Eczema

Eczema is a chronic, recurrent inflammatory skin condition that is not contagious. It is characterised by the appearance of an itchy rash, dryness, redness, and in acute stages, the formation of small blisters filled with fluid (vesicles).

The term “eczema” is often used as a synonym for atopic dermatitis, the most common form of this disease. A combination of genetic predisposition to skin barrier dysfunction and immune system dysfunction plays a key role in the development of eczema.

Aetiology and pathophysiology

Eczema is a multifactorial disease. It is based on a combination of genetic and external factors. Many patients have mutations in the gene encoding filaggrin, a protein necessary for maintaining the integrity of the stratum corneum.

A defective skin barrier becomes permeable to allergens and irritants, triggering an abnormal immune response. The immune system responds to these triggers with excessive inflammation, which causes the characteristic symptoms. Exacerbations can be caused by food allergens, stress, dry air, contact with soap or synthetic clothing.

Clinical Significance

The main and most painful symptom of eczema is severe itching, which leads to scratching, skin damage and the risk of secondary bacterial infection (most often, Staphylococcus aureus). The appearance of the rash depends on the stage of the process: from weeping blisters in the acute phase to thickened, rough skin with a “bark-like” texture (lichenification) in the chronic phase.

Diagnosis is based on clinical manifestations and anamnesis. The treatment of eczema is comprehensive and aimed at achieving control over symptoms.

• Recovery of the skin barrier. Basis of treatment. Regular use of moisturising and softening agents (emollients).
• Anti-inflammatory therapy. During exacerbations, topical (local) glucocorticosteroids or calcineurin inhibitors are used.
• Itching control. Antihistamines are prescribed.

Exclusion of triggers. Factors that trigger exacerbation should be avoided whenever possible.