In patients with chronic, recurring presentations, the nail may show dystrophic changes. These include irregular transverse ridging, pitting, thickening and discolouration.