Eczema, officially called atopic dermatitis, is an inflammatory skin condition caused by an overactive immune system. It most often first appears in early childhood but teenagers, adults and even the elderly can experience their first eczema eruption much later in life. Genetics play a role in increasing the risk of developing eczema but so do nutrition, living environment, occupational exposure, and food allergies. Fortunately, eczema is a treatable condition and eczema sufferers can get relief or even be cured of this disease.
Who Is Affected?
- Workers who come in contact with chemicals, cleaners, or other substances that are either directly irritating or indirectly cause an allergic response.
- Examples include hairdressers, construction, farming, and printing.
- Infants and toddlers, especially those who exhibit food allergies during or shortly after food introduction.
- Common food allergens are dairy, peanuts, citrus, shellfish, wheat, and soy.
- People with a family history of eczema, asthma, or hay fever have an increased risk of developing eczema.
- These commonly overlapping conditions are called the atopic triad.
What Are The Different Types Of Eczema Skin Conditions?
Touching something that causes a toxic reaction in the skin is called irritant contact dermatitis. It is localized to the skin directly in contact with the offending substance. Usually, this is from repetitive, cumulative exposure such as a harsh dishwashing soap used daily or acetone nail polish remover used by nail aestheticians.
However, it only takes a single episode to cause irritant contact dermatitis with dangerous industrial solvents and polymers. Allergic contact dermatitis is an indirect form of eczema where the person’s immune system creates an inflammatory response to a stimulus. This process requires at least two exposures; the first exposure sensitizes the individual and the second prompts the immune reaction.
Poison ivy rashes are an example of allergic contact dermatitis. Eczema triggered internally and not from touching a substance is called atopic eczema. It’s eczema that is most widely known for its chronic nature and its association with allergies, hay fever, and asthma. It can appear on a single spot or in many locations.
How Does Eczema Look And Feel?
Eczema appears as dry skin that is typically very pruritic (itchy). It can get tough or even leather-like over time from constant scratching and rubbing. This process is called lichenification. Eczematous skin is often reddened and can have scales. Swelling can occur in the affected skin such that the area appears puffy. Eczema lesions can ooze clear fluid or bleed in small amounts when scratched.
Some eczema eruptions are flat to the surface while others are raised bumps called papules (small bumps) or plaques (larger bumps). The skin can become infected with bacteria or the herpes virus, creating a change in the color or odor of the secreted fluid and/or an increased production of crusts.
Understanding Eczema: What’s Happening On The Skin Level?
A trigger from a person’s living or work environment, diet, or medication causes the immune system to create a cascade of signals and reactions. This type of hypersensitivity is called Type 1, which means that it is orchestrated by IgE immunoglobulins, which are a form of the antibody.
Think of antibodies as the body’s security guards looking to identify and bring attention to invaders. During a Type 1 reaction immune mast cells and basophils secrete vasoactive substances—vasoactive means dilating or constricting blood vessels. In the case of eczema, blood vessels dilate leading to swelling. Immune T cells, particularly a subset of T cells called T helper cells, play a role in increasing inflammation in eczema lesions.
They also recruit cytokines called interleukins, who act as the alarm ringers of your body’s immune “security system.” Other immune cells increased in eczema are IL-5, IL-12, and interferon γ. Interleukin 5 cytokines (IL-5) stimulate B cell growth and secretion of other immunoglobulins (T cells, etc) and it is also a key mediator in the activation of eosinophils.
Cytokines function as the secretaries and office managers of the immune security system, sending messages and coordinating functions. Eosinophils are a category of white blood cells, which are immune cells that help fight infections. Eosinophils can be elevated when a person has a parasitic infection or when they have allergies.
They play a large role in inflammation in allergies, eczema, and asthma. Eosinophils also produce reactive oxygen species in an effort to neutralize microbes but unfortunately, high amounts of reactive oxygen can cause DNA and protein damage. Think of them as the muscled, aggressive bouncers of your immune system – getting the job done but sometimes causing collateral damage.
What Can Elicit An Outbreak Of Eczema?
- Airborne allergens such as pollen, dust mites, or animal dander.
- Foods, particularly in children:
- eggs, milk, wheat, soybeans, shellfish, fish, and peanuts.
- Bacteria such as Staph aureus can stimulate your body’s T cells and macrophages. These immune cells recruit other immune cells and initiate signals that tell the skin to swell, redden, itch, and ooze.
- Autoimmune antibodies. The IgE antibodies discussed in the previous section can direct their assault on your own body’s proteins.
The very skin damage of eczema can recruit more IgE and T cells, sometimes leading to a vicious cycle of hyperreactivity of your immune system.
What Can Aggravate Eczema Skin?
Emotional stress can cause your body to manufacture more neurotrophin and neuropeptide, biochemicals that create changes in your skin barrier (the outer layers of your skin) and decrease the threshold for itchiness.
Read ways to decrease your stress level naturally.
- Winter aggravates eczema skin due to the dry air and possibly because of decreased skin exposure to light, and indirectly, less production of Vitamin D, which has a protective role in eczema conditions.
- Wool carpets, clothing, blankets, and scarves can trigger eczema in some individuals. Others find removing clothing of any kind can trigger itching when the skin is exposed to open air.
- Frequent hand washing or bathing can lead to skin dehydration by increasing water loss through the epidermis, the outermost layer of the skin.
Daycare or healthcare workers who wash their hands frequently have a higher incidence of hand eczema.