Children eczema

An eczema represents a medical condition during which the skin of a certain patient becomes red, inflamed, flaky as it tends to exfoliate, covered with scaly white-silvery patches, itchy and sometimes painful and also prone to infections; propensity to infection comes with the loss of the normal skin's function, that of being a barrier between the inside and the outside. Eczemas are typically divided into wet and dry eczemas, according to the production or not of different biological secretions at the place of the inflammation (for example excessive sweating or pus). Most of eczemas tend to form on flexural sides of limbs, that is on the same part as the one with the cutaneous folds, and especially within the cutaneous folds at the elbow and knee.

The type of eczema that commonly affects children, reason for which it is also called infantile eczema is atopic eczema. The term atopic refers to a propensity of certain genetically selected individuals to develop throughout their lives a series of immune-mediated inflammatory diseases; thus the association of eczema, rhinitis, rhinosinusitis, hay fever, conjunctivitis or asthma with atopic eczema in a certain individual is far from being out of the common. There is also a strong familial character of this disease; studies aim at identifying families in which the interrelated conditions mentioned above are present at different members so as to be able to obtain a natural experimental model in order to search for a genetic component. As much as genes could be implied is proven by studies made on homozygous (identical) and also heterozygous twins; chances of a twin having a flare of acute atopic eczema during his life is rendered at about 70% in case his identical twin had one, but only at 20% in case he has an unlike twin brother. In both cases the percentage fails to reach 100%, indicating a strong participation of environmental factors in the development of the condition.

Since the actual cause has not been identified (if there actually is a singular pinpoint cause) in spite of all the clinical research performed so far, treatments can't have an etiologic character; on the contrary, they are either pathogenic (addressing the immune system of the patient, clearly involved in producing the clinical aspects) or symptomatic - like for example relieving the itch, or the pain or trying to deal with the inesthetic aspect of the lesion - whichever bother the patient at the most.

A troubling aspect regarding this condition is the huge increase in incidence and prevalence over the past few decades especially in highly industrialized countries. The reason for this is the continuous immunological siege that food and cosmetics industry, but not them alone are doing on public health. Although chemicals used within human-aimed products undergo a series of complex testing before finally being approved for use, in genetically predisposed individuals who probably display a hyperactive immune system, these tend to act as antigens either by themselves or by haptenic mechanism. The second implies that smaller chemical pieces, unable to become antigens by themselves bind to plasma proteins and then convert to full antigens, activating the immune system and inducing the clinical response which can be any of the conditions mentioned. Basically numbers show a prevalence of 1 to 3 % among adults in industrialized countries. In case of children as much as 1 in 5 could be affected.

In spite of it being an inherited propensity for an abnormal immune response, eczema is precipitated by certain environmental and usually identifiable factors called triggers. Most of these are antigens with which an individual meets either by contact or by oral intake - nutrients. The fact that it can be triggered by foods, is a serious health problem, as such individuals can even go into anaphylactic shock provided that they meet the antigen that their immunity hyperreacts to. The explanation of this, is molecular similarity existent between antigens normally occurring within the structure of foods, and other antigens that an individual encounters; usually the similarity has something to do with relating classes of substances, or with common origins. Such foods, usually avoided by atopic individuals are: milk, nuts, cheese, tomatoes, wheat, eggs, yeast, soy or corn. For example you drink milk, and then spill yoghurt on the skin and get a rash, or something similar. Or, on the contrary, you come in contact with latex on the skin, and later develop hypersensitivity when eating bananas, concluding in a generalized rash. Stress, either physical or emotional, fatigue, anger and sleep deprivation have been reported to aggravate atopic conditions. Other triggers include: exposure to dust, to cigarette smoke, smoking, poor personal hygiene, a western diet (fast foods, rich in fats and chemical derivatives), exposure to exfoliated cat or dog skin, cat feces and urine, abrupt climatic changes, excessive humidity or dryness.

The age of onset is typically between 5 and 7 years old, and the condition can progress into adulthood. One of its characteristics beside the chronic evolution, is that it tends to improve and aggravate periodically under apparently no direct cause. Acute worsening is called a flare of atopic eczema. Prolonged evolution will lead to possible complications. For example the itch induces scratching, and scratching induces skin lesions that in turn can increase the local histamine levels because of local invasion of immune cells. This in turn stimulates pain and itch nervous fibers (they are the same) and then induce even more itching, thus closing a vicious circle called the itch-scratch cycle. Apart from the objective component, the itch can also become habitual, that is an individual will scratch himself without necessarily experiencing an itch at that very moment. That is why behavioral education techniques are sometimes employed in controlling the disease. Scratching can modify skin color locally, if prolonged. At the same time by continuous damage to the skin, it might induce local scarring, and roughening of the skin; the skin will get a leathery, harsh aspect, condition medically called "lichen simplex chronicus" - it looks just like lichen. Damaged skin is far more prone to infections that the normal one, either bacterial or fungal; nevertheless since topical treatment as well as systemic one aims to suppress the immune system assuming that is it involved in the pathogenic mechanisms, local defence against foreign microorganisms is also depressed, thus favoring infections. This constitutes another strong reason for improved local hygiene.

Treatment is first of all aimed at identifying triggers and as much as possible excluding them from the close environment of the predisposed individual. This method is called prevention-therapy. Identification can be done by means of a patch test in which the physician introduces a limited area of the body with an allergen, in order to investigate the reactivity of the organism to it. There are also a certain series of non-specific methods of dealing with the condition. The individual must learn that dryness of the skin seriously worsens eczema. Thus, the frequency of baths should be halved, like for example having a bath once a day, maybe once every two days if possible. This is because, frequent bathing scrub away the natural occurring oils of the skin (sebum), producing two undesirable effects: more rapid evaporation of water and increased sensitivity of skin to aggression. It is also necessary not to come in contact with detergent because they are highly allergenic; detergents yet tend to be ubiquitous (especially sodium lauryl sulfate) and therefore hard to avoid. The terms detergent and soap are not interchangeable. The so called "safe" soaps that can be purchased from drugstores, should be used in order to clean the body from detergents and other chemicals. A safe soap is rich in fat (goat milk added for example), is unscented, is not harsh, does not scratch, and has no detergents within it. In spite of this, the FDA recommends using soap sparingly to limit the possibility of it becoming a trigger to. After rinsing with plenty of water, doctors advise not to rub-dry, but to pat-dry, and before completely drying to apply an oily-based lotion to the body, in order to preserve as much moisture as possible. Clothes should not be made out of wool since it is irritating or synthetic fibers since they retain perspiration in contact with the skin, but of plain cotton. Wearing gloves during night sleep can is a good method of preventing habitual scratching. At the same time, purchasing an air humidifier might prove very useful, in order to keep the atmosphere moderately moist which is good for the skin.

After assessing the severity of the eczema, the physician can also prescribe medication. This can be administered topically (locally) in mild to moderate cases, or can be given either orally or by shot in case of severe cases. Common medication includes corticosteroids because of their immunosuppressant activity. Side effects of these include skin thinning (and thus they cannot be applied on natural thin skin areas like the face), stretch marks, decreased local resistance to infections and others. Oral corticosteroids in prolonged cures can induce bone mineral loss, gastritis, gastro-duodenal ulcers, blood hypertension, weight increase, stretch marks, suppression of the normal corticosteroid production in the body with bilateral adrenal gland shrinking and others. The many side-effects of steroids, lead to the development of immunomodulators, such as sirolimus, pimecrolimus and tacrolimus. These derive from the macrolide antibiotics class, and also suppress the immune system. The possible association with a higher degree of skin cancer incidence in patients treated with this made the FDA issue a warning on their use, and advise physicians to see them as second-line options after corticosteroids; this has been contested by pharmaceutical companies, claiming that eczema by itself (since it associates a higher rate of cell mitosis in order for the healing to occur) is a condition predisposing to skin cancer.

Cases associated with infections, may be given antibiotics and antifungal treatment, as if considered necessary. Nevertheless phototherapy, initially used in psoriatic eczema, has proven efficient in other types of eczema. This supposes the employment of either UVA in combination with photosensitizing chemicals called psoralens, or UVB by itself in order to locally irradiate (with light) the skin. The benefit can be seen with either artificial or natural light exposure; regimes should be supervised by a dermatologist because of clearly associated risk of skin cancer in case of extended exposure.