Eczema • When the skin is red, wet & itchy

Face, scalp, hands, feet or anal area: Eczema can occur anywhere on the body. The skin becomes inflamed, flaky, wet, painful and itchy. It is important for treatment to uncover the cause of the eczema. Triggers can then be avoided and the skin inflammation prevented.

Eczema is one of the most common skin diseases.
© iStock.com/F3al2

A large number of non-contagious skin changes are called eczema. The term eczema has its origin in ancient Greek, where it means something like “swell” or “boil up”. What all eczema has in common is that the skin becomes inflamed. That is why the term dermatitis is sometimes used for it. The Greek word “derma” stands for the skin, the final syllable “itis” for inflammation. However, the area of ​​dermatitis not only includes eczema, but also other skin diseases such as perioral dermatitis.

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Symptoms: How to recognize eczema

Eczema manifests itself as swelling and reddening of the skin. In addition, vesicles, nodules and edema sometimes develop, and the skin can ooze. Later on, scabs may form on the skin. As if that alone weren’t annoying enough, itching (pruritus) is often added.

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If eczema persists for a long time, i.e. if it becomes chronic, this typical picture changes. Then there is thickening (lichenification), scaling and cornification (hyperkeratosis). The skin dries out and tends to crack (fissures).

In addition, it can lead to a superinfection with bacteria.

From hand to anal eczema: the different types

Eczema occurs almost anywhere on the body – and is quite common: up to 25 percent of people with a skin disease suffer from it. About six percent of all people have hand eczema. The trend is increasing.

Most often, eczema is differentiated according to the type of trigger or its morphology (shape):

  • Seborrheic eczema: It occurs mainly in areas of the body rich in sebum such as the face, scalp, genital area and is particularly common in babies and in the third and fourth decades of life. Yellowish-red spots with greasy scaling appear, which are clearly delimited and symmetrical.

  • That atopic eczema is to be equated with neurodermatitis, a chronic disease that progresses in phases.

  • That dyshidrotic eczema (Dyshidrosis) manifests itself as itchy, plump blisters on the palms of the hands, the sides of the fingers and, less often, the soles of the feet. It is still unclear why it arises.

  • A microbial eczema is often found on the extensor sides of the extremities, trunk and buttocks. It is symmetrically arranged, wets and is often associated with bacterial superinfection.

  • Nummular eczema: The clearly delimited, coin-shaped (nummular) skin spots sometimes occur in the context of atopic or microbial eczema and are mainly on the arms and legs, but also on the trunk. The affected areas of the skin are very red, flaky and itchy. Often vesicles, pustules and crusts appear.

  • Toxic and allergic contact eczema: The skin is excessively irritated by allergenic or harmful substances. Redness, swelling and blisters develop, the skin can ooze, itch and flake.

Eczema is also described according to where it occurs and has different triggers. Usually these are:

  • Anal eczema
  • Hand eczema
  • Fingertip eczema
  • Foot eczema
  • Eczema on the face
  • Eczema on the scalp
  • Eczema in the ear
  • Eczema on the eyelid / eye
  • Eczema in skin folds (intertriginous eczema)

Triggers and causes of eczema

According to its cause, eczema can be divided into endogenous (cause lies in the body) and exogenous (cause lies outside the body). However, this division cannot be strictly adhered to. Sometimes both come together, for example in atopic or allergic contact eczema, where external factors come together with physical, immunological factors.

According to studies, twice as many people are affected by contact dermatitis today than 20 years ago. It can arise in different ways. If you handle substances that damage the skin, this initially manifests itself in the form of inflammation. How quickly eczema occurs depends on how aggressive the substance is. Cleaning agents can often be used for a long time before toxic contact eczema develops. The reaction to acids or alkalis, on the other hand, is usually not long in coming. Allergic contact eczema occurs when the body’s immune system overreacts when it comes into contact with a substance. A food allergy or a drug intolerance can also promote eczema.

Common triggers of contact eczema include:

  • Chemicals (e.g. cleaning agents)
  • cosmetics
  • Metals (e.g. nickel in jeans buttons or in costume jewelry)
  • textiles
  • food
  • Medication
  • plants
  • frequent washing and disinfecting of hands

Diseases can also trigger eczema. Anal eczema, for example, occurs in most cases as a result of irritation of the sensitive skin around the anus because the intestine is no longer sealed against the outside due to hemorrhoids, anal fistulas, intestinal inflammation or anal prolapse, which means that stool and intestinal fluid leak out. Less often, anal eczema is the result of psoriasis or a contact allergy.

Eczema on the hand and fingertips is often an expression of allergic or toxic contact eczema or dyshidrotic eczema. The latter is also responsible for many foot eczema. In adults, atopic eczema also manifests itself preferentially on the hands, neck, face, arms and knees. In children, on the other hand, it occurs preferentially on the head, arms and legs. For dermatitis of the face, ear, genital area and scalp, seborrheic eczema is also an option.

Treatment of eczema

Eczema is a case for the doctor when it occurs for the first time, the cause is unknown or it is very pronounced. Even if eczema keeps recurring despite preventive measures, medical advice should be sought. This is also strongly advised if bacteria are involved and the eczema festers or if it does not respond to self-treatment within a few days.

The ideal contact point is the dermatologist, in the case of anal eczema, preferably with additional training in the field of proctology.

To get the inflammation under control, an ointment containing cortisone is often prescribed. It also relieves itching, but shouldn’t be used for long periods of time. Once the eczema has healed, skin care products are the method of choice. They prevent re-inflammation by keeping the skin resilient and supple. Creams with urea have proven to be effective.

In the case of allergic causes, antihistamines, which are applied locally or swallowed, also work.

If eczema is also infected with bacteria, antibiotic and antiseptic preparations are used.

Other active ingredients for the treatment of eczema that are applied to the affected areas of the skin:

  • Zinc ointments help with mild inflammation.

  • Tannins, given as compresses or ointments, seal the skin, relieve irritation, reduce inflammation and relieve itching. They also reduce the skin’s sensitivity to pain. Black tea contains a lot of tannins and can be used as a home remedy for compresses for eczema.

  • Shale oils (sulfonated shale oils, ichthyol) also have a number of positive effects: They slow down inflammation, counteract bacterial colonization, promote blood circulation and reduce itching.

  • In atopic dermatitis, moist compresses have proven to be effective, supplying dry skin with fat and moisture, while cooling it and relieving itching at the same time.

Preventing Eczema: Home Remedies and Tips

The best prevention against eczema is consistent skin care. Under normal circumstances this is very tough. This is due to their protective acid mantle, which must be preserved. The following tips will help:

  • Do not use soap for washing, use so-called syndets, which most liquid cleansing products for the skin belong to anyway. They protect the protective acid mantle.

  • Apply cream to the skin after washing. Products with urea are suitable for dry skin.

  • Use products for showering or bathing that oil and care for the skin.

  • If you have atopic eczema, you shouldn’t shower too often. Bathing with oil-based additives is also better than showering, because the skin’s own fat is not rinsed off as much and the skin can absorb moisture better through the bath water.

  • Wear gloves when coming into contact with skin-irritating substances (e.g. cleaning agents).

  • Avoid known triggers of eczema as far as possible. With anal eczema, for example, it can help to gently cleanse the anus after a bowel movement and then to clamp a cotton pad between the buttocks to catch any secretion.

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