Eczema and Dermatitis

Eczema and dermatitis are essentially the same disorder. Eczema comes from the Greek, meaning a boiling up because the skin appears filled with fluid, while dermatitis means inflammation of the skin, and comes from the Latin. In the past eczema was used to describe those skin conditions for which there was no apparent outside cause, while dermatitis was the term used to cover specific allergy, but since the effects on the skin are the same the terms are now used interchangeably. There is reddening, scaling and itching, together with the formation of fluid filled blisters called vesicles which, when they’re scratched, cause the skin to weep. There are a number of different causes: atopic eczema commonly occurs in people who have an allergic tendency and who often also suffer from conditions such as asthma and hay fever. There may be other members of the family who suffer similarly. It is due to over-production of one of our antibodies, called IgE, which sensitises the cells that contain histamine, called mast cells, which are situated in the skin around blood vessels. It usually affects the inside of the elbows and the backs of knees. In chronic cases where there has been persistent scratching the skin in these areas can become thickened, a process called lichenifiation. Testing for allergy by using skin tests, when substances are placed on the skin to see if they elicit a reaction, are commonly positive in response to such things as cat fur or house dust mite.

Contact dermatitis is the name given to the condition where there is an eczematous reaction in the skin in response to contact with an outside agent such as nickel (Levi's dermatitis is patches of eczema on the buttocks where the studs at the back of Levi's jeans have been in contact with the skin). Many substances can cause contact dermatitis, such as latex, washing powders - particularly those containing biologically active ingredients - and hairdressing products, which commonly cause problems for hairdressers.

Asteatotic eczema is a generalised eczematous reaction affecting large areas of the body, more common in elderly people with very dry skin who have become sensitised to soap. The areas of the skin appear like crazy paving or dried-up riverbed.

Varicose eczema is the name given to the inflammation of the skin that surrounds chronic varicose veins in the lower part of the legs. As a result of high pressure in the veins there is leakage of red blood cells, which are degraded in the skin.The irritant effect of the Iron in the haemoglobin produces the eczematous reaction.

The management of dermatitis is aimed at damping down the inflammation, which may require the use of topical steroid creams, reducing the itch by using antihistamines, avoiding contact with the cause in the case of contact dermatitis, using emollients to moisturise dry skin and treating any supervening infection brought about by scratching. Treatment may need to be intermittent, since these conditions tend to run a chronic and relapsing course.
 
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