eczema

Last edited 06/2023 and last reviewed 11/2023

Dermatitis and eczema are often synonymous. In clinical practice, eczema is usually reserved for atopic dermatitis.

Eczema (also known as atopic eczema or atopic dermatitis)

  • is a common and chronic, relapsing inflammatory skin disorder, characterised by intense pruritus and excoriation, with erythematous, xerotic, lichenified, fissured skin, and increased risk of skin infection
  • is typically an episodic disease of exacerbation (flares, which may occur as frequently as 2 or 3 per month) and remissions
    • in some cases, it may be continuous. Atopic eczema often has a genetic component that leads to the breakdown of the skin barrier. This makes the skin susceptible to trigger factors, including irritants and allergens, which can make the eczema worse

  • eczema can develop on any area of skin - however different distribution patterns are often observed at different stages of life
    • in children younger than two years of age, eczema typically arises on the face, trunk, and limbs including the extensor surfaces
    • in older children and adults, involvement of the neck and flexural aspects of the limbs (on the inside of joints, such as behind the knees and in the elbow creases) is common, as is involvement of the hands
  • severity and extent of eczema are extremely variable, ranging:
    • from mild eczema, with localised, occasionally dry, mildly scaly patches;
    • moderate eczema, with slightly more redness and swelling, with little or no oozing or crusting;
    • severe, generalised involvement of the whole body, resulting in acute skin failure with widespread, red, oozing, secondarily infected lesions

  • both objective signs of eczema and subjective symptoms, such as itch and sleeplessness, contribute to the assessment of clinical severity

Many cases of atopic eczema clear or improve during childhood, whereas others persist into adulthood (1)

  • some children who have atopic eczema will go on to develop asthma, allergic rhinitis or food allergy; this sequence of events is sometimes referred to as the 'atopic march'
  • although atopic eczema is not always recognised by healthcare professionals as being a serious medical condition, it can have a significant negative impact on quality of life for children and their parents and carers
Characteristic features include:
  • itch
  • hot red skin
  • oedema in acute condition
  • oozing and weeping
  • crusting in the acute phase
  • fissuring and scaling in the chronic phase
  • excoriation:
    • due to scratching
    • there may be secondary thickening or lichenification
  • secondary infection
  • impairment of thermoregulation because of an increase in blood flow to the skin

Reference:

Related pages:

types of eczema

principles of management