A case study of Eczema or Atopic dermatitis by Dr Garima Asati

A case study of Eczema or Atopic dermatitis –

Homeoeczema..

Eczema or Atopic dermatitis is a skin condition in which there is redness, dryness of skin occurs with severe itching and dermatitis flare up again and again. Skin becomes cracked, rough and sometimes blisters may also see.

At a Glance –

Also known as Dermatitis.

Dermatitis – inflammation of skin ie derma – skin, it is – inflammation.

It is an inflammatory skin disease characterized by red, itchy rashes with swelling and blisters or cracked skin.

Cause is unknown but family history is more common.

Physical examination is more than sufficient.

Immediate consultancy is required from doctors, easily treatable by doctors.

Etymology of Eczema –

It has been derived from a Greek word which means to “boil over”.

What is the main cause of eczema?

Usually unknown and non contagious.
Environmental factors like poor hygiene, dampness or humidity.
Genetic causes.
Weak immunity.
Family or personal history of hay fever or asthma.

Risk factors –

Exposure to Irritants or Chemicals: like soaps, household cleaners, wool or polyester like fabrics, detergents, shampoos, disinfectants, metals or eatables like meats, vegetables or juices.
Foods: Dairy products, soy products or eggs, nuts.
Allergens: like house Dust mites, pets like cats and dogs, pollens, and mold.
Microbes: bacterial infection or any fungal infection or using Antibacterial ointments.
Stress related: It usually worsens the symptoms.

What are the symptoms of eczema?

It is very common disease. Females are more prone to it. About 10 % populations in United States are affected from different types of eczematous condition. It varies from person to person and on the basis of types of dermatitis.

Common symptoms of dermatitis are –

Redness and dryness of skin.
Severe itching especially at night.
Presence of swelling.
Red patches occur especially on hands, feet, ankle, wrist, neck, chest, inside the bend of elbows, face and scalp or genital area, back of knees ie folds.
Skin becomes scaly thick known as lichenification or cracked sometimes.
Itching causes scratching and bleeding.
Skin lesions may be sometimes oozing or weeping sores or scarring.

How eczema look like?

How many types of eczema are there?

1. Eczema or Atopic dermatitis –

It is the most common type of eczema. It is one of the atopic triad; the other two are Asthma and Hay fever.

SYMPTOMS –

It is more common in childhood especially at scalp and cheeks.
Rashes occur in the bends of elbows or on knees.
Skin may get lighter or darker or thicker where the rashes appear.
Blisters may appear which may ooze.

CAUSES –

Genetic.
Dry Skin.
Susceptible individual or low immune persons.
Environmental factors.

2. Contact dermatitis –

Contact dermatitis is of two types Allergic and Irritant. Allergic is because of delayed reaction to an allergen while Irritant is because of immediate and instant reaction to any particular substance. Irritant is more painful. It is the form of dermatitis which occurs in body because of irritation with particular substance. When any person comes in contact with those irritants it leads to irritated skin.

SYMPTOMS –

Skin becomes red irritated.
Itching is more prominent in it.
There is burning and stinging sensation.
Blisters may appear which may ooze and crusty.
Skin may get thickened or scaly or leathery.

CAUSE –

When anyone gets in contact with these substances like –

Detergents
Jewellery
Latex
Bleach
Nikil
Paint
Skin care products
Poisonous substances
Soaps perfumes
Tobacco
Smoke
Sun exposure.

3. Dyshidrotic Eczema –

It is also called as Vesicular Palmoplantar Dermatitis. It is more common in females.

SYMPTOMS –

Skin becomes red, cracked, painful and scaly or flake.
There is severe violent itching.
Small blisters occur especially on fingers, palms of hands, toes and soles of feet.
It is worse at night or in warm weather.

image source from Medical News Today[/caption]

CAUSES –

Stress related.
Dampness.
Exposure to allergens or certain substances like nickel, cobalt.

4. Stasis dermatitis –

It is also known as Gravitational Eczema. More common in ankle area over 50 years of age.

SYMPTOMS –

Skin of Lower leg is involved in it which is because of Circulatory problems.
Swelling in lower legs may be seen which increases by walking.
Pain and heaviness in legs.
Darkness in legs with severe itching.
Open sores may also develop on lower leg.
It may also lead to leg ulcers.

Image source from advdermatology.com [/caption]

CAUSES –

Pooling of blood is one of the causes.
Circulatory issues like heart problem is also one of the cause.

5. Nummular Dermatitis –

It is also known as Discoid Eczema.

SYMPTOMS –

It mainly occurs in winter.
Meals are commonly affected.
In this round, coin shaped and dry patches occur in skin of leg.
It itches alot.

image source from blogspot.com[/caption]

CAUSES –

It occurs due to reaction to an insect bites.
Exposure to allergic substances like metals, chemical.

6. Neurodermatitis –

It is also called as Lichen Complex Chronicus.

SYMPTOMS –

In this scaly , red , raw , dark colored , thick patches occur on skin of head , forearm , wrist , lower legs , back of neck , bottom of feet , back of hand , genitals.
Itching is severe while you sleep.
Scratching may lead to bleeding or infection or scarring.

image source from healthjade.com[/caption]

CAUSES –

Stress.
It is similar to atopic dermatitis.

7. Hand eczema –

As it mainly affects your hands that’s why it is termed as Hand Eczema.

SYMPTOMS –

Red itchy and dry patches occur on hand.
Cracks and blisters may also seen.

CAUSES –

Exposure to chemicals.
Jobs like cleaning or hairdressing.
Health care services like – Laundry or dry cleaning.

8.Seborrhoeic dermatitis –

It is also known as Cradle Cap in infants.
A thick yellow crusty layer or rash may appear on skin.
Skin may become dry or greasy.
Peeling of scalp eyebrows , face and trunk may seen.

9.Dermatitis herpetiformis –

Symmetrical rashes occur on arms , thighs , knees and back.
There is violent itching which is worse at night.
Papules of size 1 cm and vesicles may occur.
There is burning and stinging sensation.
It is also seen on shoulders , elbow , neck , buttocks.

10.Autoeczematization –

It is secondary to parasitic , fungal , bacterial or viral infection.

What are the complications of eczema (atopic dermatitis)?

Insomnia.

Risk of superimposed bacterial or viral infections.

Repeated scratching may lead to open sore or cracks in the skin due to breakage in the skin layer.

Lichenification may occur – ie thickening of skin due to repeated scratching and itching.

What tests are used to diagnose eczema?

Usually history and Physical examination is more than sufficient.

Patch test – ie Some allergic test may also be helpful to check out the allergies. It reveals that one is allergic to that particular allergen.

Skin biopsy.

How can I prevent my Baby from getting eczema?

Try to reduce exposure or try to avoid the things which trigger or aggravate your condition.

Take special care in humidity.

Moisturize your skin if it is dry.

Avoid stress.

Take very well care while handling chemicals.

Avoid hard soaps and use gentle soaps or detergents.

Avoid rough and tight fitting clothes.

eczema Management –

Antihistamines – for controlling itching but it has side effects like it causes drowsiness.

Corticosteroids – for controlling itching and swelling but it has side effects like it causes thinning of skin , discoloration , irritation.

Antibiotics – reduces infection.

Immunomodulators – to reduce flare-ups but it has side effects like it causes kidney diseases, high blood pressure , infection or even cancers.

Light therapy- exposing skin to mild sunlight and uv rays for treating rashes but overuse to uv rays may causes skin cancer.

Eat anti inflammatory food like omega 3 fatty acid rich food , vitamin d , e , b6 rich food or food rich in Quercetin like broccoli , cherries and blue berries.

How can I get rid of eczema on my skin?

Homeopathic medicines –

1.GRAPHITIS –

In Graphitis there is rough , hard and dry skin. Eruptions may ooze out a sticky exudation. There is rawness in bends of limb , groins , neck behind ears. Skin is unhealthy , every little injury suppurates. Eczema is more of anal region, crural or palmar. Eruptions aggravate on heat. Itching aggravates on warmth. Excoriation of skin with voluptuous itching . Skin is moist after scratching , Sticky honey-like fluid comes out on scratching.

There is weeping eczema. There is eczema of fatty people , blonde complexion who easily catches cold . Skin is very dry never perspires and is inclined to cracked . Painful to contact , starting behind ears , extending to vertex and down to cheek, eczema of scalp , forming massive dirty crusts , which mat the hair together , violent itching and burning .

Worse – Itching worse in evening or at night , Suppression ; of eruptions , Wramth of bed .

Better – Open air , after walking in , wrapping up .

RUBRICS-

[Complete ] [Skin]ERUPTIONS:Eczema:Alternating with internal complaints: 3 Graph

[Complete ] [Skin]ERUPTIONS:Eczema:Warmth agg.: 1 Graph

2.HEPAR SULPHURICUS –

It is useful in eczema of scalp , on genitals and upon folds on scrotum and thighs which is very sore and sensitive to the touch . Humid Skin , burning or sore on scratching . Violent itching on rising in the morning, it emits an offensive odor and spreads by means of new pimples appearing just beyond the old parts; BOILS ON HEAD AND NECK, very sensitive to contact (It is opposite to Graph).

Pustular eczema . It is often useful after application of salves and ointments; Also useful in crusta lactea tetter, rhagades, excoriations . Skin is unhealthy ; every little injury suppurates. There are deep cracks on hands and feet . Patient cannot bear to be uncovered ; wants to be wrapped up warmly. Great sensitiveness to slightest touch. Cold sores . Hands and feet always cold .

Worse – In cold dry air , winter, cold wind ; drafts . least uncovering , lying on painful part .

Better – Heat , warm wraps , moist heat , damp weather .

RUBRICS-

[Complete ] [Skin]ERUPTIONS:Eczema:Moist: 3 Hep

[Complete ] [Skin]ERUPTIONS:Eczema:Suppurating: 3 Hep

3-MEZEREUM –

Eczema on hairy parts like head , it is covered with thick leather like crusts under which there is thick and white pus collects – DERMATITS WITH PUSTULES . In mezereum , hair are glued and matted together . It affects specially those parts of skin which is normally deficient in fat . Itch – like eruptions after vaccination in chidren , Child scratches face incessantly .

Thers is intolerable itching , chilliness aggravated in bed and warm bath ; compells the patient to scratch and changing location again and again . Vesicular eczema which burns like a fire. Eruptions are oozing ; acrid ; gluey moisture ; it forms chalky white crusts or honey – like crusts aboout mouth and cheeks . Eruptions ulcerate ; there is offensive pus . After scratching fat pustules form.

Worse – Warmth of bed or of fire , from touch , when undressing , night , vaccination

Better – Wrapping up , radiated heat or open air .

RUBRICS-

[Complete ] [Skin]ERUPTIONS:Eczema:Vaccination, after: 3 Mez

[Complete ] [Skin]ERUPTIONS:Eczema:Moist: 3 Mez

4.PETROLEUM –

There is thick yellowish green crusts or amber colored crusts on face and neck . Eczema mostly of face , dermatitis under nose , neck , scrotum , perineum , thighs . Ecezema is dry and scaly , or moist which reappears in winter or cold weather . Thickened skin like parchment ; which gets raw and won’t heal eaily.

Skin is dry , constricted , rough , cracked , leathery , very sensitive to touch and bleeds easily . Slightest scratch to skin suppurates easily . Itching violent ; patient scratches until it bleeds and part gets cold after scratching . Clothing painful . If eczema gets suppressed it causes diarrhoea . Discharge is profuse , thin , watery , pain is like a burnt area . Inflammed skin ; heals with very diffiaculty .

Worse – At night , winter , before or during thunderstorm , touch of clothes even .

Better – Summer , warm air , open air , dry weather .

RUBRICS-

[Complete ] [Skin]ERUPTIONS:Eczema:Sun, from: 3 Petr

[Complete ] [Skin]ERUPTIONS:Eczema:Dry: 3 Petr

5-PSORINUM –

Dry scaly eczema on scalp and face , behind ears . There is crust over the scalp which causes falling of hair and oozing occurs from the crust and it produces new vesicles . DERMATITIS WITH PUSTULES ; Discharge is thick , excoriating offensive like disposed meat . Foetid eruptions . It is aggravated by cold ie winter .There is intolerable itching and dirty look of skin . There is aggravation from warmth of bed and patient scratches until there is bleeding .

Worse – Cold , open air , washing , changing of weather , heat of bed , suppressions .

Better – Washing , Hard pressure , profuse sweating , warm clothing .

RUBRICS-

[Complete ] [Skin]ERUPTIONS:Eczema:Air, open, amel.: 1 Psor

[Complete ] [Skin]ERUPTIONS:Eczema:Hereditary: 1 Psor

Can eczema just go away?

Case-

A patient aged 5 years suffering from eczema since her 4 months of age . There was severe itching , cracks , bleeding and burning sensation in the eruption area .

Her construction – She is very fast , mischievous , witty , obstinate loves to dance , attention seeking , craves appreciation, creative and impatient girl . She made mistake in writing for example she wrote b instead of d . She is very sensitive to rudeness .

In mothers pregnancy history – Mother felt that her sister-in-law got more attention than her so she felt alone .She had seen an abnormal baby during pregnancy so she had a fear of misfortune that her baby should not be like that .

After thorough case taking and analysis I took the rubrics –