Eczema is a common chronic skin condition characterized by skin inflammation, itching, and redness. It can affect individuals of any age, but the incidence is particularly high in children, with about 20% having been affected. The course of eczema is characterized by recurrent flare-ups, where patients may experience blisters or crusting during acute phases, while chronic phases may lead to skin thickening. Its causes are complex, involving interactions between genetics, immune system abnormalities, and environmental irritants.
Recent medical research shows that eczema is not just a surface skin issue but is closely related to systemic immune dysregulation. Patients often cause secondary infections due to scratching, creating a vicious cycle. Proper daily care and timely treatment can effectively control symptoms; however, the misdiagnosis rate remains high, with many confusing eczema with general dermatitis. This article will comprehensively analyze key information about eczema, from its causes and symptoms to preventive measures.
The pathogenesis of eczema involves multiple factors, with genetic predisposition playing a key role. Studies indicate that if one parent has a history of eczema, the risk for their children increases to 60%, and if both parents have a history, the risk exceeds 80%. Specific gene mutations, such as those in the Filaggrin gene, can lead to impaired skin barrier function, making it easier for allergens to penetrate the epidermis.
Environmental triggers include temperature changes, chemical irritants, and microbial infections. Dry climates can accelerate lipid loss, while exposure to fragrances and cleaning agents may trigger acute flare-ups. Immune system abnormalities are also a core mechanism, with abnormal activation of T lymphocytes leading to cytokine imbalance and persistent inflammatory responses.
During acute flare-ups, patients may experience erythema, vesicles, and exudate, often accompanied by intense itching. The skin may appear moist, and if a bacterial infection occurs, yellow crusting may develop. In chronic phases, the skin may show lichenification changes, with deepened skin texture and a leathery feel.
Symptom distribution is age-specific: infants often present on the face and neck, children commonly have involvement in the elbow and knee creases, while adults may see spread to the entire body. Emotional stress has been shown to trigger exacerbation of symptoms, and this "psychodermatological axis" phenomenon is particularly evident in adolescent patients.
Clinical diagnosis primarily relies on history taking and skin examination. Physicians will inquire in detail about allergy history, age of onset, and symptom development patterns. Skin biopsy, while not routine, may be used as a differential diagnostic tool in cases suspected of other diseases.
Differential diagnosis must distinguish between contact dermatitis, atopic dermatitis, and psoriasis. Allergen testing can help identify triggers but is not a necessary diagnostic condition. The recently proposed "Eczema Area and Severity Index" (EASI) scoring system can quantify the extent and severity of the condition.
Basic treatment includes skin moisturizing and topical corticosteroids. Moderate to severe patients may require phototherapy or oral immunomodulators, such as ciclosporin and methotrexate. The emergence of biologics like dupilumab offers new targeted treatment options for severe patients.
Emerging therapies include probiotics to regulate gut microbiota, cold plasma therapy, and autologous serum therapy. Patients should choose treatment combinations based on the stage of their condition, prioritizing anti-inflammatory treatment during acute phases and focusing on skin repair during chronic phases. Keeping a symptom diary can help physicians adjust medication plans.
Daily prevention should establish a skincare routine: using fragrance-free moisturizers daily and keeping bath water temperature below 32°C. Clothing should be made of cotton to avoid friction from wool or synthetic materials.
Environmental control includes using humidifiers to maintain humidity levels of 50-60% and regularly cleaning bedding to reduce dust mite accumulation. Psychological adjustment is equally important; mindfulness stress reduction training has been shown to decrease flare-up frequency. Family members should learn symptom management techniques together to create a supportive healing environment.
If there is unexplained skin redness and unbearable itching, one should seek medical attention promptly for diagnosis confirmation. If symptoms affect sleep or daily activities, or if there are signs of infection such as yellow crusting or pustules, immediate medical evaluation is necessary. If over-the-counter medications do not improve symptoms after two weeks, professional treatment should be sought.
Special situations require urgent care: if symptoms such as fever, skin redness and warmth, or swollen lymph nodes occur, there may be a bacterial infection that requires immediate medical attention. Pregnant or breastfeeding women experiencing changes in symptoms should choose safe treatment options, which must be evaluated by a qualified physician.
Environmental irritants (such as chemical cleaners and dry air) typically damage the skin barrier, causing redness and itching, but usually without a clear history of allergen exposure. If itching symptoms worsen significantly after contact with specific substances (such as certain metals or pollen) or are accompanied by redness and vesicles, it is more likely an allergic reaction. It is recommended to record the timing of exposure to substances and symptoms, and consult a dermatologist for allergen testing to clarify the cause.
Will using corticosteroid ointments for eczema treatment cause skin thinning or discoloration?Short-term use of low to medium potency corticosteroid ointments as directed typically does not cause skin thinning. However, long-term excessive use may lead to side effects, so it is essential to follow the physician's instructions. Discoloration issues are often related to the repair process after chronic eczema flare-ups rather than being directly caused by the ointment. If there are concerns about medication, discuss non-steroidal anti-inflammatory drugs or other treatment options with your physician.
What dietary components might exacerbate eczema symptoms?Currently, there is no direct evidence showing that specific foods directly cause eczema, but some patients may experience systemic inflammatory responses due to allergens (such as milk, eggs, peanuts), indirectly worsening skin symptoms. High-sugar diets or additives in processed foods may weaken immune regulation. It is advisable to maintain a balanced diet and keep a food diary during symptom exacerbation to analyze potential triggers with a physician.
Does using air conditioning in winter worsen eczema, and how should I adjust the environment?Dry air-conditioned environments can strip moisture from the skin, exacerbating itching and flaking associated with eczema. It is recommended to maintain indoor humidity levels between 40%-60%, use humidifiers, and apply thick moisturizers 2-3 times daily. Choose fragrance-free, low-sensitivity moisturizers and avoid wearing rough fabrics to reduce physical friction irritation.
What scientific basis is there for stress management in controlling eczema?Psychological stress stimulates the release of cortisol and cytokines, exacerbating skin inflammatory responses. Research indicates that mindfulness meditation and regular exercise can regulate the autonomic nervous system, reducing Th2 immune responses and alleviating eczema flare-ups. It is recommended to schedule 15-30 minutes of relaxation activities daily, and in severe cases, behavioral therapy or physician-prescribed anxiolytics may be used to improve symptom cycles.
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