TYPES OF ECZEMA
Eczema, how many types are there?
Take a look at the types and symptoms.
Many people are surprised to know there are multiple types of eczema, and they all look a little different. We’re going to take a look at seven of the more common ones.
1. Atopic Dermatitis (Atopic Eczema)
Atopic Dermatitis is a chronic type of eczema, and the most common form of it. The National Eczema Association informs us that of the 31.6 million people in the US affected by eczema, 17.8 million of them have Atopic Dermatitis.
Although the condition can occur at any age, it usually begins in infancy, causing it to be regularly referred to as infantile or childhood eczema. The UK’s National Health Service (NHS) notes that of all children with Atopic Dermatitis, 8 out of 10 of them develop the condition before the age of five.
The NHS goes on to point out that in roughly 50% of cases, the children see marked improvement in their Atopic Dermatitis by the age of eleven. A full 67% of them see this improvement by the age of sixteen. The general rule seems to be that milder cases will clear while more severe cases will persist into adulthood.
Adults who had Atopic Dermatitis in childhood that has since cleared up are often left with sensitive skin prone to dryness and irritation. They may also become more predisposed to developing hand dermatitis, cataracts, eyelid dermatitis, and skin infections such as herpes and staph.
The term “atopic” is defined as a sensitivity to allergens. In most instances of Atopic Dermatitis there is a family history of eczema or another atopic condition (such as hay fever or asthma). If one parent has an atopic condition, then the child has a 25% chance of also having an atopic condition. This figure doubles to a 50% chance when both parents are atopic. Atopic Dermatitis is thought to result from a combination of this genetic predisposition and environmental factors. Common triggers for atopic dermatitis are:
- Detergents, soaps and perfumes or fragrances.
- Very hot or very cold environments and changes in temperature.
- Skin infection.
- Dust mite droppings, animal fur, hair, and saliva.
- Pollen from trees, grasses and weeds.
- Clothing made of wool or synthetic fibres.
There is some connection between Atopic Dermatitis and stress, but it’s unclear which results in the other: stress-induced eczema or eczema-induced stress — or both.
Atopic Dermatitis is characterized by dry skin that becomes cracked, itchy, red, and sore. Even as other symptoms fade, excessive itching may persist and become virtually unbearable, especially at night. Sufferers often wake to scratch almost uncontrollably. Apart from disrupting sleep, scratching can cause bleeding and lead to infections. Scratching also tends to lead to worse itching and then even more scratching — a vicious cycle.
Perhaps the final symptom of an Atopic Eczema outbreak is the discoloration of the skin as the condition clears. The color change is temporary and more pronounced in persons with darker skin who may see their skin color become lighter or darker. Eventually, the skin will return to its normal color.
While Atopic Dermatitis may arise anywhere on the body and can result in near full scale coverage, some parts appear to be more susceptible than others. These include:
- The scalp, face, and neck.
- Fronts and backs of the knees.
- Hands, especially the fingers.
- Inside and outside of the elbows.
2. Seborrhoeic Dermatitis (or Seborrhoea)
Seborrhoeic Dermatitis branches into Infantile Seborrhoeic Dermatitis (also called “Cradle Cap”) and Adult Seborrhoeic Dermatitis. This form of eczema refers to a rash on areas of the skin that have numerous oil glands (sebaceous glands). It is one of the most common forms of eczema, usually appearing on the scalp, at the hairline, on the eyebrows and sides of the nose, as well as behind the ears. It can also show up on the chest. It may appear similar to dandruff but with more itching and signs of redness and inflammation.
Infantile Seborrhoeic Dermatitis usually affects children less than one year old, with a sudden onset occurring in babies between two weeks and six months old. As the name cradle cap suggests, it mainly affects the scalp, but may also be found on the face, neck, ears, diaper area, behind the knees, elbows, and armpits. Once the condition clears up, it is not normally seen again. A family history of eczema does not place babies at higher risk of developing Seborrhoeic Dermatitis.
In adults, Seborrhoeic Dermatitis tends to begin as dandruff that becomes red, irritated, and shows increased scaling. As the inflammation of the scalp worsens, the condition begins to affect the skin of the face and neck. Eyebrows, folds at the sides of the nose, temples, and neck. It is not uncommon for men, especially, to see the symptoms spread to their chest and back.
Seborrhoeic Dermatitis is thought to be caused by a yeast (Malassezia) which naturally grows on the skin, but eczematous skin has an abnormal reaction to it. The yeast thrives in areas of the body that have an abundance of oil glands. Other factors are:
- Stress and emotional trauma.
- Change of seasons.
- Cold, dry weather.
- Eating disorders.
- Heart attack or stroke recovery.
- Parkinson’s disease.
- Acne, rosacea, psoriasis.
Newborn babies are among those most likely to have Seborrhoeic Eczema (cradle cap). Adults between the ages of 30 and 60 are also at increased risk of developing this type of eczema, with men more likely than women to suffer from it.
Like many forms of eczema, the main symptoms of Seborrhoeic Dermatitis are redness, itching, and skin that is dry and flaking. There may also be burning and scaling, where the scales that flake off are either yellowish or white and appear oily or moist.
The symptoms of Infantile Seborrhoeic Dermatitis vary depending on its location. In the case of cradle cap, there are thick, yellow and waxy scales that form a crust on the scalp. The scales do not cause any itching or discomfort to the infant but are difficult to remove because they stick to the hair. The scales may also affect the eyebrows, behind the ears, forehead, neck folds and temples.
The condition is described as chronic, but many persons experience fluctuations in the severity of the symptoms. Treatment can cause the symptoms to subside, but they tend to flare up again when the treatment is stopped. In some cases, people seem to outgrow it — common for infants with cradle cap.
3. Contact Dermatitis
As the name suggests, this is inflammation caused by contact with certain substances. This comes in two forms — irritants and allergens. The substances may be irritants that act by directly damaging the skin’s outer layer, or they may be allergens triggering an immune response that affects the skin. According to the NHS, irritants cause roughly 80% of Contact Dermatitis cases.
Having Atopic Dermatitis increases the risk of developing Irritant Contact Dermatitis. These irritants include:
- Soaps and detergents.
- Disinfectants, antiseptics, and antibacterial agents.
- Toiletries and cosmetics containing perfumes and preservatives.
- Dust, powders, soil and cement.
- Water — especially heavily chlorinated water or water that is hard or chalky.
- Machine oils.
- Acids and alkalis.
- Many plants, including mustards, ranunculus, boraginaceae and spurge
Strong irritants may cause an immediate reaction, but quite often the symptoms show up after repeated exposure over the course of a few hours or several days. Some irritants only show their effects when the skin is exposed to sunlight after being exposed to the irritant (known as photosensitivity).
In terms of Allergen Contact Dermatitis, your immune system acts as your natural defence mechanism when your body is exposed to infection or develops an illness. Allergic reactions arise when the immune system mistakenly attacks healthy cells and tissues, and not just the cause of the infection. Interestingly, your body does not show any reaction to the allergen when first exposed to it, but usually takes a few days to develop. This manifests as an itchy red rash at the sites of contact with the allergen. Common allergens are:
- Hair dye, nail varnish hardeners, preservatives, fragrances and other cosmetic ingredients.
- Textiles, in particular the dyes and resins they contain.
- Metals used in jewellery (including nickel or cobalt).
- Some medicines applied on the skin (topical medicines).
- Naturally occurring latex and other forms of rubber.
- Strong glues, among them epoxy resin adhesives.
- Plants, including chrysanthemums, daffodils, primula, sunflowers and tulips.
Recurrent, persistent or severe symptoms should be reported to your doctor who will help you to determine the cause of the condition and define treatment. You may also have to undergo tests to identify your exact irritant or allergen.
Contact Dermatitis may occur anywhere on the body, but usually affects the hands and face. The symptom shows up at the point of contact with the irritant and include redness, swelling, blisters, burning or stinging, scaling and cracking. These symptoms can be worsened by rubbing against the irritant, dry air, heat and cold.
4. Dyshidrotic Eczema (Pompholyx)
A condition characterized by tiny blisters on fingers, toes, the palms of the hands and soles of the feet. In extreme cases of Pompholyx, the blisters are much larger and can be found on the backs on the hands and the limbs. The skin around the nails, as well as, the nail folds may also be affected and become swollen.
Pompholyx can occur at any age but adults under 40 are more likely to be affected. It is also twice as likely to affect women as men. A family history of Atopic Dermatitis is thought to predispose you to developing Pompholyx. It has been observed that about 50% of Pompholyx sufferers either have Atopic Dermatitis or it runs in their family.
While there are cases in which Pompholyx can become chronic, it is not uncommon for it to occur just once or twice in an individual. Most often, however, it clears and recurs over a period of several months or years. These triggers may cause a reappearance of the condition or make an existing outbreak worse:
- Stress and emotional tension.
- Sensitivity to chromium, nickel, or cobalt compounds.
- Contact with cosmetic products or perfume, detergents, household chemicals, shampoo or soap.
- Sweating, especially excessive sweating (or hyperhidrosis), common in spring and summer.
- Frequent exposure to water or damp conditions.
- Fungal skin infections which can coexist with Pompholyx and are not necessarily at the site of the outbreak.
Pompholyx begins with intense itching and a burning, prickling sensation in the palms or soles. Small blisters appear, which get bigger and ooze. They may become infected leading to pain, swelling and redness. The blisters may also develop pus or have a golden crust form over them.
This stage is usually followed by the skin drying out and peeling. The skin then becomes red, with the dryness leading to painful cracks or skin fissures. These are actually signs that the skin is beginning to heal. In most cases the blisters heal in a few weeks.
5. Discoid Eczema (Nummular Eczema)
Women in their teens to 20s and men from 50-to-70 years old are the most likely to suffer from Discoid Eczema. This condition tends to accompany other forms of eczema.
It is advised to seek medical attention immediately if you suspect you have developed Discoid Eczema. This condition lasts much longer when untreated and is much more likely to keep coming back. Additionally, the patches are susceptible to painful infection.
The most apparent triggers of this chronic form of eczema are insect bites and dry skin due to winter weather.
Although the condition is characterized by oval or circular patches about the size of a coin on the skin, it does not begin this way. In the early stages, persons notice a cluster of bumps or small red spots on their skin. Within a short space of time, the bumps or spots come together as the tell-tale pink, red or brown patches.
The patches are swollen, cracked, and itchy, with the itchiness most pronounced at night. They may also be covered with blisters which ooze and then become cracked, dry, crusty, and flaky.
The patches may occur anywhere on the body but are not usually seen on the face and scalp. The number of patches varies from person to person. If left untreated, it may take anywhere from weeks to years for the patches to clear up, but they can recur in the same locations as before. Discoid Eczema has the tendency to leave the skin discoloured even once symptoms have improved.
6. Varicose Eczema (Stasis Eczema)
A chronic condition predominantly seen on the lower legs and resulting from problems with blood circulation along the veins in the legs. Varicose Eczema occurs more in women than in men and often accompanies pregnancy. Elderly people are also at risk, as this demographic tends to have a problem with mobility and experience poor circulation which can lead to Varicose Eczema.
The problem usually arises when the veins become weakened, lose their elasticity and become stretched. This causes the small valves in the veins to malfunction, leading to backflow of blood. As the blood pools in the veins, the pressure inside them increases and fluid oozes into the surrounding tissues. The immune system’s response to this fluid under the skin is the cause of Varicose Eczema. The risks of developing varicose eczema are greater in persons who:
- Have had deep vein thrombosis (blood clots in leg veins).
- Have had to remain in one position (standing or sitting) for a long period of time.
- Suffer from varicose veins.
- Are overweight.
- Have had cellulitis (a bacterial skin infection).
- Have had phlebitis (inflammation in a vein).
Some of the symptoms of Varicose Eczema are common to all types of eczema and include itching, redness and swelling, as well as skin that is dry, flaking, scaly and possibly crusty. Other symptoms experienced by some persons include:
- Skin that is red, tight, tender and may thicken over time.
- Tiny blisters above the ankles.
- Small white scars.
- Affected skin develops a brown tinge.
- Eczema elsewhere on the body.
- Severe cases of varicose eczema may result in infection, cracking or large leg ulcers and oozing.
7. Xerotic (Asteatotic or Dry Skin) Eczema
A chronic form of eczema characterized by cracking and oozing of severely dry skin. The condition tends to flare up when the air is dry with very low humidity, usually wintertime, hence its nickname, “winter itch”.
Xerotic Eczema is more prevalent among the elderly, with persons over the age of 60 generally affected. This is because as we age, our skin loses some of its water retention capability, tending to dry out easily. The risk of developing Xerotic Eczema increases with:
- Long, hot baths and showers.
- Exposure to chemicals such as harsh soaps.
- Excessive scrubbing or washing of the skin.
- Rough drying of the skin after washing.
- Decrease in oils on the skin’s surface.
- A pre-existing condition of dry, rough skin.
- Dry environments.
Xerotic Eczema generally affects the limbs and trunk, usually being more pronounced on the arms and shins. The symptoms of Xerotic Eczema mirror those of most other types, in that the skin becomes red, dry, itchy, cracked, sore and flaky. One difference is that blisters are not seen in this condition.
What is sometimes seen is well defined plaque formation on the affected area of skin, most often on the shins. The shins may take on a “crazy paving” pattern and develop superficial cracks that are pink and red in appearance.
Don’t let eczema take over
Combat eczema by being kind to your skin.
Regardless of the form eczema takes, its symptoms can have serious, adverse effects on the quality of life of the affected person and their family. People with eczema often feel embarrassed or develop low self-esteem as a result of the condition. Additionally, symptoms may impact the ability to work or attend school, or interfere with sleep or the ability to perform basic self-care.
While eczema has no known cures, there are ways to relieve its symptoms. Healthy skin is able to withstand the effects of triggers, with symptoms ranging from none to mild. This allows the individual to pursue normal daily activities without the discomfort and embarrassment that normally accompany the condition.