Eczema overview: Difference between revisions
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{{Eczema}} | {{Eczema}} | ||
{{CMG}}, {{AE}} | {{CMG}}, {{AE}} {{EdzelCo}} | ||
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==Overview== | ==Overview== | ||
[[Eczema]], also known as [[atopic dermatitis]], or [atopic eczema]], is a [[dermatologic]] problem which is commonly seen in children. It is a relapsing-remitting skin problem that is predominantly manifested as [[pruritus]], with accompanied [[swelling]], [[redness]], and dryness of the [[skin]]. Flaking, cracking, oozing, [[blistering]] or [[bleeding]] may occur as a result of excessive scratching of the skin. | |||
==Historical Perspective== | ==Historical Perspective== | ||
It was in the 20th century when [[eczema]] came into existence, and later on, concepts on this had evolved including major insights on the nature of the [[disease]]. | |||
==Classification== | ==Classification== | ||
[[Eczema]] | [[Eczema]] is classified according to [[location]], [[appearance]], or [[etiology]]. | ||
==Pathophysiology== | ==Pathophysiology== | ||
There are two main theories on the existence of [[atopic dermatitis]], also known as [[atopic eczema]] | The mechanism of [[disease]] of [[eczema]] involves a complex interplay of abnormalities of [[skin]] [[microbiomes]], a dysfunction in the [[epidermal]] barrier, and an [[immune dysregulation]]. There are two main theories on the existence of [[atopic dermatitis]], also known as [[atopic eczema]] - the ''inside-out hypothesis'', and the ''outside-in hypothesis''. | ||
==Causes== | ==Causes== | ||
The [[etiology]] of [[eczema]] is multifactorial and complex. This involves aberrations in [[genetic]] component, [[adverse effect]] of certain [[medication]] and some environmental factors. | |||
==Differentiating Eczema from other Diseases== | ==Differentiating Eczema from other Diseases== | ||
[[Eczema]] has various mimics with regards to the [[clinical presentation]], [[severity]], and [[course of disease]]. A strong [[clinical evaluation]] by the [[physician]] based on the presenting [[signs]] and [[symptoms]] is needed to come up with the correct diagnosis. [[Differential diagnoses]] of [[eczema]] include [[infectious disease]], [[inflammatory disease]], [[immunodeficiency problem]], or a [[nutritional deficiency]]. | |||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
[[ | In the United States, [[eczema]] has a [[prevalence]] of 10.7% in children and 7.2% in adults. [[Eczema]] has more predilection in [[males]]. | ||
==Risk Factors== | ==Risk Factors== | ||
[[ | [[Risk factors]] of [[eczema]] include [[family history]] and ''[[FLG]]'' [[gene mutation]]. | ||
==Screening== | ==Screening== | ||
[[Hanifin and Rajka criteria]] are the gold standard for diagnosing [[eczema]]. | |||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
[[ | [[Eczema]] has regarded as a [[medical]] condition with a natural history that occurs consistently. It is characterized as a [[disease]] with an early onset, mostly during the [[childhood]] period, and remits during the [[adolescence]] period. If left untreated, [[eczema]] can lead to [[viral]], [[bacterial]] and [[fungal]] [[infections]]. [[Psychological]] problems could also arise brought about by constant itching. | ||
==Diagnosis== | ==Diagnosis== | ||
===History and Symptoms=== | ===History and Symptoms=== | ||
[[Family history]], [[dietary habits]], [[lifestyle habits]], and [[allergies]] should be elicited whenever considering [[eczema]] as the [[primary diagnosis]]. This is important because [[eczema]] can be based on the [[patient]]'s [[history]] and evolution and distribution of the [[skin]] [[lesion]]. | |||
===Physical Examination=== | ===Physical Examination=== | ||
[[Eczema]] is a | [[Eczema]] is a [dermatologic disease]] and [[pruritus]] is the hallmark feature of this [[disease]]. | ||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
Levels of [[IgE]] are associated with [[allergy]], aside from [[parasitic]] [[infections]], [[autoimmune diseases]], and certain [[carcinomas]]. | |||
===Other Diagnostic Studies=== | ===Other Diagnostic Studies=== | ||
No particular [[biomarker]] is reliable to diagnose [[eczema]]. However, the current practice is by using the laboratory levels of [[IgE]], which when elevated, can also be associated with [[allergy]], aside from [[parasitic infections]], [[autoimmune diseases]], and certain [[carcinomas]]. | |||
==Treatment== | ==Treatment== | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
[[Topical corticosteroids]] are the mainline treatment for [[eczema]]. Different potencies of steroids are rendered specifically for the severity of [[eczema]]. Other drug treatments oftenly used for [[eczema]] include [[topical calcineurin inhibitors]],[[crisaborole]], [[antimicrobials]], and [[antifungals]]. | |||
===Surgery=== | ===Surgery=== | ||
[[Surgical treatment]] is not commonly used as a means of management for [[eczema]]. | |||
===Primary Prevention=== | ===Primary Prevention=== | ||
[[Primary prevention]] is the most effective means to avoid [[complications]] of eczema. [[Emolients]] and consumption of [[prebiotics]] and [[probiotics]] can prevent the occurrence of this condition. | |||
===Secondary Prevention=== | ===Secondary Prevention=== | ||
[[Prevention]] of further [[trans-epidermal]] water loss is the cornerstone of [[management]] of [[eczema]]. Since dysfunctional [[skin barriers]] could lead to [[water loss]], daily replenishment of [[skin moisture]] is needed. This can be achieved through different modalities such as [[emollients]], [[occlusives]], and [[humectants]]. | |||
===Cost-Effectiveness of Therapy=== | ===Cost-Effectiveness of Therapy=== | ||
The economic impact of [[eczema]] causes a burden to patients suffering from this disease. A recent study showed that an average of $274 ($199 indirect cost, and $75 direct cost) is spent by each patient for eczema. | The economic impact of [[eczema]] causes a burden to patients suffering from this [[disease]]. A recent study showed that an average of $274 ($199 indirect cost, and $75 direct cost) is spent by each [[patient]] for [[eczema]]. | ||
===Social Impact=== | ===Social Impact=== | ||
[[Pruritus]] and constant scratching of the [[skin]] can significantly affect the social life of [[patient]]. [[Sleep disturbances]], [[attention-deficit/hyperactivity disorder]], [[headaches]], daytime [[fatigue]], and [[stunted growth]] are commonly seen in these [[patients]] and could lead to [[embarrassment]] and poor self-esteem. | |||
===Future or Investigational Therapies=== | ===Future or Investigational Therapies=== | ||
Future trends will focus more on [[genetic studies]] in [[eczema]]. | |||
[[category:needs english review]] | |||
Latest revision as of 07:42, 13 November 2023
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American Roentgen Ray Society Images of Eczema |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Edzel Lorraine Co, DMD, MD[2]
Overview
Eczema, also known as atopic dermatitis, or [atopic eczema]], is a dermatologic problem which is commonly seen in children. It is a relapsing-remitting skin problem that is predominantly manifested as pruritus, with accompanied swelling, redness, and dryness of the skin. Flaking, cracking, oozing, blistering or bleeding may occur as a result of excessive scratching of the skin.
Historical Perspective
It was in the 20th century when eczema came into existence, and later on, concepts on this had evolved including major insights on the nature of the disease.
Classification
Eczema is classified according to location, appearance, or etiology.
Pathophysiology
The mechanism of disease of eczema involves a complex interplay of abnormalities of skin microbiomes, a dysfunction in the epidermal barrier, and an immune dysregulation. There are two main theories on the existence of atopic dermatitis, also known as atopic eczema - the inside-out hypothesis, and the outside-in hypothesis.
Causes
The etiology of eczema is multifactorial and complex. This involves aberrations in genetic component, adverse effect of certain medication and some environmental factors.
Differentiating Eczema from other Diseases
Eczema has various mimics with regards to the clinical presentation, severity, and course of disease. A strong clinical evaluation by the physician based on the presenting signs and symptoms is needed to come up with the correct diagnosis. Differential diagnoses of eczema include infectious disease, inflammatory disease, immunodeficiency problem, or a nutritional deficiency.
Epidemiology and Demographics
In the United States, eczema has a prevalence of 10.7% in children and 7.2% in adults. Eczema has more predilection in males.
Risk Factors
Risk factors of eczema include family history and FLG gene mutation.
Screening
Hanifin and Rajka criteria are the gold standard for diagnosing eczema.
Natural History, Complications, and Prognosis
Eczema has regarded as a medical condition with a natural history that occurs consistently. It is characterized as a disease with an early onset, mostly during the childhood period, and remits during the adolescence period. If left untreated, eczema can lead to viral, bacterial and fungal infections. Psychological problems could also arise brought about by constant itching.
Diagnosis
History and Symptoms
Family history, dietary habits, lifestyle habits, and allergies should be elicited whenever considering eczema as the primary diagnosis. This is important because eczema can be based on the patient's history and evolution and distribution of the skin lesion.
Physical Examination
Eczema is a [dermatologic disease]] and pruritus is the hallmark feature of this disease.
Laboratory Findings
Levels of IgE are associated with allergy, aside from parasitic infections, autoimmune diseases, and certain carcinomas.
Other Diagnostic Studies
No particular biomarker is reliable to diagnose eczema. However, the current practice is by using the laboratory levels of IgE, which when elevated, can also be associated with allergy, aside from parasitic infections, autoimmune diseases, and certain carcinomas.
Treatment
Medical Therapy
Topical corticosteroids are the mainline treatment for eczema. Different potencies of steroids are rendered specifically for the severity of eczema. Other drug treatments oftenly used for eczema include topical calcineurin inhibitors,crisaborole, antimicrobials, and antifungals.
Surgery
Surgical treatment is not commonly used as a means of management for eczema.
Primary Prevention
Primary prevention is the most effective means to avoid complications of eczema. Emolients and consumption of prebiotics and probiotics can prevent the occurrence of this condition.
Secondary Prevention
Prevention of further trans-epidermal water loss is the cornerstone of management of eczema. Since dysfunctional skin barriers could lead to water loss, daily replenishment of skin moisture is needed. This can be achieved through different modalities such as emollients, occlusives, and humectants.
Cost-Effectiveness of Therapy
The economic impact of eczema causes a burden to patients suffering from this disease. A recent study showed that an average of $274 ($199 indirect cost, and $75 direct cost) is spent by each patient for eczema.
Social Impact
Pruritus and constant scratching of the skin can significantly affect the social life of patient. Sleep disturbances, attention-deficit/hyperactivity disorder, headaches, daytime fatigue, and stunted growth are commonly seen in these patients and could lead to embarrassment and poor self-esteem.
Future or Investigational Therapies
Future trends will focus more on genetic studies in eczema.