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What is Eczema
Atopic eczema is an endogenic chronic or chronically recurrent itching skin condition with genetic predisposition. Chromosome 11 and 5 predict the tendency and are parts of the atopic syndrome of atopic eczema, hay fever, sinusitis, asthma, urticaria, croup, bronchitis, keratosis pilaris and allergies of : ear, nose and throat.
These chromosomes dictate the Th2 (D4T) cells to be overactive, producing excessive lymphokines (interleukin 4+5). Also B cells are stimulated to produce excessive IgE + eosinophyls in skin and blood. Histamine, prostaglandin and cytokines, especially tumour necrotic factor are produced with resulting symptoms and signs of eczema. A lack of IgA does not prevent allergens to pass through mucous membranes, resulting in further IgE production, especially against house dust mites, milk, eggs and peanuts. Eczema is a skin illness with a tendency to allergies conditions of the ear, nose, throat and skin. Positive prick and RAST tests are frequently used but they do not correlate well with the degree of eczema and prick tests may be false positive. 1-10% of RSA population and more in developed countries and incidence increasing in the last 100 years.
The condition usually presents with an ill defined reddish colour of the cheeks and also of the folds of the elbows and knees, in babies 6 months to 5 years old, but may present at a much later age.
Vesicles, erythema, oozing and crusts are seen in the acute phase, but later lichenification may be noticed.
In young children the typical skin folds of arms, legs, and behind ears are effected. The course is unpredictable and waxes and wanes.
These children are frequently staphylococcus aureus carriers and potent super antigenic endotoxin stimulates Th2 cells with interleukin 3, 4 and 5 produced. Also Th1 cells produce interleukin 2 and interferon gamma. Not controlling these staphs prevents healing and resistant eczema then seen. Triclosan kills these bacteria (Crème Classique soap and Crème Classique cream.)
More prone to: Warts, mollusca, herpes simplex, vaccinia, alopecia areata.