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Eczema – Symptoms

Anna Chacon, MD Anna Chacon, MD February 13, 2021


"The symptoms of eczema are key and very important in making a clinical diagnosis. Most types of eczema have the following symptoms: itching, scaling, and flaking of the skin, puritis, excoriation from scratching and lichenification, which means thickening of the skin from chronic scratching. Other symptoms include inflamed, reddish, blistered, and weepy patches, and acute flares. In between flares, the skin may appear itchy, dry and thickened or lichenified. In certain areas. Symptoms can vary greatly depending on the type of individual patient scenario. The way atopic dermatitis looks and feels can change depending on the presence of comorbidities or additional dermatologic conditions, the topicals used, the age of the patient, ethnic origin and other factors. However, some general patterns may be more prevalent than others, depending on the age of the patient and the effected body surface area. Clinical features of atopic dermatitis include paritic exumenous lesions that are often excoriated and appear on a spectrum.

Acute lesions have erythematous and adenomatous papules and plaques that have oozing, crusting and vesicles. Subacute lesions include erythematous, patches or plaques with scaling, and variable cresting. Chronic lesions include thickened plaques with lichenification and often increased skin markings plus scaling. Papular eczema is common in patients with very dark pigmented skin and appears as small perifollicular papules. There are also regional variants of eczema: post inflammatory depigmentation, hyper or hypo pigmentation that can be seen as the lesions evolve. Atopic dermatitis is divided into certain stages, such as infantile, pediatric and adult with characteristic skin lesions and morphologies. Infantile atopic dermatitis occurs in patients under the age of two and often features acute skin lesions. It frequently begins on the cheeks, forehead and scalp, and also favors the extensors of the extremities and the trunk. It spares the central face and diaper area.

Childhood atopic dermatitis occurs in individuals between the ages of two and 12 and have skin lesions that appear less acute and become more lichenified. It favors a popliteal and antecubital fossa, wrists, ankles, hands, feet, neck, and periorificial areas. The sites favor in more flexural eczema. It is often associated with widespread dryness or cirrhosis. Over 50% of children with atopic dermatitis go into remission by the age of 12. Adolescent or adult atopic dermatitis typically occurs in individuals older than 12 and presents with subacute to chronic lichenified lesions with a distribution similar to childhood atopic dermatitis. Some patients have a chronic involvement limited to a particular site such as the hands, face and eyelids. Chronic papules develop due to rubbing or scratching. The eczema can become more chronic, erythrodermic or red or extensive, particularly if it continues to evolve since childhood. Features that are commonly associated with atopic dermatitis include central facial pallor, anterior neck folds, follicular prominence with a goosebump-like appearance, post-inflammatory hyperpigmentation at previous sites of eczema, pityriasis alba, ill-defined fine scaling and hypopigmented macules, linear or punctate excoriations, Dennie-Morgan folds on the lower and upper eyelids, allergic shiners or periorbital targeting, varying from gray to violet brown with [?] Cirrhosis or dry skin with fine scaling, palmar and plantar hyper linearity, keratosis pilaris, follicular papules with a keratotic rim on a background of erythema.

And ichthyosis vulgaris, fine whitish to polygonal brown scaling favoring the shins and sparing the flexures can also develop."

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