Eczema is the more common name for atopic dermatitis, an umbrella term often used to describe the relapsing-remitting cycle of dry, itchy, rashy skin.

Highlights

• Eczema commonly starts with dry, itchy skin. The scratching is what turns it into the angry, red rash we’re so familiar with.
• It’s most commonly found in the skin flexures – the elbow patches, knees, neck
• It can affect all age groups, but it is most commonly diagnosed before 5 years of age and affects 10% – 20% of kids. About half will outgrow it before adulthood.
• Diagnosis is primarily clinical and based on symptoms.
• Atopic Dermatitis is the most common form and is part of the “atopic triad,” along with asthma and allergies.
• Approximately 70 percent of patients have a positive family history of atopic diseases.
• Most common triggers: food, stress, irritants, and environment
• Incidence of eczema is increasing 2- to 3x in industrialized nations since the 1970s.
• Western treatment approaches: First-line treatment is with emollients and topical corticosteroids. Other options that may be used in patients unresponsive to first-line therapy include topical calcineurin inhibitors, phototherapy, or immunosuppressive agents.
  
  

Phases of Eczema

• Acute phase

• Itching is often the first sign of acute eczema. This happens even before the rash is apparent. The itch causes us to scratch, resulting in red, weepy, and torn up skin.

• • • Extreme redness
    • Intense itching
    • Bumps
    • Fluid-filled blisters, called vesicles, which may ooze or weep
    • Pain
    • Tenderness
    • Swelling
    • Heat
• Subacute

• The transitional phase between the acute and chronic stages.

• • Symptoms are generally less severe. You may be less itchy, but more burny and stingy as you could have open scratches. Rash borders aren’t as distinct. The rash is drier rather than blistered and oozing.
  • Many acute eczema rashes move into the subacute phase as they are healing. Subacute rashes can bounce back into the acute phase during an eczema flare, while long-lasting subacute rashes often become chronic.
  • For some people, eczema begins as a subacute rash and simply stays at this stage.
    • Flaky, scaly skin
    • Cracks in the skin
    • Itching, burning, and/or stinging
    • Redness that may be less intense, but not always

• Chronic
  • Refers to eczema flares that are longer-lasting. In general, it takes three or more months to transition into this stage. Chronic eczema isn’t solely determined by a timeframe, however. It has its own set of symptoms that are quite different from the other two stages.

• • • Thickened, leathery-looking skin or lichenification (called lichen simplex chronicus)
    • Accentuated skin lines
    • Cracks in the skin
    • Dark, dull, or discolored skin
    • Larger areas of skin breakdown called excoriations
    • Itching

Types

• Atopic Dermatitis (most common)
  • Allergic disease and  part of the “atopic triad” and is often found with asthma and allergies.
  •  Approximately 70 percent of patients have a positive family history of atopic diseases.
  • It’s most commonly found in the skin flexures – the elbow patches, knees, neck etc
• Contact Dermatitis
  • Allergic: delayed reaction to some allergen (poison ivy)
  • Irritant: occurs when chemicals or physical agents damage the surface of the skin faster than the skin can repair the damage
• Xerotic
  • Damaged, dry skin that turns into eczema
  • Worse in winter and cold, dry weater
  • Limbs and trunk most often affected
• Seborrheic Dermatitis
  • Closely related to dandruff
  • Causes a dry or greasy peeling of the scape, eyebrows, face and torso

Causes and Risk Factors

Development of eczema is complex and multifaceted. Genetics plays a part, but not the only part. It takes a combination of internal genetic factors combined with early environmental exposures to create a recipe for eczema.

• Impairment in the Skin Barrier
  • Some studies have demonstrated that the development of atopic dermatitis showsgenetic linkage to chromosome 1q21, which causes mutations in the filaggrin gene, This gene encodes a protein necessary for terminal differentiation of epidermis, can result in impairments in the barrier function of the epidermis result in increased exposure and sensitization to cutaneous antigens.
• Genetics and Family History
  • Approximately 70 percent of patients have a positive family history of atopic diseases. Eczema is one of these atopic diseases, the others being asthma and allergies.
• Birth and Childhood Experiences
  • Early childhood experiences can cause epigenetic and subsequent developmental Whether you were born vaginally or via c-section, as well as if you were breast fed or bottle fed, can have drastic effects on the microbiome. Food introduction schedule and types also play an important part in the development. Where you grew up, including environment allergen exposure such as pollens and pets also play a part. Vaccinations and toxin exposure can increase the toxic body burden and cause the body to have more trouble detoxing.
• Gut and Microbiome
  • The state of our skin almost directly correlates to the state of our gut health. Food sensitivities, poor diet, yeast and toxins, and an imbalanced microbiome can cause irritation of the local immune system in the gut, leading to leaky gut and subsequent inflammation in tissues such as the skin.
• Immune System Imbalance
  • Those with eczema and atopic conditions are often what is called “TH2 dominant”. Thismeans that a certain branch of the immune system is overactivated, leading toincreased incidence of allergies, cancer, and certain autoimmune diseases.
• High Toxic Load
  • When our body’s are overburdened with more toxins than they are able to excrete, theycan come out in the skin. This can cause a direct irritation, as well assystemic inflammation leading to more immune system activation and allergic tendenciesin general.

Treatment

Each person is unique, and each person will have different requirements and imbalances. A number of treatment options are available and may work in different combinations for different people. These will likely need to be adapted and customized for each person and changed throughout the process according to cycles and symptoms.

Naturopathic Therapies

• Diet and nutrition therapies
• Herbal medicine
• Acupuncture and Chinese medicine
• Supplements, and orthomolecular medicine
• UNDAs and biotherapeutic drainage
• Light and phototherapy
• Hydrotherapy
• IV therapy
• Pharmaceuticals (if required)
• Moisturizer withdrawal

A note: Topical Steroid Withdrawal

Some people who use topical steroids may develop a condition called topical steroid withdrawal (TSW). TSW is a severe, inflammatory skin condition that looks like eczema, but has distinct patterns and cycles. It can take anywhere from 1-5 years for this condition to burn itself out, for our skin to detox from the steroids, and our body to rebalance itself.

For some, what they think is worsening eczema may actually be topical steroid withdrawal.

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Sources

1. Weidinger S, Novak N. Atopic dermatitis. Lancet 2016; 387:1109.
2. Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol 2014; 71:116.
3. Sidbury R, Davis DM, Cohen DE, et al. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol 2014; 71:327.
4. Eichenfield LF, Tom WL, Chamlin SL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol 2014; 70:338.
5. Spuls PI, Gerbens LAA, Simpson E, et al. Patient-Oriented Eczema Measure (POEM), a core instrument to measure symptoms in clinical trials: a Harmonising Outcome Measures for Eczema (HOME) statement. Br J Dermatol 2017; 176:979.