eczema Eczema is a chronic, inflammatory, pruritic skin condition characterized by polymorphic rash, symmetrical distribution, intense itching, and a protracted course, significantly impacting the patient's quality of life. Patients often have concurrent allergic rhinitis, asthma, and other allergic diseases, and there is also a frequent occurrence of similar allergic conditions within their families. Most patients exhibit elevated serum immunoglobulin E (IgE) levels.

A chronic, inflammatory, pruritic skin disease

Polymorphic rash, symmetrical distribution, tendency to exude, and subjective pruritus

Eczema affects a wide range of people, regardless of age, gender, or geographic location

Tends to recur and requires long-term treatment

Eczema is a chronic, inflammatory, pruritic skin disease characterized by a polymorphic rash, symmetrical distribution, intense pruritus, and a chronic course that significantly impacts the patient's quality of life. Patients often have concomitant allergic rhinitis, asthma, and other allergic diseases, and there is often a family history of similar allergic conditions. Most patients show elevated levels of serum immunoglobulin E (IgE).

Based on the course of the disease, eczema can be classified as acute eczema, subacute eczema, and chronic eczema.

Based on the affected areas, eczema can be categorized as eczema of the ears, eczema of the breasts, eczema of the hands, eczema of the external genitalia, eczema of the scrotum, and eczema of the anus, among others.

Additionally, there are some special types of eczema, such as nummular eczema, dyshidrotic eczema, and auto-sensitivity eczema.

Genetic factors

Genetics are the most important factor in determining whether a person has an allergic disposition. Many eczema patients have varying degrees of genetic factors, with the most typical being atopic eczema (genetic allergic dermatitis or atopic dermatitis). Research has found that if both parents have an atopic disposition, 70% of their offspring will develop atopic eczema, and if one parent has an atopic disposition, 50% of their children will develop the condition.

Immune abnormalities

Eczema patients often exhibit activation of Th2 cells, an increase in eosinophils in the blood, and elevated serum IgE levels. Allergy testing often reveals the presence of IgE antibodies to various allergens.

Fluctuations in female hormone levels

Some female patients with chronic eczema experience skin lesions before or during their menstrual cycle due to the development of autoantibodies to endogenous progesterone in the late phase of the menstrual cycle, which may be related to allergic reactions.

Some women during pregnancy may develop eczema-like skin rashes that are intensely pruritic, possibly due to an allergy to pregnancy hormones, which typically resolve shortly after childbirth.

Endocrine and metabolic disorders

Diabetes and thyroid disorders can lead to skin pruritus and eczema, sometimes as the initial symptoms of the disease. These patients often experience pruritus first, followed by the appearance of papules, patches, and thickened plaques, characteristic of subacute and chronic eczema. Generally, these patients respond poorly to anti-allergic treatments. In addition to pruritus and eczema, they may also exhibit other skin manifestations such as mucosal edema (in patients with hyperthyroidism) and vascular lesions and fungal infections (in patients with diabetes), among others.

Chronic infectious foci

Some patients with chronic eczema often have chronic infectious foci, such as chronic gastritis, chronic cholecystitis, chronic appendicitis, chronic genitourinary tract infections, or infections of the pharynx, tonsils, or paranasal sinuses. These patients often experience fluctuations in their eczema, and once these infectious foci are eliminated, the eczema often improves.

Dietary habits and inhaled substances

Many eczema patients have a relationship between their condition and poor dietary habits:

Some patients are allergic to alcohol but continue to consume it.

Prolonged alcohol abuse can lead to gastrointestinal and hepatic diseases, resulting in secondary eczema.

Some patients lead irregular lifestyles, disrupting the body's normal biological rhythms, leading to eczema and other diseases.

Some patients have a diet rich in spicy foods, leading to the development or exacerbation of eczema.

Certain foods have strong antigenic properties or can cause allergic reactions due to increased permeability of the digestive tract or decreased detoxification function of the liver, leading to eczema. These foods include animal products such as beef, lamb, and chicken; seafood (cod, lobster, scallops, mackerel, etc.); shellfish, shrimp, crabs, and snails; fruits such as peaches, cucumbers, cantaloupes, strawberries, apples, lemons, mangoes, plums, and apricots; yams, bamboo shoots, wheat, coriander, peanuts, garlic sprouts, spinach, eggplants, and tomatoes, among others.

Certain inhaled substances are more likely to cause allergic rhinitis and asthma but can occasionally also lead to eczema:

Animal dander, such as dog and cat hair.

Fungi, such as Aspergillus fumigatus, Alternaria, Cladosporium, Penicillium, Fusarium, and black mold.

Mites, such as house dust mites and dust mites.

Pollen, including that from willow, poplar, elm, mulberry, and Chinese parasol trees, among others.

Ragweed, mugwort, house dust, alcohol, and cudweed, among others.

Chemical products

Certain food additives, natural or synthetic substances in food, including artificial dyes, preservatives, and antioxidants, as well as yeast, salicylic acid, citric acid, derivatives of benzoic acid, and alcohol, can exacerbate eczema. These substances may be present in medications, chewing gum, and even toothpaste.

Local factors

Trauma and skin infection sites can develop eczematous lesions, possibly due to the combined action of local microorganisms, necrotic tissue, or medications, manifesting as redness and clustered papules with intense pruritus around wounds or infection foci. These patients are prone to developing auto-sensitivity dermatitis, where eczematous lesions can occur in distant areas, especially on the hands and feet.

In addition, vulvar eczema often persists due to irritation from menstrual and vaginal discharge, while eczema in skin folds is often related to excessive sweat secretion and poor evaporation.

Psychological factors

Many patients with chronic eczema experience long-term insomnia, anxiety, vivid dreams, and excessive sweating, indicating dysfunction of the autonomic nervous system. Some patients develop eczema following significant psychological trauma, while others exhibit dermatological behavioral disorders, repeatedly using various soaps, bath products, and even more irritating detergents to wash their bodies, leading to eczema.

For these patients, psychological trauma and eczema often form a vicious cycle, significantly affecting the patients' mental and physical health. Effective treatment of psychological factors can lead to gradual improvement and recovery of eczema.

During the acute phase, eczema presents as redness, swelling, papules, vesicles, oozing, and exudation. In the subacute phase, the redness and exudation decrease, and the affected areas scab and peel. In the chronic phase, the main manifestations are thickening, roughness, and lichenification. Eczema tends to recur, significantly impacting the patient's quality of life.

Patient Education

It is important to understand the nature of the disease, potential outcomes, its impact on overall health, contagiousness, clinical effectiveness of various treatments, and possible adverse reactions. Under the guidance of a physician, patients should seek to identify and avoid common allergens and irritants in their environment and refrain from scratching. Attention should be given to the physician's advice on clothing, diet, living conditions, activities, and hygiene.

Avoiding Triggering or Aggravating Factors

Collaborate with the physician to collect detailed medical history, conduct thorough physical examinations, and use diagnostic tests rationally to identify suspected causes and triggering factors, with the goal of eliminating the causes and treating the condition. For instance, in the case of xerotic eczema, moisturizing and emollient use is important, while infectious eczema requires treatment of the primary infection.

Protecting Skin Barrier Function

Eczema patients have a compromised skin barrier function, making them susceptible to irritant dermatitis, infections, and allergies that exacerbate skin lesions. Therefore, protecting the skin barrier function is crucial. Patients should appropriately use moisturizers to prevent and address secondary infections.

Develop healthy eating habits and avoid picky eating. The daily diet of eczema patients should primarily consist of light, easily digestible, low-salt, and low-oil foods. They should consume less milk, fish, eggs, and other allergenic foods, as well as avoid spicy foods. For infants and young children with eczema, breastfeeding should be ensured as much as possible.

Bathe appropriately, ideally 2-3 times a week. During bathing, showering is preferred, and hot water or excessive washing of the affected skin should be avoided to prevent exacerbation of the condition. Patients should use neutral bath products or soaps, dry themselves promptly after bathing, and apply topical moisturizers to affected areas.

Wear soft, loose-fitting clothing made of cotton or other natural fibers, and avoid clothing made of synthetic fibers or wool that can cause allergies, to prevent exacerbation of allergic symptoms.

Pay attention to controlling indoor temperature and humidity. Both excessively hot and dry environments can lead to recurrent eczema. Therefore, patients should ensure air circulation indoors in summer and use humidifiers or place a basin of water indoors in winter when using heating to maintain indoor relative humidity. If necessary, oily lotions can be applied to moisturize the skin.

When going out, protect the affected areas, especially avoiding exposure to wind or prolonged sunlight to prevent skin dryness and exacerbation of the condition.

Eczema patients should maintain a pleasant mood in daily life, avoiding negative emotions such as tension, depression, anxiety, irritability, and anger, as this is also beneficial for recovery.