Types of ECZEMA

Itch. . . scratch. . . .
Itch. . . scratch. . . scratch. . . .

In brief, this is the story of what people frequently call

"eczema"and what dermatologists call "atopic dermatitis." It is the disease that starts from scratch and one that may last a lifetime. It is the eczema of infancy, the chronic, relentless derma­titis of childhood and adolescence, and the fierce and uncontrol­lable itching of the adult.

Eczema is a general term which, to most people, means a diffuse rash with itching. It is a synonym for dermatitis, which literally means "inflammation of the skin."

But when physicians speak of eczema, they usually refer to the persistent, incessant itchy eruption that almost invariably begins in infancy, is inherited, is often accompanied in later years by hay fever or asthma, and in rare circumstances lasts a lifetime. It is a topic dermatitis, a disease that affects about 10 millions people in the United States alone.

No one yet knows the "why" of this virtually uncontrollable, allergic process. It begins with itching on a perfectly normal looking skin. You then rub, claw, tear, and scratch where it itches and you, yourself, produce the rash we know of as eczema.

There are three different types or "stages" of atopic dermatitis.

The infantile form. This usually begins about six or eight weeks after birth. The itching is often intense and lasts up until about the age of two years. The rash, which almost always affects the cheeks and mouth, usually worsens after vaccinations and immunization injections and during the teething phase. During the second year of life, the itchy areas develop over the hands, wrists, and outer portions of the arms and legs.

The childhood type. While the infantile form in over half the cases fades out between the ages of two and four, it may continue into the so-called childhood type of eczema. The areas that suffer most here are the creases in the elbows and the bends of the knees. The affected areas are more dry, the skin becomes thicker and grayish in color, the itching becomes fierce, and the children are restless, anxious, and hyperactive.

Of all the eczemas that occur during childhood, atopic derma­titis is not only the most prevalent disorder, but it is also one of the most mystifying and difficult to manage.

The adolescent and adult types. The infantile and childhood eczemas often disappear after a few years only to reappear in late adolescence. While it usually fades away by the age of thirty, it may persist throughout the entire lifetime of some unfortunate person. The itching, again, may be intense and is usually worse at night. The areas affected are the bends of the elbows and knees, the face, the shoulders, and the upper back. The itchy and scratched skin becomes thick and leathery, darker than the surrounding skin, and develops dry scales.

Another characteristic feature is the accentuated groove be­neath the lower eyelids. This is called the atopic pleat.

The management of eczema is an enormous challenge for the physician. No one treatment for eczema works for everyone, since the areas involved and the degree of itching affect different people in different ways. At best we try to alleviate the intense itching which, in essence, is the disease. Interrupt and stop this fierce symptom and we break the itch-scratch reflex which is wholly responsible for the clinical manifestation-the rash.