Eczema (dermatitis)

Non-infectious inflammation of the skin, characterized in its acute phase by one or more of the following symptoms: redness, pimples, blisters and/or scales, and scab formation. The affected patches itch or cause searing pain. There are a number of forms of eczema, which can be subdivided according to cause and clinical picture. Contact eczema is caused by contact with a particular substance, either an irritant, which would cause eczema in anybody (orthoergic contact eczema), or with an ordinary substance to which the patient is hypersensitive (allergic contact eczema). Contact eczema occurs only at the point of contact, and clears up of its own accord when the substance is avoided. It has many forms, with clinical pictures very like those of other eczemas; the only sure diagnosis is by the so-called patch test, in which suspect substances are deliberately applied to the skin. Eczema in infants is often known as ‘ringworm’, and can cover the whole body. The signs are redness with spots and severe itching; scratching can lead to local impetigo as a result of bacterial infection. Constitutional eczema or neurodermatitis occurs in older children, usually at the toddler stage, and affects arms and legs, particularly inside the elbows and behind the knees. The skin seems to have thickened, because a number of spots have grown together. In this case violent itching is again the most striking symptom. Neurodermatitis is caused by an intricate pattern of factors, including significant psychological ones: symptoms increase during periods of tension, and patients are often hay fever or asthma sufferers. Seborrhoeic dermatitis occurs in infants, and is a greasy scaly condition usually of the scalp, often associated with greasy skin. On the nose and forehead it often produces fine scales and slight redness. In head hair the complaint is usually a very stubborn form of dandruff; seborrhoeic eczema can also affect the chest, back and folds of skin. Other forms are dyshidrotic eczema (small blisters between fingers and toes) and eczema nummulare (patches the size of coins on the buttocks). Nappy rash (caused by the effect of urine on the skin), eczema cruris (brown scales on the lower legs) and eczema craquele (in older people) are other forms. In the last case small blisters appear in the horn layer of the skin of the lower legs and the back of the hands, with moist patches and scales in later stages. The condition is often caused by washing too much with soap, which removes the protective layer of fat on the skin, and dry winter air then causes eczema.

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