Eczema or dermatitis is a type of inflammatory reaction pattern in the skin which may be provoked by a number of external or internal factors (Graham-Brown and Burns, 2006). The term eczema comes from the Greek for ‘boiling’, which refers to the small vesicles or blisters that are often observed at the early acute stages of the disorder. Eczema and dermatitis are synonymous terms, often used interchangeably.
Eczemas may be categorised as exogenous, due to an external agent, or endogenous, related to a constitutional factor; however, in some cases both causal factors may be present (see Box 9.1).
| | | | | | Box 9.1 Eczema classification Endogenous - Atopic eczema (see Figure 9.1)
- Seborrhoeic eczema (see Figure 9.2)
- Discoid eczema
- Varicose eczema
- Endogenous eczema of the palms and soles
- Asteatotic eczema (eczema craquele)
Exogenous - Primary irritant contact dermatitis
- Allergic contact dermatitis (Figure 9.3)
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Source: Reprinted from Graham-Brown and Burns (2006) | | |
Some clinical images of eczema can be seen below. Endogenous eczema is exemplified by atopic eczema, which often presents in early childhood – with facial involvement (Figure 9.1). Other images include seborrhoeic eczema (Figure 9.2) and exogenous eczema, such as contact (allergic) dermatitis.
| | Figure 9.1 Atopic (endogenous) eczema. (Source: Reprinted from Buxton and Morris-Jones, 2009.) | | | | | | | Figure 9.3 Contact dermatitis (allergic) to nickel in a jean stud. (Source: Reprinted from Graham-Brown and Burns, 2006.) | | | | | Figure 9.2 Seborrhoeic eczema. (Source: Reprinted from Graham-Brown and Burns, 2006.) | |
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Figure 9.4 Lichenification. (Source: Reprinted
from Weller et al., 2008.) |
Another useful distinction is that of acute and chronic eczema. Acute eczema is characterised by weeping crusting, blistering redness, papules, swelling and scaling. Chronic eczema may reveal these changes but it is typically less vascular and exudative, more scaly, pigmented and thickened and more like to fissure and show lichenification (see Figure 9.4). Lichenification describes a state where the skin is dry, leathery and thickened with skin markings secondary to repeated scratching or rubbing (Weller
et al., 2008). Chronic eczemas may have acute flare-ups, as in the case of a child with atopic eczema having an eczema flare due to infection. Those living with eczema or their carers need to understand the triggers that may lead to acute flare-ups and their management; these are discussed later in this section. For people living with a long-term or chronic condition, specific attention is needed to support them and their families with utilising their treatment effectively and appropriately adhering to treatment. Such issues have been examined in
Helping patients make the most of their treatment.
