Eczema and Gut health: Is there a Link?

What Is Eczema?

Eczema is a chronic inflammatory skin condition that affects people of all ages and is very common.1 It is often caused by the body's immune system overreacting to small irritants or allergens.

This overreaction causes the skin to become inflamed in those areas.2 Eczema is often referred to as atopic dermatitis, although there are other forms of eczema too. 

Eczema comes in different forms including:2

  1. Atopic dermatitis
  2. Contact Dermatitis
  3. Dyshidrotic eczema
  4. Nummular eczema
  5. Seborrheic dermatitis
  6. Stasis dermatitis

    Usually, the symptoms of eczema are dry and itchy skin, rashes, scaly patches of skin, blisters on the skin and skin infections. Itchy skin is the most common symptom of eczema.2

    The most commonplace for eczema to happen is on the hands; 31.6 million Americans have hand dermatitis, which equates to 20-35% of all cases of eczema in the US.3 Eczema is more commonly found in children than adults. For most people, eczema begins in childhood.

    In fact, 70% of cases begin in children under the age of 5, with 60% of these people continuing to have one or more symptoms in adulthood. Globally, 20% of children and 3% of adults have eczema of some kind. 

    What Causes Eczema?

    The cause of eczema can vary, and is not limited to but does include immune system issues, genetics, environmental triggers or stress.2 

    Weather can have an impact on eczema symptoms - with low humidity drying out the skin, and high heat causing sweating can irritate the skin, too.

    Environmental factors such as tobacco smoke, air pollutants, harsh soaps, some fabrics like wool, and particular skin products. Stress can also have an impact on eczema.4 

    What are the Different Types of Eczema and Treatments?

    Atopic Dermatitis

    Atopic dermatitis is the most common form of eczema. “Atopic” means an inherited tendency to develop dermatitis, asthma, and hay fever. “Dermatitis” means that the skin is itchy and red.5 

    Atopic dermatitis usually begins in early childhood and can continue into adulthood, although the flare-ups are usually less severe. The more a person scratches the red, itchy skin, the worse it generally gets.

    A clear fluid sometimes leaks from the area. The rash can become scaly as it crusts over. It will usually appear in places such as the elbow creases, behind the knees, cheeks or the bum.5

    Treatment

    Emollients can be used daily to limit the impact of dry skin. Topical corticosteroids can be used to reduce symptoms during flare-ups. Antihistamines may be used to calm severely itchy areas. The area may also be covered in bandages to limit scratching and allow the skin to heal underneath.6

    Usually, these treatments will combat the symptoms well. If these are not cutting it, a Doctor or a dermatologist should be consulted for more specialist treatment.6 If the area is infected, the Doctor may recommend antibiotic creams or tablets to eliminate the infection.

    The FDA has recently approved a new injection called Dupilumab. It is a type of antibody created in a laboratory. It can be used to treat those with severe atopic dermatitis who do not respond to other treatments. It is new and incredibly expensive, so will usually be used as a last resort.7

    Dyshidrotic Eczema

    Dyshidrotic eczema - also referred to as pompholyx - will usually be found on the palms of the hands, sides of the fingers and soles of the feet. Symptoms will often occur for months or years at a time, which can be painful and irritating for the sufferer.8 

    Although the cause is unknown, it is believed that contact with strong chemicals like soaps, cleansers and detergents could be the cause. An allergy to certain metals such as nickel or cobalt could also be a cause.

    Heat, sweat and regularly having wet hands could cause symptoms to arise. To limit the impact, these triggers should be avoided, by wearing gloves to limit contact on the skin.9

    These symptoms can include:8

    • fluid-filled pustules and small blisters. These appear in clusters, or can merge into bigger ones. 
    • The skin can become intensely itchy, painful and have a burning sensation. 
    • The skin can become red and scaly as the blisters dry out. 
    • The skin can appear dry and cracked. 
    • The skin where the blisters were can appear abnormally thick afterwards

    Treatment

    Emollients can be used daily to stop the skin becoming dry. Topical steroids may be used for short periods of time to reduce irritation and limit symptoms. When the blisters are leaking fluid, a Doctor may recommend soaking the affected area in a potassium permanganate solution.9

    This causes the blisters to dry out, and limits the risk of infection. If they do become infected, the Doctor may prescribe antibiotics to calm the infection.9

    If these treatments are ineffective, a dermatologist may be consulted. Steroid tablets may be prescribed for short term use to reduce or eliminate infection. Light therapy may also be used on the affected area, where the skin is exposed to ultraviolet light. Alitretinoin capsules may be given by the dermatologist if the eczema is severe.9

    Contact Dermatitis

    Contact dermatitis happens when the skin comes into direct contact with something that causes a rash, such as a substance or material. There is no correlation between contact dermatitis and hayfever or seasonal allergies.

    Research has suggested that there is also no link between genetic predisposition and contact dermatitis, whereas other forms of eczema do share a link. It is most common for those who often touch irritants such as hairdressers, cleaners and carers.8

    The symptoms can be:

    • Mild to severe itchy skin 
    • Red, dry or cracked skin that is painful, swollen or tender
    • Blisters
    • A bumpy rash

    Treatment

    The usual treatment for contact dermatitis will be emollients. These can be used frequently and in large amounts. The type of emollient that will be most effective can vary from person to person.

    For dry skin an ointment, a cream or lotion can be used; for less dry skin, an emollient soap substitute if soap is an irritant, and varying emollients for different parts of the body such as hands, face and body can be used.10

    If the skin is inflamed, topical corticosteroids may be prescribed to apply to the affected area. The strength of the cream or ointment will depend on the area and the severity of the symptoms. Steroids (corticosteroid tablets) may be prescribed if a large area of skin is affected by contact dermatitis.10

    If these treatments are not effective, a doctor may refer the patient  to a dermatologist for further treatment. They may use light therapy, where the affected area of the skin is exposed to ultraviolet light.

    Immunosuppressant medicines may be given to reduce inflammation by suppressing the immune system. If severe contact dermatitis is present on the hands, alitretinoin capsules may be given to alleviate the symptoms.10

    Nummular Eczema

    Nummular eczema can also be referred to as nummular dermatitis or discoid eczema. It is a treatable form of eczema that causes coin-shaped spots to develop on the skin.

    It will usually appear after an injury to the skin such as a burn or an insect bite, but there can be other causes, too. The spots that occur can be in just one patch, or in multiple patches of the coin-shaped lesions and may last for several months.11

    The symptoms of the coin shaped spots are:

    • Spots that are often very itchy and well-defined. 
    • Spots that ooze clear fluid
    • Spots that become dry and crusty

    This form of eczema is actually more commonly found in men than women. For men, symptoms will usually show after the age of 50. For women, it will usually show up before the age of 30. Children who suffer with severe atopic dermatitis may develop nummular eczema.11 

    Treatment

    Treatments can vary depending on the severity of the eczema, and whether it has become infected. Emollients can be used constantly to treat the infected area, such as an ointment for dry skin, a cream or lotion, an emollient soap substitute, and varying emollients for different parts of the body.

    Hypoallergenic soap substitutes can be used to replace irritant products. If the area is severely itchy, antihistamines can be used to combat the itch. Topical corticosteroids can be used for flare ups, or steroid tablets can be prescribed by a Doctor if the flare up is severe. If the area has become infected, antibiotics will be prescribed to calm the infection.12

    Seborrheic Dermatitis

    Seborrheic dermatitis is a form of eczema that usually appears on the scalp, but can also appear on the nose, upper back, eyebrows, mid-chest, groin or armpits. This is due to there being many sebaceous glands in these areas, which produce a lot of oil.

    The skin is having an inflammatory reaction to excess Malassezia yeast. This is an organism that usually lives on the skin’s surface. When there’s too much of it, the skin can react and cause seborrheic dermatitis.13

    In infants, this is commonly referred to as ‘cradle cap’. In this case, it usually appears on the scalp or the bottom as scaly or greasy patches, and will go away on its own. In adults, it is most common in males between the ages of 30 and 60, and can reappear often.

    Certain medical conditions can increase the risk of developing seborrheic dermatitis, including psoriasis, HIV, acne, alcoholism, eating disorders and Parkinson’s disease. It can also appear when a patient is recovering from a stroke or a heart attack. (13)

    Triggers for seborrheic dermatitis can be certain medications such as psoralen, interferon and lithium. It can also be triggered by cold and/or dry weather, stress, illness, or harsh chemicals and products.13

    Symptoms include:14

    • Dandruff on your scalp, hair, eyebrows, or facial hair
    • Patches of greasy skin covered with flaky white or yellow scales or crust 
    • Red skin
    • Itching

    Treatment

    There are lots of home remedies recommended before seeking medical intervention for seborrheic dermatitis. Dandruff shampoos can be an effective treatment when used daily.

    Over-the-counter antifungal or anti-itch creams are also readily available. Hypoallergenic soaps and detergents can be used to limit irritation. It can also be effective to shave off facial hair, which can be an irritant. Wearing loose cotton clothing can limit irritation on the body.15

    If home remedies aren’t cutting it, a Doctor can prescribe treatment options. Prescription strength shampoos or ointments that contain hydrocortisone, fluocinolone or desonide can be applied directly to the affected area.

    Antifungal medications can also be prescribed where necessary. All of these options can cause side effects, particularly when used for a prolonged period, so should be used with caution. A cream or gel called metronidazole can also be prescribed to combat symptoms.15

    A doctor may also prescribe a combination of psoralen and light therapy to manage symptoms. Psoralen can be taken orally, or applied directly to the affected area. That area will then be exposed to ultraviolet light for a short period of time.15

    In infants, ‘cradle cap’ doesn’t usually require treatment and will go away on its own in up to 6 months. To manage the symptoms, you can loosen the scales by massaging the baby’s scalp or with a soft-bristled brush.

    The baby’s hair can also be washed with a mild shampoo, and the hair and scalp must be rinsed thoroughly. A tip for difficulty with loosening the scales is to massage olive oil into the area before shampooing.15

    Stasis Dermatitis

    Stasis dermatitis can also be referred to as gravitational dermatitis, venous eczema and venous stasis. The cause of this form of eczema is poor circulation in the lower legs, which is known as venous insufficiency.

    We have valves in our legs that help push blood back to the heart, and here, they weaken and leak fluid. This causes water and blood cells to pool in the lower legs.16

    Venous insufficiency can be caused by underlying medical conditions such as heart disease or kidney disease, but is most commonly caused by ageing. As we get older, our circulation becomes less effective, so those over the age of 50 are most likely to suffer from stasis dermatitis. It is also more common in women.16

    It’s important to note that not everyone with venous insufficiency will develop stasis dermatitis, but poor circulation does increase the risk factor. Other risks can be varicose veins, high blood pressure, multiple pregnancies, a history of blood clots, obesity and vein surgeries.

    Having very little physical activity, for example having a job that involves hours of sitting or standing can increase the risk of stasis dermatitis.16

    Symptoms of stasis dermatitis:

    • One or both legs being affected, or feet. 
    • Ankle swelling
    • Orange-brown speckles of discolouration (capillaries bursting)
    • Redness in lighter skin tones or brown, purple, grey or ashen in darker skin tones
    • Itching
    • Scaly skin
    • Dryness
    • Aching or heavy feeling after long periods of inactivity

    Treatment 

    Unfortunately, if stasis dermatitis goes untreated, the swelling can move beyond the ankle to the calf. The skin can become shiny in this area. Venous ulcers which look like open sores can form on the lower legs and the tops of the feet. These ulcers may bleed, ooze and leave scars.16

    When stasis dermatitis is severe, it can cause permanent skin changes. These can be the skin thickening, darkening, hardening or the skin can appear bumpy.16

    Compression stockings can be used to reduce swelling in the legs and ankles. The legs may also be elevated above the heart every two hours to reduce swelling. This is to encourage blood flow to the area.

    If the skin is infected, a topical or oral antibiotic can be prescribed. For itchy skin that is red or discoloured, a topical corticosteroid can be used to calm the inflammation.

    Avoiding foods that are high in salt can help to calm symptoms of stasis dermatitis. Taking a Vitamin C and Rutin supplement can also calm symptoms by keeping the blood vessels flexible and healthy, limiting venous insufficiency. 

    Final Thoughts

    Different forms of eczema can have very similar symptoms, but a doctor will usually be able to diagnose the type just by looking at it due to their advanced medical training.

    Eczema can be severe, irritating and debilitating. It can also be just a mild inconvenience; it all depends on the type of eczema, where it is, and how extreme the symptoms are.

    There are many treatment options out there, but it’s really important to get eczema diagnosed to ensure you are trying the right treatments that will work for you.

    Don’t suffer, get it looked at!

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