Allergic Eczema , Dermatitis Symptoms, Causes And Treatment

The imbalance between the itch and the scratch leads us into the world of Eczema. Ever heard of people who can’t use a particular wrist watch (WRISTWATCH ALLERGY) because they are allergic to the leather strap or to the chrome/nickel/stainless steel plated ones? Sometimes, we come across others who can’t wear ornaments or brass (hook) containing these metals. Some of us actually have trouble using footwear (FOOTWARE ALLERGY) made of leather or plastic. The story spills further into almost anything that we use. Anyone’s skin can become sensitive to anything that contacts it.
Indeed, the human skin can react to a myriad of chemicals (COSMETIC OR CHEMICAL ALLERGY) ranging from soaps and shampoos to cosmetic powders, paints and pastes. This hypersensitivity of the skin is not limited to contact agents alone. Eatables such as seafood/ fish, milk, eggs and black pepper are notorious for manifesting reactions on the human skin. Inhaled spores during autumn or spring cause respiratory allergy and in addition are silent triggers of seasonal skin itchiness. The rarest I’ve heard is of a lady having skin reactions to gold! Even odd is the tale of a surfer allergic to sunscreen!

SYMPTOMS OF DERMATITIS

Dermatitis manifests with symptoms of erethema, edema, pruritis and oozing. Simply put – redness, swelling or the orange peel appearance and itching occur initially. Unabated exposure to the offending article or chemical produces a chronic plaque or lichenification with scaling.
Infections (fungal candidiasis or ringworm) and infestations (Scabies, Lice) also have associated eczema but these need specific organism based treatment, while dermatitis resolves when treated or may be treated with use of topical creams containing steroids (BETNOVATE/ CELESTONE) in such cases.

What then are the types of dermatitis or eczema.

Urticaria This is the commonest allergic skin reaction manifesting as sudden eruptions of itchy wheals either localized or generalized all over the body. Severe attacks may be associated with headache, nausea, vomiting, tummy cramps and loose motions.
Rarely angioedema or swelling of the lips, tongue and larynx (windpipe) could kill from respiratory paralysis. Who hasn’t heard of the bee sting causing a fatality, now digest this, I’ve heard of a person who died of severe urticaria induced angioedema, when he inadvertently consumed prawns/shrimp at a restaurant despite being allergic to it!

What is Eczema?

Eczema is a broad term used to describe inflammation of the superficial skin layer (Epidermis), and is technically known as ‘Dermatitis’.

OFFENDERS – What causes Eczema.?

Besides bees, wasps, ants and a few other bug bites the following cause urticaria. Foods- Known perpetrators include Seafood/ fish, milk, eggs and black pepper. Vegetarians beware, even wheat, rice, pulses and nuts are possible triggers. Condiments and food additives are also implicated.
Medicines- Penicillin, tetracyclines, sulfonamides (BACTRIM) and even aspirin. Temperature – Cold climate, cold water, ice, cold breeze, hill stations, air conditions as well as hot exposure sources like kitchen fire, ovens, fireplaces, room heaters, sunlight (Photo Dermatitis), sun bathing and exercise induced heat with sweating can initiate attacks. Pressure - Prolonged pressure from tight belts, bra straps, elastics in belts, garters and socks.

DERMOGRAPHISM

Patients of urticaria exhibit ‘wheal lines and reddening’, in the pattern that their skin is scratched or stroked. An inflammatory painting of sorts with skin as the canvas!

Atopic Dermatitis

It is another variant of eczema. There is a polygenic recessive pattern of inheritance. Atopic Dermatitis often occurs in conjunction with asthma, allergic rhinitis and urticaria. This group of atopic disorders suggests depressed immunity. Low levels of Immunoglobulin A, retarded T-cell function and decreased Phagocytotic activity are the hallmarks. A peculiar type is the ‘Infantile Eczema’.

Infantile Eczema

It is an atopy presenting in childhood. The infant has a severely itchy, red, raised rash (erethematous papules) on either cheek. The rash can spread all over. Exudation, crusting and secondary infection with pyogenic organisms is not uncommon.

Contact Dermatitis

This is an allergy mediated by delayed hypersensitivity. Contact Dermatitis takes place when an article or chemical comes in contact with the skin directly and behaves like an antigen sparking the reaction. Indirectly, inhaled vegetative matter or chemicals get converted into antigens in vivo ultimately targeting the skin.
Clothes, Shoes, Jewellery, Cosmetics, Plant spores, vegetable and fruit juices and chemicals can elicit the response.

Treatment of Allergic Eczema

Identify the wrongdoer – It is the sufferer who must delve into his or her lifestyle and dig out the offending article or chemical or food item.
Avoid the antigen - Once the agent producing Eczema is identified, repeated exposure is to be avoided. Allergic or contact eczema heightens with every exposure until you can’t even step out into the morning sun if you’ve got Photo dermatitis. The same is true for any other agent.
Corticosteroid Therapy- Topical corticosteroid treatment is the dictum. Several choices are available. Betamethasone (BETNOVATE/ CELESTONE), Beclomethasone, Clobetasone (EUMOVATE), Clobetasol (CLOBEX), Fluticasone (CUTIVATE), Mometasone (ELOCON), Hydrocortisone and Triamcinolone.
Betamethasone (BETNOVATE/ CELESTONE) skin cream is a time tested an efficacious ointment.

How Does Betnovate Work

Betnovate / Celestone works by suppressing the body’s inflammatory mediators, namely leukotrienes, interleukins and prostaglandins.

Effect Of BETNOVATE/CELESTONE

There is instant relief to the affected site reported with use of (CELESTONE/ BETNOVATE) but recurrences are known if offending antigens cannot be avoided. It is safe for use in children. Injectable steroids (Hydrocorisone- Solu cortef, Hydrodcortone) are reserved for serious, emergency and severe reactions.

Anti histamines

Histamine, Kallekrien and Bradykinnin produce the typical itchiness, flushing and burning sensation of urticaria or dermatitis. These work wonders in seasonal allergic dermatitis and inhalational allergic dermatitis. They can be used orally, parenterally and topically. However, the oral or injectable preparations are freely and widely available.
Anti histamines abate any acute attack of dermatitis in conjunction with corticosteroids. Pheniramine (AVIL), Promethazine (AVOMINE), Ceterizine (zyrtec) and Terfenadine are good examples of anti histamines.

Combinations

Itching is a universal phenomenon with any dermatitis and human nails are worse than sewers. Connect these seemingly unrelated statements and voila one has the cause for secondary infection. Repeated scratching breaks down the protective keratin layer of the skin. Abrasions facilitate a conduit for germs from under the nail bed into the skin capillaries. Therefore many pharmaceuticals have prudently combined BETNOVATE with topical antibiotics and antifungals such as Neomycin or clotirmazole.

Side Effects of Betnovate

BETNOVATE is a novel topical agent that is cheap and readily available online at your favorite drugstore. It’s a drug whose benefits far surpass its side effects. These are minor skin responses like burning, tanning (especially with long term treatment), blistering and plaque/ scale formation due to skin drying.

Conclusion - Eczema Treatment

The adage ‘One learns to itch where one can scratch’ exquisitely summarizes the entity of eczema. Until we learn to avoid the inciters of Eczema, we shall continue to scratch. But then again, did I hear someone shout ‘happiness is an itch you can scratch’!