Eczema
Eczema
Eczema

Eczema, also referred to as Dermatitis, is a type of inflammation of the skin.

Inflamed or eczematous skin is red, itchy and swollen sometimes with fluid-filled bumps that ooze and crust.

Common causes of eczema include an allergic reaction to something touching the skin such as poison ivy or nickel and contact with chemicals that damage the outer skin such as strong soaps and substances that dry or irritate the skin.

Eczema is a common problem but it is not contagious. Some types are hereditary. Although eczema cannot be cured, a dermatologist can provide a proper diagnosis and a treatment plan to manage your eczema and control flare-ups.

Chronic eczema causes people to miss work and often sleep is interrupted, affecting school and work performance.

Common Types of Eczema

Atopic Dermatitis (AD) is hereditary and the most common type of eczema. In Canada, the lifetime prevalence is higher than the worldwide average. It is estimated that up to 17% of Canadians suffer from AD at some point in their lives (Eczema Prevalence in Canada. Ipsos-Insight Health, 2003).

AD usually starts in infants and young children and is characterized by itchy, inflamed skin, usually behind the knees, the inside of the elbows, and on the face, neck and hands. Children with eczema often develop asthma and/or hay fever and have family members who also have these problems.

Contact Dermatitis: There are two types of contact dermatitis: allergic and irritant.
Allergic Contact Dermatitis (ACD) is caused by a delayed immune reaction following skin contact with an allergenic substance. About 48 hours after contact with the allergen, the skin becomes inflamed. Poison ivy is the most common cause of ACD. Other common causes include metals, dyes, perfumes and preservatives in cosmetics.

Irritant Contact Dermatitis is more common than ACD and is caused by repeated exposure to substances that chemically damage the skin, such as harsh soaps, detergents, and cleaning products. These irritants remove oil and moisture from the outer layer of the skin, damaging the protective layer and triggering inflammation.

What causes Contact Dermatitis (a form of eczema)?

Two causes of contact dermatitis are exposure to allergens and irritants. An allergy occurs when the immune system reacts to a chemical. An irritant can be a strong soap or chemical.

Exposure to allergens and irritants frequently occurs in the workplace.

An allergy causes contact dermatitis in two ways:

  • Contact urticaria – the immediate appearance of hives (transient itchy swellings)
  • Allergic contact dermatitis – chronic areas of itchy, red, crusty or scaly skin

Irritant contact dermatitis is produced by repeated exposure to a harsh or drying chemical that damages the outer skin barrier. Damage can be:

  • Acute (sudden and quick) after contact with a high concentration of a chemical that sets off a reaction such as a burn
  • Chronic (persistent) or delayed (when it occurs after months or years of contact with an irritant)

Eczema, also referred to as Dermatitis, is a type of inflammation of the skin. Inflamed or eczematous skin is red, itchy and swollen – sometimes with fluid-filled bumps that ooze and crust. Common causes of eczema include an allergic reaction to something touching the skin such as poison ivy or nickel and contact with chemicals that damage the outer skin such as strong soaps and substances that dry or irritate the skin.

Atopic Dermatitis and Contact Dermatitis are the most common types of eczema. Below is a list of some additional types of eczema.

Dyshidrotic Eczema An acute recurrent eruption of multiple tiny, intensely itchy water blisters on the palms, sides of fingers and soles of the feet.
Lichen Simplex Chronicus Localized, chronic thick itchy plaques that commonly occur on the sides or back of the neck, wrists, ankles, lower legs and inner area of the thighs.
Nummular Eczema Multiple, round plaques of eczema that are usually associated with dry skin and occur on the outer surfaces of the hands, arms and legs.
Seborrheic Eczema Yellowish-brown, greasy, scaly patches on the scalp, eyebrows, nose and chest.
Stasis Dermatitis A chronic eczema on the inner area of the lower legs and associated with varicose veins.
Where does eczema usually appear?

The areas of the body that eczema affects tends to vary with age. In babies, a patchy rash usually appears on the face, elbows, and knees. Diaper rash is also common. In older children, the rash appears most often behind the knees, inside the elbows, on the sides of the neck, and on the wrists, ankles and hands.

How can I help my child?

You can help prevent eczema in your child by keeping the skin soft and moist and avoiding known triggers that cause itching and flare-ups.

When should you call your child’s doctor?

Children with eczema are prone to skin infections. Call your child’s doctor if you notice signs of skin infection, which may include: fever, redness and tenderness, or pus-filled bumps on or around affected areas. Also, call your child’s doctor if you notice a sudden change or worsening of your child’s condition.

When should you see a dermatologist?

If following thses guidelines and your’s doctor’s treatment is not improving your child’s skin, a dermatologist will be able to help.

What is cradle cap?

Cradle cap is common in babies and is easily treated. It is caused by the normal buildup of sticky skin oils, and scales of sloughed skin cells on a baby’s scalp.

Cradle cap is not harmful to your baby. It usually goes away by a baby’s first birthday.

Tips for parents
  1. Avoid skin contact with wool and rough fabrics
  2. Do not let children play in tall grass
  3. Moisturize their skin daily
  4. Apply medication to any areas of inflamed skin regularly every day
Cool compresses relieve inflammation and itching. Follow these easy instructions for fast relief:
  1. Use several layers of cheesecloth or soft cotton cloth cut to fit over the affected area.
  2. Soak the cloth with water or Burow’s solution
  3. Place on the skin for 20 to 30 minutes
  4. Keep the cloth continuously wet and uncovered to allow evaporation.
  5. Then pat the skin dry and apply your medication
Eczema FACTS
  • Eczema is not contagious
  • Eczema is most common in children, and about half will grow out of it
  • Baths are good – apply a moisturizer right after
  • Wear and sleep on soft natural fabrics
  • Avoid harsh soaps, scented products and perfumes
  • Without a proper diagnosis and adequate treatment, eczema can become chronic and disabling
How common is it?

The number of cases of contact dermatitis in Canada is not currently known but according to some US statistics, skin disorders comprise more than forty-five percent of all occupationally related diseases. Among all occupational dermatitis, irritant contact dermatitis accounts for about 80 percent and allergic contact dermatitis accounts for about 30 percent (some patients have both).

Can you still work?

Most workers who have contact dermatitis can return to work. It will depend on:

  • What kind of contact dermatitis you have
  • How severe it is
  • How it is treated
Think you may have occupational eczema?

Ask yourself these questions:

  1. Did your skin problem start when you changed jobs?
  2. Does your skin problem improve when you are away from your job?
  3. Do you think that any specific substance at work is causing your skin problem?

If you have answered ‘yes’ to any of these questions, consult your dermatologist.

Cool compresses relieve inflammation and itching. Follow these easy instructions for fast relief:

Use several layers of cheesecloth or soft cotton cloth cut to fit over the affected area.

  • Soak the cloth with tap water or Burow’s solution
  • Place on the skin for 20 to 30 minutes
  • Keep the cloth continuously wet and uncovered to allow evaporation
  • Then pat the skin dry and apply your medication
Some irritants and allergens found in many jobs
Job
Irritant
Allergen
Agriculture workers Artificial fertilizers, disinfectants, pesticides, cleaners, gasoline, diesel oil, plants and grains Rubber, oats, barley, animal feed, veterinary medications, cement, plants, pesticides, wood preservatives
Cabinet makers, and carpenters Glues, detergents, thinners, solvents, wood preservatives Stains, glues, woods, turpentine, varnishes, colophony
Construction workers Cement Chromates, cobalt, rubber and leather gloves, resins, woods
Daycare workers Detergents, cleaners, wet work
Dentists and dental technicians Detergents, hand cleansers, wet work Local anaesthetics, mercury, methacrylates, eugenol, disinfectants, rubber, dental impression material
Electricians Soldering fluxes Fluxes, resins, rubber
Hairdressers Permanent wave solutions, shampoos, bleaching agents, wet work Dyes, persulphates, nickel, perfumes, rubber
Homemakers Detergents, cleansers, foods, wet work Rubber gloves, foods, spices, flavours, nickel, chromates, polishes
Mechanics Oils, greases, gasoline, diesel fuel, cleaners, solvents Rubber gloves, chromates, epoxy resin, antifreeze
Medical personnel, Nurses, Hospital workers Disinfectants, detergents, wet work Latex gloves, anaesthetics, antibiotics, antiseptics, phenothiazines, formaldehyde, glutaraldehyde, liquid chloroxylenol, hand creams
Plastics workers Solvents, acids, styrene, oxidizing agents Hardeners, phenolic resins, polyurethanes, acrylics, plasticizers
Teachers Chalk dust

Information provided by WSIB. View the full Workplace Contact Dermatitis fact sheet

Patients with AD lack an essential oil in their skin. This means that their skin has a reduced water-holding capacity. Dry skin is more sensitive to irritants and makes it more difficult to control the eczema. Therefore management of dry skin is essential for treatment success. Daily dry skin management should include gentle cleansing and moisturizing.

Cleansing

Regular soaps can irritate skin and worsen the condition. Use a mild liquid cleanser or gentle bar soap. Liquid agents are often better choices for patients with sensitive skin, as they are less abrasive and are more easily and effectively rinsed off.

Bathing

This is a critical component of dry skin management and hydration. Take one or more baths daily in lukewarm water for approximately five minutes. Adding a capful of emulsifying oil will help the skin retain moisture.

Moisturizers

After bathing, leave the skin moist and apply a greasy moisturizer within three minutes to trap moisture on the skin. The choice of moisturizer depends on the degree of dryness and scaling of the skin. Greasy moisture creams are best for very dry, cracked and sensitive skin. They do not sting. Moisturizing creams and lotions containing urea, alpha hydroxy acids (lactic and glycolic acids) smooth out scaly dry skin.

Avoid irritants and triggers to reduce flare-ups

AD and ACD can worsen with exposure to allergens and irritants. Avoid the common ones, such as dust, animal dander, smoke and grass. Allergy testing can often identify specific environmental allergens. If you have ACD a dermatologist will do patch testing to try to determine the cause.

Do:
  • Use mild detergents to wash clothing, with no bleach or fabric softener
  • Double-rinse clothing
  • Moisturize often, especially in colder weather
  • Choose cotton for bed linens and clothing
  • Reduce stress as much as possible
Don’t:
  • Expose skin to very hot or very cold water
  • Expose skin to excessive heat or low humidity
  • Dress in synthetic fabrics or wear wool next to the skin
  • Use harsh detergents or perfumed products

Most types of eczema require a combination of treatments and medications. Your dermatologist will choose the ones that will work the best to control your condition.

Nonprescription Medications

Antihistamines relieve itching and help sleep.

Moisturizers and emollients decrease dryness and scaling, leaving the skin feeling more comfortable. Barrier repair moisturizers also known as physiologic moisturizers, contain some of the essential oils that are missing from eczematous skin, most commonly ceramide.

Coal tar is an old remedy but still effective. It soothes inflamed skin and helps reduce itching, flaking and redness. It is available in bath oils, shampoos, gels, creams, ointments and in combination with corticosteroids.

Cool compresses relieve inflammation and itching.

Prescription Medications

Antibiotics are used to treat secondary skin infection, which is a common complication of any type of eczema. The skin barrier is broken both by scratching and the inflammation allowing bacteria to penetrate the skin.

Corticosteroids are the most effective anti-inflammatory agents. They come in a variety of strengths, ranging from mild to extremely potent. They should be applied regularly until the inflammation has resolved.

Topical Calcineurin Inhibitors specifically inhibit the cells of the immune system in the skin. They are very effective at reducing itch and preventing flare-ups if applied regularly.

Phototherapy: In those who have severe eczema, regular exposure to specific rays of ultraviolet light is very effective in reducing symptoms. This treatment should only be done under the supervision of a dermatologist.