Eczema is an inflammatory disease of the skin that causes typical discomfort: the skin is red and swollen, blisters or nodules form and the affected areas itch. The inflammation is not caused by pathogens such as bacteria or viruses and is therefore not contagious.
Eczema is one of the most common skin diseases. Almost every person has eczema at some point in his life. The rash can occur at any age: some forms of eczema already occur in babies and toddlers, others occur only in adults, others, especially in the elderly.
An eczema can only occur for a short time and completely disappear again. But it can also last a long time or occur again and again in intervals. Then the skin changes in a typical way: It thickens, crusts and shivers. Doctors also speak of chronic eczema here.
The causes of a rash can be very different. The treatment depends on the type of eczema, how severe the symptoms are and how long they have been.
The main types of eczema are:
- Allergic contact dermatitis: It is caused by an allergic reaction.
- Toxic contact dermatitis: eczema is the result of irritants or harmful effects on the skin.
- Atopic eczema (another word for atopic dermatitis): In this common disease, predisposition plays an important role.
- Seborrhoeic dermatitis: It occurs mainly in regions with many sebaceous glands, such as on the scalp or on the face.
Eczema can occur in almost all parts of the body:
- On the face: around the eye, on the eyelid, under the eye, around the nose or around the mouth
- On the hairy parts of the body: on the scalp or on the eyebrows
- On the head, for example on the ear or in the ear
- On the hands or on the feet
- On the trunk: on the chest, on the stomach or on the back
- On the arms or legs: The flexor sides (elbows, knees) or the extensor sides (elbows, knees) can be affected
- In skin folds: under the armpits, under the breast, between the fingers or between the toes
- In intimate parts of the body: on the buttocks, on the anus, on the penis, on the vagina or on the nipples
Typical of eczema on the hand or on the foot (see also: dyshidrotic eczema) are small, very itchy blisters that occur mainly on the palms, on the sides of the fingers and on the soles of the feet. This type of rash can have different causes.
Depending on the nature of the eczema, the cause and the stage of the disease, the symptoms may vary: in the acute stage, the skin is typically red and swollen. The affected areas itch strongly and may form nodules or fluid-filled blisters. The bubbles often burst after a while and wet. Later they dry out and form crusts, which eventually heal.
Chronic eczema, which has been present for a long time or recurring, typically causes a change in the skin: it forms crusts and flakes. The skin texture coarsens and the skin becomes thicker overall. In addition, deep cracks can form.
There are different types of eczema that have different triggers. Most eczema are classified according to their causes. The most common eczema are allergic contact dermatitis, toxic contact dermatitis, atopic dermatitis (eczema) and seborrheic dermatitis. There are also other forms that occur less frequently.
The dishidrotic eczema
Typical of the dyshidrotic eczema are small, very itchy blisters on the palms, on the sides of the fingers and on the soles of the feet. The causes can be different: Eczema often occurs in people who have atopic dermatitis or contact allergy. Even a fungus infection can trigger the symptoms. If the skin has been damaged by frequent contact with soaps or cleansers, this may promote dyshidrotic eczema. For treatment, it is sufficient in mild cases, to avoid the triggers and to care for the skin well. In case of increased inflammation cortisone-containing creams can be applied.
Allergic contact dermatitis
Allergic contact dermatitis is one of the most common skin diseases. It is caused by an allergic reaction of the skin on contact with certain substances, so-called contact allergens, such as jewelry or care products. Once the allergy has developed, the next contact with the substance causes eczema relatively quickly - within one to three days.
At the beginning, the skin is reddened, then itching bubbles form, which can burst open and later crusts. The symptoms can spread - they then go beyond the skin area where the allergen has been acting. If you no longer have contact with the allergen, the eczema heals relatively quickly. However, if the substance in question continues to affect the skin, the eczema becomes chronic: the skin is constantly reddened, the skin texture coarsens and corneas and cracks develop.
Irritative toxic contact dermatitis
This eczema is the result of harmful effects on the skin, without an allergic reaction occurs. For example, the trigger may be frequent exposure to soaps, alkalis, oils, acids or water. Also, repeated physical stimuli such as heat, cold or friction can permanently damage the skin and thus cause eczema. In contrast to allergic contact eczema, inflammation is clearly limited to the site where the harmful influence occurs.
The irritative-toxic Kontakekzem is very common. It often occurs when working in the home or in certain professions, in which harmful substances are constantly acting on the skin.
Specialists distinguish between acute and chronic toxic contact dermatitis. In the acute form, toxic substances, heat or strong sunlight significantly damage the tissue. The skin is very red, it forms blisters, crusts and sores. On the other hand, chronic toxic contact dermatitis is caused by small but long-lasting harmful effects. In the chronic form, the skin shivers, becomes cracked and the skin texture coarsened.
Atopic eczema (atopic dermatitis)
Atopic dermatitis is a common, mostly chronic, skin condition that affects 10 to 20 percent of people and is common in young children. It is typical that longer periods alternate with little or no symptoms and phases with strong symptoms. In the acute phases, the skin is inflamed, itches strong and there are reddened, partly weeping, partly encrusted houseplants. It can cause blisters and nodules and the skin sheds.
Atopic eczema develops when several factors come together. Many sufferers are at increased risk of developing skin disease due to genetic traits. In general, the skin is very dry and the barrier function of the skin is disturbed. As a result, allergy-causing substances and pathogens can penetrate more easily and quickly cause inflammation. Finally, the immune system increasingly produces certain antibodies, which contributes to an allergic inflammatory response.
Typical triggers of the symptoms are:
- Contact allergens and allergens in the air: for example, pollen, pet dander, dust mites, fragrances, nickel, disinfectants
- Food: in small children egg white, cow's milk, citrus fruits
- Irritation of the skin by wool, detergents or scratching
- Climatic influences: dry air, heat, sweating
- Psychological factors: mental stress and stress can trigger a boost or worsen the symptoms.
An eczema usually begins early in life: over 75 percent of those affected fall ill in the first two years of life. The symptoms can occur for the first time at any age.
Seborrheic dermatitis, on the scalp
Seborrheic dermatitis is common in infants and adults. Men are more affected than women. Eczema is most prevalent on the scalp and on the face in areas of the skin with many sebaceous glands - such as the eyebrows and around the eyes, on the eyelid and between the nose and mouth. The body can also be affected: above all, the so-called welding channel in the middle of the chest and back, the armpits and skin folds. Experts suggest that sensitivity to certain yeasts on the skin contributes to eczema.
The affected areas are red and it forms fine, yellowish, greasy scales. In infants, the scales appear in the first few weeks of life on the scalp, on the hairline or on the face. The symptoms usually disappear after a while. Common to adults are reddened, distinctly small plaques with yellowish scales on the hairy scalp, hairline, face and behind the ears. In rare cases, the whole body may be affected.
In order to reduce the colonization with yeast fungi, the doctor prescribes active substances that kill the fungi (antimycotics). They can be used as creams or - in the case of the scalp - as shampoos. These contain, for example, ketoconazole, selenium sulfide or zinc pyrithione. If the skin is highly inflamed, a cortisone-containing cream may be useful for a short time. For skin care you should use soaps and shampoos with neutral or slightly acidic pH. Because seborrheic dermatitis worsens with stress, it is important to learn how to handle stress appropriately.
Eczema Herpeticatum is a serious but rare disease caused by herpes viruses. It can be a complication of eczema or other skin conditions - especially in atopic eczema (atopic dermatitis). Due to the damaged skin, the viruses can easily spread to the skin. When eczema herpeticatum occur on large areas of herpes blisters, itching and pain. The bubbles burst after a few hours or days and then form crusts. The most commonly affected are face, neck and upper body. At the first illness, the symptoms are often severe. It can be fever, a strong malaise, swelling of the lymph nodes and headache. If the disease recurs, it usually works more easily and with fewer symptoms.
An eczema herpeticatum is treated with drugs that inhibit the proliferation of herpes viruses (antivirals). These should be used as soon as possible, as soon as the diagnosis is established, because they can shorten the duration of the disease. Most are applied as creams or gels on the skin. In order to avoid infection, you and others should touch the affected skin as little as possible.
A severe eczema herpeticatum can be a medical emergency that requires hospitalization. The drugs are given in the form of infusions. In babies and toddlers, eczema herpeticatum is a medical emergency.
Experts refer to eczematous dermatitis as causing eczema on the body. They form days or weeks after the original inflammatory reaction of the skin. Triggers can be an allergic or a toxic-irritant contact dermatitis or an inflammation by bacteria, viruses or fungi. Eczematoid dermatitis occurs at sites other than the site of inflammation, such as the hand following a fungal infection on the foot. The affected areas are reddened, they itch strongly and form blisters and nodules. Cortisone preparations often do not work well in this case. In contrast, the symptoms often disappear when the original inflammation is successfully treated. However, creams with cortisone may be helpful to relieve the symptoms.
Intertriginous eczema is an eczema that occurs in skin folds. The skin is red and inflamed, the affected areas itch, burn and often wet. Intertriginous eczema is often caused by friction and softening of the skin, such as heavy sweating. Often it occurs in the spaces between the toes and fingers, under the armpits, under the breast or on the buttocks between the buttocks. Obese people often suffer from eczema in skin folds that arise due to overhanging skin. Intertriginous eczema can be caused by bacteria or fungi. These should then be treated with the appropriate medication. In addition, careful skin care is important.
The nummular eczema
In nummular eczema, coin-shaped (nummular), brownish-red skin lesions occur, which occur again and again exactly in the same place. Eczema often occurs on the lips, face, hands, feet, arms or legs. The affected areas itch and burn strongly and can form bubbles. The causes of nummular eczema may vary: it may be in response to certain medicines, but also to contact allergy, atopic eczema or other types of eczema. If the cause is a medicine, you should discontinue it. The symptoms are treated with cortisone-containing creams and anti-histamines in the case of severe itching.
The diaper dermatitis
Diaper dermatitis is a special form of irritant-toxic contact dermatitis. It arises when, in infants or incontinent patients, who regularly wear diapers, urine and / or stool under the diaper, so under exclusion of air, a longer time on the skin act. As a result, the skin reddened, inflamed and the tissue softens.
The desiccation eczema
The desiccation eczema mainly affects the elderly and is caused by dried out skin. It often occurs in the cold season or with frequent washing. Most often, the lower legs are affected. In desiccation eczema, dry, scaly, itchy plaques form and the skin is torn like a net. For treatment you should avoid the triggering factors, especially soaps and frequent contact with water. Refatting skin creams or oils and medicated oil baths can usually relieve symptoms quickly. In case of severe itching also antihistamines can be taken.
The stasis eczema
Stomach dermatitis can occur in people who suffer from venous insufficiency. The blood accumulates in the lower legs and feet. This favors contact allergies - for example, against drugs that treat congestion. This can lead to allergic contact dermatitis. Compresses help to reduce congestion - and this usually improves the stasis eczema. If this is not enough, cortisone-containing ointments can be used for a short time.
Eczema can have different causes and be triggered by very different factors. These are often external factors, such as substances that trigger allergies or skin irritation. Some people also have a genetic predisposition that favors eczema.
Important to know: Eczema is not contagious! Because the inflammation of the skin is not caused by pathogens. So you do not have to worry about getting infected - or infecting other people if you have eczema yourself.
In case of rash of unclear cause you should definitely consult a doctor. He can determine if it is an eczema and find out the cause of the eczema.
Frequently, eczema is the result of an allergic reaction to certain substances - so-called allergens - such as nickel, fragrances or dyes. This is the case with allergic contact eczema and atopic eczema (atopic dermatitis). Irritation from chemical substances, soaps, alkalis or certain medications can also trigger eczema - for example, in the case of toxic-irritant contact dermatitis. Certain eczema types such as seborrheic dermatitis are associated with increased sebum production and certain fungi on the skin. In some eczemas also a predisposition in the family plays a role - especially in atopic eczema (eczema).
Other triggers of eczema may include dry skin, moisture and friction - such as in skin folds or under a diaper - or stasis in the legs.
To make the diagnosis, the doctor looks closely at the diseased parts of the skin. Often he can already recognize by the typical skin, which eczema is present. In addition, he will ask you, since when the rash occurred, with what substances you have recently had professional and personal contact with and if similar symptoms have occurred in your family. So he can often already track down the causes of eczema. If your doctor suspects allergic eczema, in some cases he will also do an allergy test.
There are several effective ways of treating eczema. The therapy depends on the type of eczema, the causes and the stage of the disease. In many cases, topical treatment with ointments, creams or lotions is sufficient. Home remedies can also help in some cases to relieve the symptoms of the rash.
Avoid triggering substances
If an allergy or an irritant causes eczema, it is important to consistently avoid contact with the triggers. This is often enough, so that the rash heals and will not occur in the future.
The most important substances that can trigger eczema are:
- Nickel: for example in costume jewelery and coins
- Cobalt chloride: in metals with nickel, cement, ceramics, blue kohl
- Chrome salts: in leather and building materials
- Palladium: in gold and platinum alloys, especially in dental metals
- Cosmetics such as parabens, tea tree oil, eucalyptus oil
- Para-phenylenediamine: dye in printing ink, black garments, hair dye
- Epoxy resin: in adhesives
- Rosin: in adhesives, for example in shoes
- Plants: primroses, chamomile
In order to find possible triggers, it is important to tell the doctor exactly which substances you have at work and in private life, for example, in hobbies, contact. Often, the place where the rash occurs, the trigger can find out: Thus, an eczema on the earlobe or neck caused by costume jewelry - the trigger is then an allergy to nickel.
An allergy test can also be helpful in detecting the triggers. The doctor wears various test substances on his back, where they remain for 48 hours (patch test). He can then determine which substances the patient is allergic to.
When treating it, it is important to avoid the allergens that cause them as much as possible. The doctor will give you an allergy pass, in which all substances are listed, to which you are allergic. The symptoms are treated with cortisone-containing, nourishing creams. In case of severe itching, the doctor may additionally prescribe antihistamines. In some cases, light therapy may also be helpful.
Creams, ointments, soaps and proper skincare
An important ingredient that is helpful in the treatment of many types of eczema is cortisone. The substance is often included in nourishing ointments, creams or lotions that the doctor prescribes. Cortisone inhibits inflammation in eczema, suppresses the allergic reaction and relieves the itching. To avoid side effects, patients should not use cortisone-containing preparations over an extended period of time, over a large area, or under a bandage.
In addition, patients can regularly apply individually tailored, nourishing ointments, creams or lotions to their home. They provide the skin with fat and water, make it more supple and strengthen the barrier function. This helps to make germs harder to penetrate the skin.
Depending on the type of eczema, the care products are different: in an acute, weeping rash these should contain a lot of water. With eczema that has been around for a long time, the skin is often dry and flaky. Here you should use products that contain a lot of fat. Even if the eczema has healed again, it makes sense to continue to care for the skin. For this you can apply moisturizing creams or lotions.
For washing, you should use mild soaps that will not degrease the skin. In chronic eczema, some doctors recommend dispensing with soaps and detergents and instead taking oily baths. Even if the rash itches heavily: It is important not to scratch as possible! This damages the skin and causes the symptoms to worsen.
House and herbal remedies can help alleviate the symptoms of eczema. You can also use these in addition to the therapy with ointments or other medications prescribed by the doctor. Nevertheless, it is always useful to talk to a doctor if you have a rash. Because he can recommend the treatment that helps the most effective against the eczema.
Home remedies that doctors often recommend for eczema are menthol and camphor. They can relieve the symptoms of itching, but they do not cause the eczema to heal. Other herbal remedies that are especially recommended in alternative medicine are ointments with Cardiospermum from the flowers of the balloon vine or with the natural substance Ectoin. They can be used in symptom-free stages for the prevention of eczema, to have less resort to cortisone-containing ointments.
Various herbal extracts can help to moisturize and soften the skin, as well as relieve itching and pain. They can be applied in the form of nourishing creams, lotions or oils. These include, for example, evening primrose oil, borage, aloe vera, marigold or chamomile.
Sometimes external treatment is not enough to ameliorate the symptoms of eczema. Then it may be necessary to take cortisone in the form of tablets. In case of severe itching, the doctor may also prescribe antihistamines. These are active ingredients that relieve the itching. Because certain antihistamines make you tired, you should take them in the evening before falling asleep.
If the eczema is extensive and severe, it may be necessary to give cortisone for a short time in the form of an infusion so that the symptoms disappear quickly. The treatment can then be continued with tablets.
Light therapy and brine baths
Therapy with UV light can help alleviate the symptoms of chronic eczema. It can take place at the same time for external treatment with ointments or creams. Sometimes it is also combined with brine baths. But beware: If the eczema develops due to an allergy to sunlight, no light therapy should be carried out.
Patient education and psychological support
It is also important that the patients know exactly about their illness, the causes and the various treatment options. For example, if the rash is caused by an allergic reaction, your doctor will tell you where the substances you are allergic to are present in the environment and how you can avoid them.
Especially with chronic eczema - such as atopic eczema - patient education is important. In the process, those affected learn how to curb the symptoms themselves and stay symptom free for as long as possible. Research has shown that patient education can significantly improve the quality of life of eczema.
Psychological support can also help relieve eczema. So you can learn psychological strategies that help break the vicious cycle of itching and scratching. Often, people with chronic eczema also feel psychologically stressed - and this often worsens the symptoms. Psychological support can help them deal better with psychological stress.
Treatment of infection by bacteria, viruses or fungi
Sometimes the skin is severely attacked by the eczema and its protective function is disturbed by pathogens. This can additionally cause inflammation by bacteria, viruses or fungi. It is important to treat such an infection properly! The doctor decides which treatment is appropriate in this case.
For mild inflammation, you can apply creams or ointments that kill or contain the germs. In the case of severe, extensive inflammation, it may be necessary to take appropriate medications, for example antibiotics or antivirals (antivirals). In severe cases, in which the inflammation spreads to the whole body, the active ingredients are given in the form of infusions.
Skin diseases are among the most common occupational diseases in Germany - a large proportion of which are eczema. Often substances that people do with a work-related, allergic reaction or skin irritation trigger and lead to eczema.
This is how allergic skin eczema develops, for example, with craftsmen when dealing with building materials or when hairdressers with hair dyes and other chemicals. But even a constant contact with water, soaps or alkalis can cause skin irritation and eczema.
If you or your doctor suspect that the eczema has been caused by substances with which you are dealing professionally, the relevant professional association should be involved. This must assess whether the eczema is recognized as an occupational disease. If it is not possible to avoid the triggers of the eczema, a retraining or a change of occupation may be necessary.
If you have had eczema before, it is important to do something yourself to prevent it from recurring. This includes avoiding substances or stimuli that can cause eczema as much as possible (see above). At the same time you should regularly care for the skin with individually tailored, moisturized and fatty products. It is also important to protect the skin from harmful influences - for example, by appropriate work clothes.
Heavy sweating, friction and poorly ventilated skin can contribute to eczema. Therefore do not wear too tight, breathable clothing. Since heavy skin overgrowth causes extra skin folds, weight loss can help prevent eczema.
Even dry skin can promote eczema. Therefore, you should avoid anything that dries out the skin, such as harsh cleansers and other chemicals, as well as alkaline soaps and hot baths. Moisturizing care products restore moisture to the skin. This is especially important in winter with dry heating air.
In general, a healthy, balanced diet contributes to a healthy, resilient skin. In particular, omega-3 fatty acids and vitamin E may help prevent allergies. For example, omega-3 fatty acids are found in nuts and fish, vitamin E in vegetable oils, and wheat germ.