Symptoms, Causes, Treatment and More

Eczema is the term for a group of skin conditions that cause irritated, red, and itchy skin. The most common form of eczema is atopic dermatitis.

Flexural eczema describes the location where an eczema rash occurs. It appears around the creases of the joints, most frequently the elbows and knees. It can also occur at the ankles, wrists, and neck. Flexural eczema most commonly appears in late childhood and adulthood.

Here’s everything you need to know about flexural eczema.

Flexural eczema causes red, irritated, and itchy patches of skin to appear on the skin near your or your child’s joints. The condition is chronic, which means you might notice that symptoms clear up for a while only to return again several weeks, months, or years later.

Typically, an eczema rash starts as itchy skin. Once you or your child starts scratching it, the rash will develop.

Eczema can affect a person at any age and can continue into adulthood in some more severe cases, but it can look different based on age.

While babies tend to have eczema on the face, scalp, and extensors, like the front of the knee or back of the elbow, children between 2 years old and adolescence are more likely to develop the itchy rash around the creases in their elbows and knees. Other areas of eczema that are common in this age group are the neck, wrists, and ankles.

Other symptoms and signs of eczema in children can include:

• itchy, scaly patches
• rash that appears in the knee or elbow creases or in other areas of the body
• darkening or lightening of skin near the rashes
• permanent goose bumps
• thickened skin that develops from chronic itching or rubbing

The exact cause of eczema is still unknown, but researchers have some ideas. According to the National Eczema Association, causes of eczema include:

• genetics, which may influence whether someone develops eczema as a child
• environmental factors, also known as triggers, like allergens, chemicals, or other stimuli that causes eczema to start or flare

Children or adults living with eczema may also have an overactive immune system. In this case, the immune system overreacts to a substance outside or inside the body, which results in inflammation.

Evidence suggests that people with eczema may have a mutation in the FLG gene that encodes a protein called filaggrin. Filaggrin helps create a protective barrier between the skin and the outside world. Without a sufficient barrier, your skin or your child’s skin can become dry and prone to infection.

Eczema does not have a cure, but you can take steps to help lessen the severity of symptoms and prevent flares for you or your child.

Medical treatments can involve both topical and systemic medications. During a flare, you can apply topical medications, such as topical calcineurin inhibitors (TCIs) and steroids, directly to the affected skin.

Your doctor may also recommend phototherapy to topically treat eczema. Phototherapy involves using light to help reduce the severity of an eczema flare and help heal the skin.

A doctor may also recommend taking systemic medications such as methotrexate, cyclosporine, and mycophenolate mofetil. Additionally, over 40 clinical trials are underway or in the process of getting approval, which means new medications may eventually become available that better treat eczema.

You or your child may also find some relief with complementary therapies. Some techniques include meditation, hypnosis, and biofeedback.

Some at-home treatments may also help improve flexural eczema symptoms. These include:

• oatmeal baths
• cool compresses
• petroleum jelly or other moisturizing cream or ointment
• finding distractions from the itch

Taking steps to avoid known triggers can help prevent flexural eczema flares. It is important to take time to set up a treatment plan for flexural eczema.

Several treatment options can help prevent flares. For example, systematic medications can have a preventive effect on flexural eczema. Keeping your or your child’s skin moisturized can also help prevent new flares from occurring.

Research shows that most children will “outgrow” eczema by the time they are adults. However, several factors can make lifelong eczema more likely. The following factors affect whether eczema will subside or go away completely over time:

• severity of the condition, as more severe cases are more likely to continue into adulthood
• time of onset, as eczema that appears later in life is more likely to last
• persistency of the condition

Flexural eczema is a type of eczema that appears around the creases of joints, often on the elbows and knees. It causes an itchy rash to form. Children may be more likely to develop flexural eczema, though it can occur in adults as well. If your child develops eczema, there is a chance that it will go away as they age.

There are many treatment options for eczema, like topical medications, systemic medications, and home remedies. Talk with your doctor about creating a treatment plan that is right for you or your child’s eczema.

Symptoms, Causes, Treatment and More

Eczema is the term for a group of skin conditions that cause irritated, red, and itchy skin. The most common form of eczema is atopic dermatitis.

Flexural eczema describes the location where an eczema rash occurs. It appears around the creases of the joints, most frequently the elbows and knees. It can also occur at the ankles, wrists, and neck. Flexural eczema most commonly appears in late childhood and adulthood.

Here’s everything you need to know about flexural eczema.

Flexural eczema causes red, irritated, and itchy patches of skin to appear on the skin near your or your child’s joints. The condition is chronic, which means you might notice that symptoms clear up for a while only to return again several weeks, months, or years later.

Typically, an eczema rash starts as itchy skin. Once you or your child starts scratching it, the rash will develop.

Eczema can affect a person at any age and can continue into adulthood in some more severe cases, but it can look different based on age.

While babies tend to have eczema on the face, scalp, and extensors, like the front of the knee or back of the elbow, children between 2 years old and adolescence are more likely to develop the itchy rash around the creases in their elbows and knees. Other areas of eczema that are common in this age group are the neck, wrists, and ankles.

Other symptoms and signs of eczema in children can include:

• itchy, scaly patches
• rash that appears in the knee or elbow creases or in other areas of the body
• darkening or lightening of skin near the rashes
• permanent goose bumps
• thickened skin that develops from chronic itching or rubbing

The exact cause of eczema is still unknown, but researchers have some ideas. According to the National Eczema Association, causes of eczema include:

• genetics, which may influence whether someone develops eczema as a child
• environmental factors, also known as triggers, like allergens, chemicals, or other stimuli that causes eczema to start or flare

Children or adults living with eczema may also have an overactive immune system. In this case, the immune system overreacts to a substance outside or inside the body, which results in inflammation.

Evidence suggests that people with eczema may have a mutation in the FLG gene that encodes a protein called filaggrin. Filaggrin helps create a protective barrier between the skin and the outside world. Without a sufficient barrier, your skin or your child’s skin can become dry and prone to infection.

Eczema does not have a cure, but you can take steps to help lessen the severity of symptoms and prevent flares for you or your child.

Medical treatments can involve both topical and systemic medications. During a flare, you can apply topical medications, such as topical calcineurin inhibitors (TCIs) and steroids, directly to the affected skin.

Your doctor may also recommend phototherapy to topically treat eczema. Phototherapy involves using light to help reduce the severity of an eczema flare and help heal the skin.

A doctor may also recommend taking systemic medications such as methotrexate, cyclosporine, and mycophenolate mofetil. Additionally, over 40 clinical trials are underway or in the process of getting approval, which means new medications may eventually become available that better treat eczema.

You or your child may also find some relief with complementary therapies. Some techniques include meditation, hypnosis, and biofeedback.

Some at-home treatments may also help improve flexural eczema symptoms. These include:

• oatmeal baths
• cool compresses
• petroleum jelly or other moisturizing cream or ointment
• finding distractions from the itch

Taking steps to avoid known triggers can help prevent flexural eczema flares. It is important to take time to set up a treatment plan for flexural eczema.

Several treatment options can help prevent flares. For example, systematic medications can have a preventive effect on flexural eczema. Keeping your or your child’s skin moisturized can also help prevent new flares from occurring.

Research shows that most children will “outgrow” eczema by the time they are adults. However, several factors can make lifelong eczema more likely. The following factors affect whether eczema will subside or go away completely over time:

• severity of the condition, as more severe cases are more likely to continue into adulthood
• time of onset, as eczema that appears later in life is more likely to last
• persistency of the condition

Flexural eczema is a type of eczema that appears around the creases of joints, often on the elbows and knees. It causes an itchy rash to form. Children may be more likely to develop flexural eczema, though it can occur in adults as well. If your child develops eczema, there is a chance that it will go away as they age.

There are many treatment options for eczema, like topical medications, systemic medications, and home remedies. Talk with your doctor about creating a treatment plan that is right for you or your child’s eczema.

Atopic dermatitis or skin inflammation

What is atopic dermatitis or skin inflammation?

Atopic dermatitis is a chronic skin disease with exacerbations and improvements, the main symptom of which is itching.

In atopic dermatitis, the formation of the natural protective layer of the skin is disrupted. Characterized by dry and flaky skin. During an exacerbation, inflamed red and scaly (scaly) or weeping patches appear.

Where is the atopic dermatitis rash located?

The location of the rash on the body depends on age. In infants, young children, adolescents, and adults, the location of the rash varies.

Baby (infant):

• The face and cheeks are red and rough.
• Inflammation covers the chest, back and folds of the limbs.
• The rash is symmetrical.
• Under eyes, area around mouth and nose mostly without rash.

Small child:

• The rash is located on the folds of the elbow and knee joints.
• Often rash on the neck, wrists, back of the hand, ankle.
• The skin pattern is strongly pronounced, the skin is often thickened.
• Skin shows scratch marks.

Adolescents and adults:

• The rash is localized on the elbows and knees, wrists and palms.
• The skin pattern is strongly pronounced, the skin is thickened.
• Characteristic skin fold under the eyes.

What are the complaints caused by atopic dermatitis

• Symptoms range from short and mild to severe itching and rash causing sleep disturbance.
• Due to sleep disturbances, children are tired during the day, their attention is distracted, their academic performance and ability to work are reduced.
• One of the main risk factors for exacerbation of atopic dermatitis is stress. At the same time, a visible rash and excruciating itching, in turn, lead to psychological stress, which makes it difficult to control the disease.

What is the cause of atopic dermatitis and its exacerbation

The cause of the disease is still unclear, although heredity and human environment play an important role. Exacerbation of dermatitis can cause physical and chemical irritants that get on the skin. For example, coarse clothes (wool and synthetics), smelly detergents, hot water, wiping with a hard towel, cold and hot weather.

Exacerbation of atopic dermatitis can cause a general illness, which can be caused by severe respiratory tract infections or severe purulent inflammation of the skin.

Exacerbation of atopic dermatitis rash can cause a state of mental irritation or an allergen contained in food or air. About a third of children with atopic dermatitis are allergic to food or air allergens.

What to use for atopic dermatitis

Atopic dermatitis cannot yet be cured, but the disease can be controlled with daily skin care. To improve the elasticity of the skin, to avoid cracks, reduce itching and flaking of the skin, increase the protective function of the skin, you can smear softening base creams on dry areas of the skin several times a day. When choosing a base cream, it is very important that it is suitable for the patient and does not cause burning and redness. Zinc-containing creams reduce inflammation and soothe, but at the same time dry the skin. Zinc-containing creams can be alternated with base creams.

Creams with a high fat base generally need to be applied less frequently than water-based creams.

Considerations for atopic dermatitis

• For particularly sensitive skin, a base cream is used.
• Showering, bathing or swimming pool can be used for short periods of time
• Oils can be added to the water while taking a bath.
• Skin irritation can be avoided by using fragrance-free and color-free detergents.
• Wipe the skin with a soft towel, blotting lightly and then immediately apply the cream.
• Avoid sweating as much as possible, as this can irritate the skin.
• Choose a cool place to sleep, as coolness reduces itching.

Compiled by: sister of the children’s clinic Tiija Kõivist

01

Atopic dermatitis is a disease characterized by an inflammatory process in the upper layers of the skin. Its frequent symptoms are itching of varying intensity, foci of rashes (in some cases with exudate), redness, peeling, dry skin. Atopic dermatitis may be accompanied by food allergies, pollinosis, bronchial asthma ⁵ .

Most often, atopic dermatitis appears in childhood, and remission occurs with adulthood. However, in some patients, the disease persists for life and significantly affects its quality. Severe itching interferes with sleep, work and communication, a person’s mental health worsens, bacterial and viral infections easily “sit down” on the affected areas of the skin – this is what atopic dermatitis in adults is dangerous for.

Causes of atopic dermatitis

The disease does not occur without a cause: atopic dermatitis in adults appears against the background of hereditary predisposition under the influence of provoking factors. A genetic defect can be both in the structure of the skin, and at the level of the immune system as a whole ³ .

Healthy skin consists of 15-20 layers of corneocyte cells and intercellular substance. The synthesis of these cells occurs due to the protein filaggrin. Sometimes a mutation occurs in the gene for this protein. As a result, the integrity of the barrier is broken, opening the gate for secondary infections and allergens ³ .

It happens that a malfunction occurs at the level of the immune system as a whole: it becomes prone to allergic reactions and triggers inflammation in the skin.

Aggravation of atopic dermatitis can be caused by unfavorable environmental conditions, frequent handwashing, stress, Staphylococcus aureus bacteria, contact with house dust mites, mold fungi, aggressive cosmetics or irritating clothing.

Diagnostics

The Hanifin and Raiki criteria ^{1 2} are used to diagnose atopic dermatitis.

The main criteria include:

• Itching

• Localization of foci of irritation in the area of ​​the elbows and under the knees, lichenification (thickening of the skin) and scratching at the site of the rash

• Hereditary predisposition

• Chron ic course with periods of exacerbations

Additional criteria are:

• Dry skin

• Excessive wrinkling of the palms and soles, follicular hyperkeratosis (“goosebumps”)

• Elevated levels of total and specific IgE in blood serum

• Early onset of the disease (up to two years)

• Tendency to skin infections ( Staphylococcus aureus, herpes)

• Localization on the hands and feet

• Eczema of the nipples

• Inflammation and fissures on the lips

• Frequent conjunctivitis

• Double crease on the lower eyelid

• Change in the shape of the cornea from spherical to conical

• Anterior subcapsular cataract

• Dark spots around the eyes

• Pallor of the face or the presence of round rashes

• Seborrheic eczema

900 04 • Aggravation of symptoms under the influence of provoking factors (soap, products-allergens, stress, etc. )

• Seasonality of relapses

• Change in skin color at the site of irritation to a paler one

• Folds on the front of the neck

• Itching with profuse sweating

• Food intolerance

• Perifollicular accentuation

If a patient has at least three main and three additional criteria, the doctor may make a diagnosis of atopic dermatitis.

^Treatment

The treatment of atopic dermatitis uses a stepwise approach depending on the severity of the disease ¹ .

During the remission period, atopic patients have enough basic care. For this, moisturizing emollients are used, which form a film on the surface of the skin and do not allow their own moisture to evaporate. They are produced in the form of lotions, creams, bathing products, etc. A wide selection allows everyone to choose an individual care depending on the characteristics of the skin, climate, season, personal preferences. Emollients are applied at least 3-4 times a day. It is especially important to use them after swimming in hard tap water. Normally, an adult consumes up to 600 grams of emollients per week.

For minor local exacerbations, the doctor may prescribe topical glucocorticosteroids (GCS). These are local preparations that suppress the activity of the allergic process in the skin. They are available in the form of ointments, lotions, creams, gels, solutions. Ointments are well suited for treating areas of rough or very dry skin (eg feet, hands, elbows) ⁴ . The cream has a lighter texture and is suitable for the bends of the limbs and intimate areas. Sprays, foams and gels are convenient to apply on the face and hair.

Topical glucocorticosteroids include PheniVate, the latest generation drug that acts at the cellular level and helps to reduce the symptoms of dermatitis and eczema ^{6 7} .

Severe atopic dermatitis in adults is treated with systemic glucocorticosteroids. Most often they are prescribed in the form of tablets, but in some cases they resort to injections. As a rule, the course of treatment is short, and the doses are small: this minimizes side effects ⁴ . Against the background of taking GCS, the symptoms of atopic dermatitis quickly disappear, but they can only be used under medical supervision.

Also in the fight against atopic dermatitis, topical calcineurin inhibitors – local non-steroidal immunosuppressors ¹ are used. They inhibit the synthesis and release of pro-inflammatory cytokines. Drugs stop the symptoms of the disease and prevent its recurrence. Calcineurin inhibitors expand the arsenal of dermatologists and allergists in the fight against atopic dermatitis: they are prescribed to patients with tolerance to corticosteroids or with severe side effects during their use.

Along with drugs, phototherapy is often used in Russia – irradiation of affected skin areas with UV rays.

Also, people suffering from atopic dermatitis should avoid stress and contact with allergens.

Perspectives

Only symptomatic treatment is indicated for this disease: atopic dermatitis in adults is chronic and cannot be completely cured. Traditional therapy often allows achieving remission, but there are a number of patients for whom it either does not help or is not suitable due to the toxic effect of drugs on organs and systems. This encourages researchers to constantly search for new treatments ¹ .

Sources

1. Clinical recommendations “Atopic dermatitis” from the Russian Society of Dermatovenereologists and Cosmetologists, the Russian Association of Allergists and Clinical Immunologists, the Union of Pediatricians of Russia. 2020.

2. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol. 1980; 92 (Suppl): 44–47.

3. Maksimova Yu.V., Svechnikova E.V., Maksimov V.N., Lykova S.G. Heredity and atopic dermatitis. Medicine and education in Siberia. 6. 2013.

4. Uteshev D.B., Krylov I.A., Bunyatyan N.D. The use of systemic glucocorticosteroids in atopic dermatitis and bronchial asthma. Medical advice. 8.2008. 26-28.

5. Ovsyannikova O.