Eczema

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 Knowledge drop: In your 20s, your skin cell turnover decreases. (Cell turnover is a key component in keeping your skin youthful.) You know what else slows down? Your collagen production. Starting in your 20s, collagen decreases by about 1 percent per year. Should you want to prevent fine lines and wrinkles, start by eliminating behaviors that contribute to premature aging. “If it’s bad for you, it’s bad for your skin,” says dermatologist Michel Somenek. “Cigarette smoking reduces blood flow to the skin and causes premature wrinkling and a dull skin texture. Making the repeated pursed motion to inhale can also cause smoker’s lines. Alcohol and recreational drugs are toxins for the skin that damage its cellular structure and DNA,” Somenek tells us. “The faster you eliminate vices while you are young, the better chance your skin and body have to recuperate.” Also, adopting an anti-aging routine in your 20s is key. After all, the best offense is a good defense. We spoke to Somenek and experts Joshua Ross and Audrey Kunin to find out more. Keep reading for the best anti-aging products for your 20s, according to skincare professionals. Sunscreen “We all know that the sun is the number one cause of skin aging and starting the prevention in your 20s is very important,” Ross says. “The majority of your sun damage won’t start to appear until you’re in your 30s, so don’t wait until you see it surface or you’ll be behind the curve. Stay ahead of it with a good-quality zinc-based sunscreen worn daily.” Farmacy Green Defense Daily Mineral Sunscreen An invisible sunscreen with SPF 30, plus botanical extracts meant to protect skin with tons of antioxidants. Bonus: It’s clean and fine to use under makeup. Bareminerals Complexion Rescue™ Tinted Moisturizer Broad Spectrum SPF 30 Although we recommend you use your SPF and moisturizer separately, we also understand moments when you don’t have time or energy for that extra step. For those times, this bareMinerals moisturizer is a great thing to have on hand. Vitamin C Serum “A great introduction to anti-aging is to start with a vitamin C serum in your morning skincare routine,” Ross says. “It’s a powerful antioxidant that will neutralize free radicals and brighten the skin.” He adds that it’s a great way to counteract the effects of the sun’s harmful rays, which, as previously mentioned, are among the biggest causes of premature aging. Drunk Elephant C-Firma™ Vitamin C Day Serum The Drunk Elephant C-Firma is a lightweight serum that promises to give skin a glow by combining the brightening powers of vitamin C with ferulic acid, l-ascorbic acid, and vitamin E. The included sodium hyaluronate is meant to replace hydration loss, so you shouldn’t have to deal with any irritation. Sunday Riley C.E.O. Rapid Flash Brightening Serum This potent serum is jam-packed with vitamin C (15 percent, to be exact), which means it’s a potential superstar at both brightening skin and dousing it in antioxidants. Peptides Using peptides on your skin has many benefits, says Somenek. “The skin barrier is what defends the body against pollution, UV rays, bacteria, and toxins. It can be damaged by several everyday factors. Using topical peptides aids in building a stronger barrier,” he says. “Peptides comprise elastic fibers, which are a type of protein. These fibers help to make skin appear taut and firm. Peptides can also help repair damaged skin, relieve inflammation, and even out skin tone. Some peptides can kill acne-causing bacteria that is common in 20-somethings.” Kunin agrees, saying, “Peptides are an excellent entry point for supporting collagen.” She recommends looking for face and eye treatments that contain these collagen-boosting powerhouses. Charlotte Tilbury Magic Eye Rescue Cream This Charlotte Tilbury super-emollient eye cream has a base of coconut oil and shea butter (read: it’s incredibly hydrating). Botanicals plus peptides are meant to help reduce dark circles and boost collagen, respectively. This creamy moisturizer serves up potent collagen-boosting peptides and pycnogenol, and antioxidant-rich vitamin C. “Instead of sitting on top of the skin, peptides penetrate the outer layer so they go deep. The ‘signals’ they send tell the cells to produce elastin and collagen, which are needed for youthful-looking skin,” explains Somenek. At-Home Peel Pads Remember that skin cell turnover fiasco we talked about earlier? One way to help support it is by exfoliating. “Exfoliation is important to help keep skin fresh and luminous,” Kunin says. She recommends using at-home peel pads as an easy and effective way to exfoliate. “The goal in your 20s is to fight the slowing pace of cell turnover. It is wise to use products that gently exfoliate, yet still remove oil and other impurities. Products that have Alpha Hydroxy Acids (AHA) or Beta Hydroxy Acids (BHA) are a good choice.” According to Somenek, you should only exfoliate two to three times a week. “People of all ages are guilty of over-exfoliating and that can be too much of a good thing,” he says. Dermadoctor Kakadu C Intensive Vitamin C Peel Pad A few swipes of this Derma Doctor powerful peel pad promise to leave your skin glowing and smooth, thanks to the seven (yes, seven) types of chemical exfoliants, including AHA and BHA. It also contains vitamin C via Kakadu plum extract for added brightening and antioxidant protection. KEY INGREDIENTS Kakadu plum extract is sourced from the Kakadu plum, a fruit grown in northern Australia. It contains vitamin C, which restores the skin’s natural barrier, increases collagen production, and soothes irritation. Dr. Dennis Gross Skincare Alpha Beta® Universal Daily Peel Pads These are the gold standard of peel pads, with a cult following and over 900 five-star reviews on Sephora. They’re easy to use and contain a blend of anti-aging exfoliating acids. Emollient Night Cream “In your 20s, you need to start upping the hydration in your skincare routine. You may have been cautious of over-moisturizing because of acne in your teens, but as you enter your 20s, your skin transitions and becomes drier,” Ross says. “I recommend an emollient night cream added into your evening skincare regimen.” “Twenty-somethings need to make sure that they are not using creams that will clog their pores and cause excess oil production,” says Somenek. Opt for non-comedogenic products. Cerave Skin Renewing Night Cream One great choice is the CeraVe Skin Renewing Night Cream, which is a non-comedogenic night cream that leaves skin soft and glowy. It combines the moisturizing powers of ceramides and hyaluronic acid. RoC Retinol Correxion Max Hydration Creme “The best night cream ingredients contain retinol, benzoyl peroxide, and/or salicylic acid or hyaluronic acid. The goal is to moisturize, yet remove excess oil,” says Somenek. This Roc Retinol Correxion cream fits the bill as it contains both hyaluronic acid and retinol so it promises to moisturize while also being non-comedogenic.

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