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Eczema

6 March 2025


Eczema




What is Eczema?



Is your skin dry, cracked and itchy? Is your skin so dry and sensitive that it is getting thicker in the places you have been scratching? If so, then you may have eczema – a common dry skin disease that tends to appear on the hands, behind the elbows (called the antecubital fossa) and behind the knees.




If you suffer from severely dry skin, you know that the itching and irritation of eczema can really impact on your confidence and quality of life. Have you ever noticed that your skin inches more at night? That is a common symptom of eczema. Using an eczema cream or a soothing oil at night and taking an antihistamine like diphenhydramine can help you get a good night’s sleep.



Here we review the causes of eczema, and the role of the skin barrier in this skin disease.




What is eczema?



Eczema vs Atopic Dermatitis




Eczema is also called atopic dermatitis. They are different names for the same skin disease, The word ‘dermatitis’ basically means ‘skin irritation’ or “skin inflammation.”



Eczema is caused by an impaired skin barrier that leads to dry skin and inflammation.




Eczema is a chronic, long-term condition that tends to come back. It is usually genetic but can be acquired.



If you have eczema, or think you have eczema, then be sure to schedule a consultation with your dermatologist because there are many new eczema prescription medications on the market that your doctor can prescribe for you. Y




ou can combine these eczema medications with eczema creams to soothe and calm irritated skin.



What’s the Difference Between Eczema and Dry Skin?




Dry skin is the most common symptom of eczema, but it is possible to have dry skin without having eczema. Eczema is a skin disease – you cannot have eczema without having dry skin.



What causes eczema?




Skin Diseases That Get Confused with Eczema



Many patient come into my dermatology practice in Miami thinking they have eczema, but many times they actually do not have eczema at all.




These are the skin diseases that get confused often with eczema (also called the differential diagnosis):



Allergic contact dermatitis



Simple dry skin

Fungal infection

Hives

Irritant dermatitis

Perioral dermatitis

Psoriasis

Seborrheic dermatitis

Tinea corporis (Ringworm)

Tinea versicolor

A dermatologist can easily tell which skin disease you have. When deciding between eczema vs psoriasis we look where the rash is. For example, eczema causes an inner elbow rash while psoriasis occurs on the elbow. Eczema is behind the knees and elbows while psoriasis is on the bony part of the knees and elbows.

We also listen closely to the history of the rash. If you tried a new laundry detergent before the rash began, it is probably a skin allergy.

The shape and feel of the skin lesions are give clues. Hives are smooth and feel swollen like large blisters but do not have rough skin on the top.

To diagnose a fungal infection we can look under a microscope or send a fungal culture to the lab.

What causes eczema?

The impaired skin barrier seen in eczema can be caused by using the wrong skin care products, over exfoliating, prolonged submersion in chlorinated water, very dry climates, and frequent use of irritating soap.

Some cases of eczema are caused by a genetic deficiency of filaggrin – a skin protein that plays an essential role in the outermost layer of the skin’s surface (the epidermis).

The epidermis is the skin’s natural barrier that helps to prevent moisture loss and protect the body from bacteria or allergens (e.g. pollen or dust mites). If this skin barrier is impaired, then skin diseases like eczema can be the result.

What is the skin barrier

What is the skin barrier?

The skin barrier is an essential structure on the surface of the skin that has an impact on the skin’s ability to hold moisture, and prevent attack from allergens, irritants and bacteria. By doing so, it protects the other layers of the skin and cells in the body.

The skin barrier is located in the stratum corneum, on the top layer of the epidermis, and is composed of keratinocyte cells and fine layers of lipids that stack between the skin cells to protect them and make them water tight.

A properly functioning skin barrier is essential for your skin’s overall health and appearance, but when the skin barrier is damaged or impaired it can lead to something known as transepidermal water loss (TEWL). In addition, bacteria and allergens can also easily enter the lower surfaces of the skin when the skin barrier is impaired, which can lead to additional skin complaints.

This impairment of the skin barrier is the primary issue in eczema, but using an appropriate eczema cream will help to restore the skin barrier and ease the symptoms of eczema.

Is Eczema Contagious?

Eczema in itself is not contagious. You cannot catch eczema by touching someone who has it. However, it’s worth noting that eczema-prone skin can often become infected with bacteria, and these bacterial infections can be contagious. To mitigate the risk of bacterial infection on eczematous skin, using soaps with chlorine, topical antibiotics, or silver sprays can be beneficial, as these can help reduce bacteria on the skin and prevent further infection.

Types of Infections that Eczematous Skin Is More Likely To Get

Bacterial Infections in Eczema

Eczematous skin can provide an environment conducive to bacterial colonization due to its compromised barrier function. Among the various types of bacteria, the following are most likely to colonize eczematous skin:

Staphylococcus aureus (S. aureus): This is the most common bacteria associated with eczema. It’s estimated that a significant majority of people with atopic dermatitis (a type of eczema) are colonized with S. aureus, even when there are no visible signs of infection. This bacterium can exacerbate skin inflammation and can sometimes lead to impetigo, a contagious skin infection.

Streptococcus pyogenes: This bacterium is less common than S. aureus but can still colonize eczematous skin, leading to secondary infections.

Pseudomonas aeruginosa and other gram-negative bacteria: These bacteria are less commonly associated with eczema but can become problematic, particularly in individuals with chronic, open skin lesions or those who are immunocompromised.

Maintaining a proper skin care regimen, including the regular use of moisturizers and appropriate treatments, can help restore the skin’s barrier function and reduce the risk of bacterial colonization and secondary infections.

Viral Infections in Eczema

Eczematous skin can be more susceptible not only to bacterial infections but also to certain viral infections. A prime example is the herpes simplex virus (HSV), which causes cold sores and genital herpes.

When someone with eczema becomes infected with HSV, it can lead to a severe and widespread herpes infection known as “eczema herpeticum.” The condition is characterized by numerous painful and itchy blisters that can spread across areas affected by eczema, and even to areas where the skin is healthy. This condition requires immediate medical attention.

People with eczema should be cautious and avoid direct contact with cold sores or any other skin conditions caused by the herpes virus. If an individual with eczema suspects that they might have eczema herpeticum, it’s crucial to seek medical care immediately. Early diagnosis and treatment, which usually involves antiviral medications, can help manage the condition and prevent complications.

Fungal Infections in Eczema

Individuals with eczema are more susceptible to certain fungal infections due to the compromised skin barrier and the altered immune responses associated with the condition.

People with eczema may be more prone to infections caused by the Candida species, which can lead to conditions like candidiasis. Candidiasis can manifest as red, itchy rashes, often accompanied by blistering, oozing, or scaling. The moist and damaged skin associated with eczema can provide an ideal environment for this yeast to multiply.

Another fungal organism that can affect those with eczema is the Malassezia species. While Malassezia is a normal inhabitant of the skin, it can sometimes proliferate in individuals with eczema, leading to conditions such as seborrheic dermatitis. This condition often presents as scaly, itchy, and red patches, particularly on the scalp, face, and trunk.

For those with eczema, maintaining the skin’s integrity and barrier function through regular moisturizing and appropriate treatments can reduce the risk of both bacterial and fungal colonization and subsequent infections. If fungal infections are suspected, antifungal treatments should be considered under the guidance of a healthcare professional.

In Summary

Eczema is a common skin disease that causes dry skin, itching and redness, caused by an impairment in the skin barrier. It is a chronic, long-term condition, but use of a barrier repair cream can ease the symptoms. The best barrier repair creams show a maltese cross pattern when viewed under a microscope.

DQH Can I use salicylic acid first and then vitamin C? It’s easy to create a skincare routine, but knowing how to use it is another thing entirely. In most cases, if you’re not getting the desired skin results, it could be due to the layering of conflicting ingredients. So, is it possible that salicylic acid and vitamin C are such ingredients? Or are these active ingredients the duo that’s been missing from your skincare routine? If you want answers, stick around because today we are going to explain the benefits of salicylic acid and vitamin C and how they can be used in your daily life. What are the benefits of salicylic acid for skin? Salicylic acid is one of the most commonly used beta hydroxy acids and is favored by many people with oily, acne-prone skin. This acid is derived from willow bark, and unlike its water-soluble relatives (called alpha-hydroxy acids), salicylic acid is oil-soluble, which means it can penetrate deeper into the lower layers of the skin. Once it reaches the lower layers, it can help unclog pores of excess sebum, dirt, bacteria, debris, and impurities. This results in clearer skin tones and greater definition. Not only does salicylic acid benefit the underlying layers, but the outer surface of the skin benefits as well. When applied to the skin, salicylic acid removes the buildup of dead skin cells. This is accomplished by breaking the bonds that hold dead cells to the surface. Over time, this can cause the complexion to look dull and prone to acne, blackheads, and other blemishes. If you’d like to learn more about salicylic acid and how it can improve your skin, check out this dedicated blog post from a beauty insider. What are the benefits of vitamin C for skin? Vitamin C is considered one of the most powerful antioxidants, which means it is very effective at fighting free radicals and preventing them from causing further skin damage. Examples of free radicals include pollution, central heating, UV rays and harsh climate. They attack proteins, fats and cell membranes as soon as they come into contact with the skin, causing signs of premature aging such as fine lines and wrinkles as well as hyperpigmentation, flaky patches of skin and loss of elasticity. Many people usually prefer to use vitamin C in their morning routine as this ingredient gives the complexion a radiant glow. You’ll also find that vitamin C can target areas of hyperpigmentation, plumping the skin and reducing the appearance of fine lines and wrinkles. The thing about vitamin C is that there are a lot of outdated studies going back to the 1950s that describe vitamin C as an unstable skin component. Thanks to improvements in modern technology, this is no longer the case as all products now contain a stable form of vitamin C. Visit The Beauty Insider to learn more about vitamin C. So please check out our blog post. Can I use salicylic acid first and then vitamin C? Yes, you absolutely can. In fact, it’s thought that using salicylic acid before using vitamin C ensures it penetrates faster and works faster. This is an efficient way to utilize two power sources, and the reason has to do with pH. For example, the skin’s natural pH is about 4.7, making it slightly acidic. Salicylic acid and vitamin C are also both acidic, and you’ll find that vitamin C is absorbed quickly into the skin. Therefore, using salicylic acid beforehand can increase the acidity of the skin and allow vitamin C to penetrate into the skin faster. While this is considered an effective way to combine two powerful ingredients, you need to be aware of your skin type and how it reacts to certain active ingredients. Even people with perfect, normal skin can experience skin sensitivity and irritation. Therefore, always consult a doctor or dermatologist before using any new products on your skin. It’s also important to follow skin application rules. In this case, you need to use the product correctly to ensure you get the best results for your skin. If you’re not sure what I mean, the basic rule for skin is to start with the thinnest consistency and work your way up to the thickest consistency. This prevents a barrier from forming on the surface, preventing other active ingredients from penetrating the skin. Can I use salicylic acid at night and vitamin C in the morning? Yes, absolutely, this is considered the most effective way to get returns without any adverse side effects. This is because there is enough time between applications to ensure that the skin’s pH levels return to balance. You’ll also find that Vitamin C is rich in antioxidants and is perfect for use in the morning to ensure your skin is protected and looking its healthiest. Due to the small size of salicylic acid molecules, it is an acid that is able to reach the deepest parts of the skin. While this is effective at keeping skin clear, it also increases the risk of irritation and photosensitivity. Therefore, many people prefer to use powerful BHAs in their evening routine without exposure to UV rays, pollution, or harsh weather. Warning: If you avoid using sunscreen every day, none of these ingredients will do what your skin needs. The combination of chemical peels and powerful ingredients increases the risk of further damage to the skin’s surface. Use SPF 50 every day to keep your skin protected and your lipid barrier healthy, even on cloudy days, keeping your skin in top condition.
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