What is Eczema?
People with eczema have itchy skin. In fact, if there is no itch, you do not have eczema.
A person with eczema may also have:
- Symptoms showing up before age 2
- Dry skin (usually all the time)
- Someone in the family with an allergic disease
- Symptoms that come and go
- Thick and hardened skin
Eczema: a chronic skin disease
Eczema is a chronic skin condition involving periods of apparently clear skin, first signs and symptoms, and flares. Some people refer to this as the eczema cycle.
Did you know?
- Eczema triggers can cause flares.
- Eczema itch tends to get worse at night.
- About 80% of people with eczema also tend to develop asthma and/or allergic rhinitis (“allergies”).
About skin and Eczema
The skin is the body’s largest organ and it is our first-line of defence against the environment.
- Forms a protective barrier to keep the inside in and the outside (toxins and other substances we don’t want in our body) out
- Prevents loss of essential body fluids
The skin is composed of three layers:
- Subcutaneous tissue
The top layer of the epidermis – the stratum corneum – keeps water in and irritants out
The stratum corneum
The stratum corneum consists mainly of three things:
- Skin cells (corneocytes)
- Fat (“waterproofing” between the cells)
- Desmosomes, dense attachments that hold the skin cells together
The stratum corneum--a “brick wall” that protects us from the environment
The skin cells are like a brick wall, with the bricks joined together with glue (fat) and stabilized with iron rods (desmosomes).
In normal skin the iron rods are strong and keep the bricks together, allowing the cement to keep
Irritants: include soaps and rough or woolly clothing that leads to skin irritation and worsening of eczema. and
Allergens: may include certain foods (that a person with eczema is allergic to) as well as inhaled house dust mites, weeds, animal danders and molds. out.
Skin in people with Eczema
In the skin of people with eczema, the iron rods are rusted – weaker. Soap is an irritant that makes this worse and can cause the brick wall to fall apart. When this happens, other irritants and allergens can enter which may trigger a flare of eczema.
“Clear” skin in Eczema
Clear skin in a person with eczema is not the same as clear skin in someone without eczema. For people with eczema, their skin is naturally more sensitive to soap and other irritants than normal skin. With eczema, the skin is less able to keep water in and irritants out all the time--even when it appears clear.
First signs and symptoms
Patients with eczema will usually experience signs and symptoms telling them that a flare is on the way. Usually, the first sign is itch. Itch is defined as the unpleasant sensation in the skin that makes you want to scratch. It can become so unbearable that patients may prefer the pain of scratching to the itch.
Itch often happens before there are any visible signs of eczema on the skin. Other first signs include a tingling sensation, whitening, a tiny bump or a bit of redness. If scratching occurs at this stage, development of a flare is more likely.
A flare can happen for many reasons: exposure to irritants, emotional stress and for no apparent reason at all. During a flare the affected part of the skin becomes red and extremely, uncontrollably itchy. Since it is almost always scratched, the skin tends to be broken and can be oozing and crusted. With time, the skin can redden, swell, crack, weep, scale and become markedly thick and hardened.
Flares can occur many times every year
Eczema patients experience 9 flares per year lasting 15 days each time
|Total||Severity of Eczema|
|Number of flares per year||9.2||8.3||11.1|
|Total duration of flares - days||14.8||13.6||17.3|
|Number of days per year in eczema flare||136.2||112.9||192.0|
All about itch
Itch (pruritus) is a fundamental characteristic of eczema and can be mild to extremely intense. Patients with eczema have a lower threshold for itch (cutaneous hyperreactivity) and for scratching.
The most common things that cause itch are heat and perspiration, wool, certain foods, emotional stress, alcohol, common colds and dust mites. Eczema itch can occur throughout the day but tends to be worse at night, disrupting the patient’s sleep and quality of life.
There are three main categories of eczema severity. Doctors determine severity by considering the following factors:
- Body surface area affected
- Frequency of flares
- Intensity of flares
- Effect on quality of life
The vast majority (85%) of patients with eczema have mild to moderate disease.
Eczema and age
Eczema can develop at any age but about 85% of sufferers first experience it within the first five years of life. About 60% of cases are diagnosed before age 1. Many children outgrow eczema by adolescence but 30% to 40% of patients still have eczema as adults.
Eczema tends to appear on different parts of the body depending on the age of the patient
- Infants and children tend to get eczema on their face, scalp and on the tops of hands and feet.
- Older children and adults are more likely to get eczema on the hands, neck, upper chest and genital areas and on the insides of elbows and knees.
- Hand eczema is very common, affecting 60-70% of adults.
Eczema, asthma and allergic rhinitis
Nearly 80% of children with eczema also tend to develop asthma and allergic rhinitis (“allergies”).
Scientists have also called progression from eczema to asthma and allergic rhinitis the ”Allergic March”.