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==Pathophysiology==
==Pathophysiology==
There are two main theories on the existence of [[atopic dermatitis]], also known as [[atopic eczema]]. These are the ''inside-out theory'', and the ''outside-in hypothesis''.
There are two main theories on the existence of [[atopic dermatitis]], also known as [[atopic eczema]] - the ''inside-out theory'', and the ''outside-in hypothesis''.


==Causes==
==Causes==

Revision as of 20:59, 25 May 2022

Eczema Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Eczema from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Social Impact

Future or Investigational Therapies

Case Studies

Case #1

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Most cited articles

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Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Eczema

CDC on Eczema

Eczema in the news

Blogs on Eczema

Directions to Hospitals Treating Eczema

Risk calculators and risk factors for Eczema

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Edzel Lorraine Co, D.M.D., M.D.

Overview

Eczema is a dermatologic problem manifested as swelling, redness, dryness, and itchiness of the skin. Flaking, cracking, oozing, blistering or bleeding may also occur.

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

There are two main theories on the existence of atopic dermatitis, also known as atopic eczema - the inside-out theory, and the outside-in hypothesis.

Causes

There are several possible causes of eczema, majority of which are genetic in origin. Adverse drug effects also manifest as eczema.

Differentiating Eczema from other Diseases

Several medical conditions can mimic eczema, with overlapping features. These conditions could be due to an inflammatory, infectious, immunodeficiency, or a nutritional deficiency problem. It is important to differentiate one from another to render proper medical treatment.

Epidemiology and Demographics

Eczema has been noted to have affected 1-3% of the adult population and 15-20% of the children population worldwide. In the United States, the prevalence is 10.7% in children and 7.2% in adults. Eczema is more commonly observed in males, particularly in those with severe cases, and has a late-onset.

Risk Factors

Family history and genetic mutation in the FLG gene are the two main risk factors of acquiring eczema.

Screening

Using the Hanifin and Rajka criteria as the gold standard, eczema is commonly diagnosed when 3 out of 4 major criteria, or 3 out of 23 minor criteria have been satisfied. United Kingdom Working Party diagnostic criteria is another alternative method of diagnosing eczema, which only requires 1 mandatory criterion, and 5 major criteria, and no laboratory testing is required. To assess the long-term control of this disease, three methods are used, namely the repeated measurement of outcomes, the number of medications used, and the occurrence of flares or remissions.

Natural History, Complications, and Prognosis

Bacterial, viral and fungal infections, as well as some psychological problems are some known complications of eczema.

Diagnosis

History and Symptoms

A number of things should be ascertained when diagnosing eczema. A thorough history taking must be done to elicit family history, dietary habits, lifestyle habits, and allergies. If the patient is positive for any of these, this disease can be detected through its clinical manifestations.

Physical Examination

Eczema is a chronic, relapsing dermatologic disease. Patients with eczema have pruritus which is an essential feature of this disease.

Laboratory Findings

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. This can be achieved by applying emolients on the skin, and consumption of probiotics and prebiotics.

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

The quality of life of patients suffering from eczema can be tremendously affected, as the pruritus and consequent scratching can bring about sleep disturbance, daytime fatigue, attention-deficit/hyperactivity disorder, headaches, and stunted growth. Ultimately, patients could develop poor self-esteem, embarrassment, and hence, an overall reduced social life.

Future or Investigational Therapies

More emphasis on genetic studies will be given in the future to unfold the remaining majority of unexplained heritability in eczema. However, the challenge still lies in the economical and computational requirements.