INTRODUCTION-
Eczema (also known as dermatitis) is a collective term used for non-contagious inflammatory chronic skin condition (different types of skin swelling) whose onset is early childhood present in the form of dry, itchy skin and rashes on the face, elbows, behind knees, hands and feet, etc. when scratched it turns more reddish and even increase in itching, etc. with family history of hay fever and asthma, mostly inherited because of the complete loss or relative lack of a skin protein in the individual although causation is unknown mostly affected by environmental factors and genetic both.
Diagnostic criteria-
In most of the cases it begins in childhood as plaques of oozing and itchy skin with personal or family history of eczema, asthma, and/or inhalant allergies most of the time. Body parts involved are in the folds of the skin in front of the elbows and behind the knees in young age which tends to improve as the age advances.
Etiology-
The defect in the production of ‘filaggrin’ (particular skin protein responsible for skin barrier function) is considered as one of the reasons for eczema other than this they also suffers from dry skin, itching during
sweating, hyper-reactivity to wool, colonization by pathogenic staph bacteria, susceptibility to disseminated herpes simplex infections, and immunity disorders also also present.
Exciting causes includes–
1)Soap and detergents.
2)Cosmetics.
3) Clothing.
4) Sweats.
5) Jewellery.
6)Temperature changes.
7) Allergens (dust, food, etc.)
8) Stress.
Sign and symptoms-
In an acute stage of rash, it is oozy in nature, later after some weeks due to continuous scratching and rubbing it leads to lichenification (hyperpigmentation and thickening of skin).
In children and adults symptoms appear in exact spots which can be very useful in making correct diagnosis, as they have typical distribution on the surface of the skin, In crawling children the rash is typically seen on the elbows and knees but spares the diaper area while In adults and older age , it is present in the folds of skin opposite to the kneecap and elbow but completely absent in armpits, in advanced cases it involves the area of the cheeks, neck, wrists, and ankles, etc.
Classification of Eczema-
It has significance in treatment as it depends on the correct diagnosis of the eczema in the patient. It is broadly classified into 7 types, as follows-
- Atopic dermatitis
- Contact eczema
- Seborrheic eczema
- Neurodermatitis
- Nummular eczema
- Dyshidrotic eczema
- Stasis dermatitis
1)Atopic dermatitis–
This is inherited type in which family or personal history of patient with case of allergies like hay fever or asthma is also mentioned. It is characterized by lesion which is itchy, oozy whose intensity depends on the moisturization of the skin (less common in humid areas while aggravated in dry or winter time). Most of the cases starts in infancy (mostly before the age of 5) but gradually improves as the age advances to adulthood.
2) Contact eczema-
Irritants or allergenic substance exposure cause response in form of damage to the skin cells due to toxic effects to cells as they are recognised by body immune system which when once stimulated causes dermatitis at the site of exposure. The best way to manage this type of dermatitis sis to avoid any type of contact with the allergen or irritant once diagnosed.
3) Seborrheic eczema-
It is classified as most common chronic recurrent (alternate flare and clean phase) dermatitis. It affects mainly scalp (as cradle cap in infants), forehead, brows, ears, nasolabial folds, middle of the chest and back.
4) Neurodermatitis-
It is also known as ‘Lichen simplex chronicus’ which causes localized lichenification , any eczematous eruptions can turn into lichen simplex chronicus if they are rubbed for considerable period of time.
5) Nummular eczema-
It appears on the lower legs in elderly people as characteristic round plaques mostly associated with dry skin issues.
6) Dyshidrotic eczema-
It is also termed as pompholyx which usually affects lateral hands (fingers too) and feet in form of very itchy small blisters (vesicular endogenous eczema) which usually aggravate due to stress and strain.
7)Stasis dermatitis-
Those individuals who sustained valvular injuries in lower legs of those larger veins which are related to heart suffers from it as it causes enough hydrostatic pressure on walls of such veins so small leak occurs leading to swelling and brownish blood pigment (degradation of Hb) is deposited in the skin,dermatitis thus often occurs in such individuals as well as they suffers from ulcers too.
Prevention of Eczema-
Eczema is mostly recurring or relapses as complete cure is not yet established but there are few ways to avoid its flare up as well as risk of occurrence, they are as follows-
1)In individuals with family history, babies must be breast feed strictly for first 3 months (6 months continuous breastfeeding is recommended) as they are at risk of eczema too in order to avoid any allergic manifestations and to build their immune system.
Newly born should also be protected from potential allergens around them such as pet hair, mites, and molds, dusts, any food article after starting their solid diet, etc.
2) Once suffering from eczema, individual must relax and take time for themselves (like exercise to check stress and increase circulation) in order to check stress and strain in order to prevent flares of eczema.
3) Eczema tends to worsen when a person is exposed to certain aggravating factors so patients must take precautionary measures against-
a) Pollen grains, dust mites, animals and their fur, and certain food ingredients (for allergic individuals like peanut allergy, etc.)
b) Dry and cold atmosphere and winds in particular.
c) Physical contact (skin or touching by bare hands ) with certain chemicals, rough fabrics, contents of soaps or lotions, etc.
d) Avoid taking frequent baths or showers but at the same time moisturize the skin properly after every bath in order to prevent the aggravation of eczema.
SCOPE IN HOMOEOPATHY-
Treatment is base on symptom similarity in homoeopathy where after case taking every individual case is treated on the basis of ‘Similia Similibus Curantur’. Skin ailments have a great scope in homeopathy as it do not suppress it for temporary relief and later on it relapses in severe forms which is very common when skin disorders are treated only externally.
Some important remedies in case of eczema and their keynote indications are as follows-
1) Calcarea carbonica–
Typical sluggish metabolic activity in a ‘Fair flabby Chilly patient’ who is anxious and overwhelmed when overworked with clammy hands and feet, and tendency to develop eczema n cracked skin which is aggravated during winter. Cravings for sweets and eggs is marked in calcarean patient.
2) Arsenicum album-
It is one of the ‘Trio of restlessness’ marked by compulsively neat and orderly personality with general weakness and chilliness who suffers from dry, itchy and intense burning of skin where scratching leads to aggravation while heat ameliorates the itching in general.
3)Hepar sulphuris calcareum (HPUS)
It is suited to ‘Chilly, sensitive, vulnerable, irritable and vulnerable patient with low immunity in general’ who suffers from eczema especially on the hands and feet, which is extremely sore, chapped with deep cracks and prone to slow healing and infection.
4)Graphite
This remedy is often indicated in long-term history of skin disorders of various kinds (eczema, herpes, impetigo, etc) where patient suffers from lack of concentration especially in morning and suffers from leathery skin with soreness and cracks with golden oozing discharge which forms crusts, commonly affects area around mouth, hands, back of the ears, etc. which causes people to scratch till bleeds which is quite troublesome especially aggravated from warmth of bed.
5)Rhus Toxicodendron-
This remedy is one of the ‘Trio of restlessness’ where cause is discomfort which makes the patient restless, anxious as well as irritable, they suffer from eczema (vesicular eruptions over abscess is also found)) worse in places with hair (eroded by pus) also in cases of area involving genitals which is characterized by reddish hue, swollen, burning, dry, thick milky crusts with intense itching alternating with dysentery. which is ameliorated by hot applications while aggravated from getting wet. It is often indicated in ‘Baker’s itch’ & ‘Urticaria’.
6)Mezereum-
Eruptions starts as blisters which progresses to oozing (thick & white pus) and crust (leather like) formation with intense itching (feeling of thousand s of small insects crawling over the body) which leads to typical lichenification is present which ameliorate by cold applications as well as in open air while get aggravated in bed or from touch. Marked site for eczema in this remedy is ‘Scalp’. Patient suffer from anxiety which is felt in their stomach. Often indicated in cases of ‘eczema after vaccinations’.
7)Sulphur-
It is indicated in all sorts of skin eruptions (eczema, abscess, boils, etc) especially that have been treated by other modes of treatment as well as suppressed by ointment and other local medications.
Keynote is ‘Dirty, filthy look of the skin with filthy odour.’ Patient is averse to washing or bathing and easily affected from atmospheric changes mostly aggravated by heat, at night, washing while relieved from uncovering, open air. Eruptions can be either dry or moist with voluptuous itching where scratching feels good but follows by severe burning, sore and raw feeling of the affected part.
8) Antimonium crudum-
Disposition to abnormal growth of skin along with tendency to indigestion with craving to eat pickles and other sour things with marked sensitive as well as sentimental nature is keynote to this remedy. Eczema is marked by thick, cracked skin with scaly pustular eruptions with burning and itching which is aggravated at night time, by warmth and sun exposure.
9)Calendula-
‘It is great homoeopathic antiseptic.’ Most suited for skin conditions which are prone to infection. It is mainly used to soothe the irritated skin by using it topically so as to prevent inflammation and infection without suppressing it.
10)Petroleum-
Skin in appearance is marked by ‘rough, ragged, exfoliated and bleeding with cracks and fissures all over or in affected area (fingertips & palms are often affected) is the key note of this remedy’. All the eruptions itch violently so much that its scratching leads to skin peeling and part become moist, bloody, raw and inflamed. Often indicated in eczema which involves especially scalp and occiput with oozing which is thin and watery . Modalities involved are aggravation from getting warm in bed, winter but get better in summer.
HAPPY HEALING
Contributor- Dr. Apurva Varangi
