ECZEMA - CASE STUDY:

ATOPIC AND
CONTACT
DERMATITIS
BIOLOGY PROJECT

Submitted by: Sapna Harilal

Grade: 12 Section: A
Roll no:

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CERTIFICATE

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ACKNOWLEDGEMENT

I would like to express my gratitude and appreciation

towards all those who provided me with the opportunity
to successfully complete this project, with special thanks
to our Principal Ms. Lalitha Suresh, Vice Principal Ms.
Reshmi Menon, and Supervisor Ms. Sheeba Manoj.
I also extend my gratitude to my biology teacher, Ms.
Allen Varghese, without whose guidance, support and
encouragement, the completion of this project would not
have been possible.
Last but not least, I wish to thank my family and friends
who provided valuable suggestions and willed me to stay
motivated throughout the duration of this project.

Thanking you

Sapna Harilal
12 - A

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INDEX

1. Introduction 5

2. Methodology 20

3. Discussion 36

4. Conclusion 41

5. Summary 43

6. Bibliography 44

7. Picture sources 44

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INTRODUCTION

Eczema is the name for a group of conditions that cause the skin to
become itchy, inflamed and red in lighter skin tones or brown,
purple, gray or ashen in darker skin tones. Some types can also cause
blisters.
Eczema is not contagious.
When an irritant or an allergen from outside or inside the body
triggers the immune system, it produces inflammation. It is this
inflammation that causes the symptoms common to most types of
eczema.
There are seven different types of eczema, and it is possible to have
more than one type of eczema on your body at the same time. Each
form of eczema has its own set of triggers and treatment
requirements.

Fig. 1

SYMPTOMS
The symptoms of eczema can vary depending on a person’s age and
the condition’s severity and can vary by individual.

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People with the condition will often experience periods of time when
their symptoms worsen, followed by periods of time when their
symptoms will improve or clear up.
The general symptoms are as follows:
• dry, rough, flakey, inflamed, and irritated skin
• intense itching
• red or brownish-gray patches
• open, crusted, or weeping sores
• thickened, scaly skin
• crusty patches of dried yellowish ooze, which can signal infection

Scratching eczema further irritates and inflames the skin. This can
cause infections that must be treated with antibiotics.

CAUSES
Researchers do not know the definitive cause of eczema, but many
health professionals believe that it develops from a combination of
genetic and environmental factors.
Children are more likely to develop eczema if a parent has it or
another atopic condition. If both parents have an atopic condition,
the risk is even higher.
Some environmental factors may also bring out the symptoms of
eczema. These include:
• Irritants: These include soaps, detergents, shampoos,
disinfectants, juices from fresh fruits, meats, and vegetables.
• Allergens: Dust mites, pets, pollens, and mold can all lead to
eczema. This is known as allergic eczema.
• Microbes: These include bacteria such as Staphylococcus aureus,
viruses, and certain fungi.
• Hot and cold temperatures: Very hot and very cold weather,
high and low humidity, and perspiration from exercise can
bring out eczema.

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 • Foods: Dairy products, eggs, nuts and seeds, soy products, and
wheat can cause eczema flares.
• Stress: This is not a direct cause of eczema, but it can make the
symptoms worse.
• Hormones: People assigned female may experience increased
eczema symptoms when their hormone levels are changing,
such as during pregnancy and at certain points in the
menstrual cycle.

MECHANISM (THEORY)
Eczema is believed to be triggered by an overactive immune system
that responds aggressively when exposed to irritants.
It is sometimes caused by an abnormal response to proteins that are
part of the body. Normally, the immune system ignores proteins that
are part of the human body and attacks only the proteins of invaders,
such as bacteria or viruses. In eczema, the immune system loses the
ability to tell the difference between the two, which causes
inflammation.
Research shows that some people with eczema, especially atopic
dermatitis, have a mutation of the gene responsible for creating
filaggrin. Filaggrin is a protein that helps our bodies maintain a
healthy, protective barrier on the very top layer of the skin. Without
enough filaggrin to build a strong skin barrier, moisture can escape
and bacteria, viruses and more can enter. This is why many people
with atopic dermatitis have very dry and infection-prone skin.

DIAGNOSIS
The diagnosis is made on the physical examination and visual
inspection of the skin. The personal history of inhalant allergies and
family history will often support the diagnosis. Although itching is

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necessary but not sufficient to diagnose atopic dermatitis,
consideration of other itchy eruptions is often necessary.
A patch test can pinpoint certain allergens that trigger symptoms,
like skin allergies associated with contact dermatitis (a type of
eczema).

Fig. 2

During a patch test, an allergen is applied to a patch that’s placed on

the skin. If you’re allergic to that allergen, your skin will become
inflamed and irritated.

TREATMENTS
There is currently no cure for eczema. Treatment for the condition
aims to heal the affected skin and prevent flares of symptoms.

Doctors will suggest a treatment plan based on an individual’s age,

symptoms, and current state of health. For some people, eczema goes
away over time. For others, however, it is a lifelong condition.

Following are some treatment options.

Home care

There are several things that people with eczema can do to support
skin health and alleviate symptoms:
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 • taking lukewarm baths
• applying a cold compress
• applying moisturizer within 3 minutes of bathing to “lock in” moisture
• moisturizing every day
• wearing cotton and soft fabrics
• avoiding rough, scratchy fibers and tight fitting clothing
• using a humidifier in dry or cold weather
• using a mild soap or a non-soap cleanser when washing
• taking extra precautions to prevent eczema flares in winter
• air drying or gently patting the skin dry with a towel, rather than
rubbing the skin dry after bathing or taking a shower
• where possible, avoiding rapid changes of temperature and activities that
cause sweating
• learning and avoiding individual eczema triggers
• keeping fingernails short to prevent scratching from breaking the skin.
• People can also try various natural remedies for eczema, including aloe
vera, coconut oil, and apple cider vinegar.

Medications

Oral over-the-counter (OTC) antihistamines may relieve itching.

They work by blocking histamine, which triggers allergic reactions.
Examples include:
▪ cetirizine (Zyrtec) ▪ diphenhydramine (Benadryl)

▪ fexofenadine (Allegra) ▪ loratadine (Claritin)

Several antihistamines can cause drowsiness, so it’s recommended

they be taken when you don’t need to be alert.
Cortisone (steroid) creams and ointments can relieve itching and
scaling. But they can have side effects after long-term use, which
include:
• thinning of the skin
• irritation
• discoloration

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Low-potency steroids, like hydrocortisone, are available over the
counter. If your body isn’t responding to low-potency steroids, high-
potency steroids can be prescribed by a doctor.
In severe cases, a doctor may prescribe oral corticosteroids. These
can cause serious side effects, including bone loss.
To treat an infection, a doctor may prescribe a topical or oral
antibiotic.
Immunosuppressants are prescription medications that prevent the
immune system from overreacting. This prevents flare-ups of
eczema. Side effects include an increased risk of developing cancer,
infection, high blood pressure, and kidney disease.

Even after an area of skin has healed, it is important to keep looking

after it, as it may easily become irritated again.

Therapies

Light therapy, or phototherapy, uses ultraviolet light or sunlamps to

help prevent immune system responses that trigger eczema. It
requires a series of treatments, and can help reduce or clear up
eczema. It can also prevent bacterial skin infections.

TYPES

1. Atopic Dermatitis
Atopic dermatitis (AD) is the most common form of eczema. It
usually starts in childhood, and often gets milder or goes away by
adulthood. Atopic dermatitis exists with two other allergic
conditions: asthma and hay fever (allergic rhinitis). People who have

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asthma and/or hay fever or who have family members who do, are
more likely to develop AD.

Fig. 3

Fig. 4

Symptoms
Itching is the hallmark of AD, with some data showing that more
than 85% of people with the condition experience this distressing
symptom every day. Sore or painful skin and poor sleep caused by
itching are also common.
People with AD can get rashes and bumps anywhere on the body
that can ooze, weep fluid and bleed when scratched, making skin
vulnerable to infection. Skin can become dry and discolored, and
repeated scratching can cause thickening and hardening — a
process called lichenification.
The rash often forms in the creases of your elbows or knees.

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Causes
In people with AD, the immune system becomes disordered and
overactive (due to genes, environmental triggers, etc.). This triggers
inflammation that damages the skin barrier, leaving it dry and prone
to irritants and allergens, causing itching and rashes that may appear
purple, brown or grayish hue in darker skin tones and red in lighter
skin tones.

Treatment
When AD is mild, management may include:
• avoiding known triggers
• maintaining a regular bathing and moisturizing routine to protect and
strengthen the skin barrier
• getting high-quality sleep
• eating a healthy diet
• managing stress

If these methods are not enough, other treatments include:

• topical corticosteroids
• non-steroidal topicals
• biologics

2. Contact dermatitis
Contact dermatitis happens when the skin becomes irritated or
inflamed after coming in contact with a substance that triggers an
allergic reaction. It bears some of the same symptoms as the six
other types of eczema. But unlike atopic dermatitis, it doesn’t run in
families and isn’t linked to other allergic conditions such as hay fever
or asthma.
It comes in two types:
❖ Allergic contact dermatitis - a delayed allergic reaction that appears as a
rash a day or two after skin is exposed to an allergen. Poison ivy,
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 fragrances, nickel and the preservative thimerosal, which is found in some
topical antibiotics, are common causes of allergic contact dermatitis.

Fig. 5

❖ Irritant contact dermatitis - it happens when skin cells are damaged by

exposure to irritating substances (doesn’t involve an allergic reaction by
the immune system), such as solvents, detergents, soaps, bleach or nickel-
containing jewelry. Makeup, hair dye, nickel-containing scissors, belt
buckles or clothes with metal snaps or zippers can also trigger reactions —
as can over-washing hands with hot water and soap and wearing scratchy
wool.

Fig. 6

Irritant contact dermatitis is common in people whose professions

involve daily use of chemicals, such as mechanics, custodians,
healthcare workers or hairstylists.

Symptoms
In addition to itch, contact dermatitis may cause burning or
blistering of the skin, and can have a major impact on a person’s
quality of life, including sleep disturbances, difficulty
concentrating or performing duties at work and in school.
Treatments

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• Topical steroids may resolve itching and other contact dermatitis
symptoms, but if the rash is widespread, dermatologists may prescribe a
short-term course of oral or injectable corticosteroids.
• Preventing future outbreaks depends on pinpointing—and then avoiding—
the irritant or allergen that triggers flares.
• With irritant contact dermatitis, the trigger is usually easy to identify, as
stinging, pain or discomfort usually happens within minutes of contact.
• For allergic contact dermatitis, knowing what to avoid often requires an in-
office procedure called patch testing. This is when the doctor applies
patches with small amounts of various allergens to the patient’s arm or
back and then evaluates skin after about 48 hours.

3. Dyshidrotic eczema
Dyshidrotic eczema causes small, intensely itchy blisters on the
palms of hands, soles of feet and edges of the fingers and toes. While
the actual cause of dyshidrotic eczema isn’t known, it is more
common in people who have another form of eczema and tends to
run in families, suggesting a genetic component. It is more common
in women than men.

Fig. 7

4. Neurodermatitis
Neurodermatitis is similar to atopic dermatitis. It causes thick, scaly
patches to pop up on your skin. These patches can be very itchy,
especially when you’re relaxed or asleep.
Neurodermatitis usually starts in people who have other types of
eczema or psoriasis. Doctors don’t know exactly what causes it,
although stress can be a trigger.

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 Fig. 8

5. Nummular eczema
Nummular eczema, also known as discoid eczema and nummular
dermatitis, features scattered circular, often itchy and sometimes
oozing patches.
Nummular eczema can be triggered by a reaction to an insect bite, or
by an allergic reaction to metals or chemicals. Dry skin can also
cause it. You’re more likely to get this form if you have another type
of eczema, such as atopic dermatitis.

Fig. 9

6. Seborrheic Dermatitis
Considered a chronic form of eczema, seborrheic dermatitis appears
on the body where there are a lot of oil-producing (sebaceous) glands
like the upper back, nose and scalp.

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 Fig. 10

An inflammatory reaction to excess Malassezia yeast, an organism

that normally lives on the skin’s surface, is the likely cause of
seborrheic dermatitis. The Malassezia overgrows and the immune
system seems to overreact to it, leading to an inflammatory response
that results in skin changes.

7. Stasis dermatitis
Stasis dermatitis, also called gravitational dermatitis, and venous
eczema, happens when fluid leaks out of weakened veins into your
skin. This fluid causes swelling, redness, itching, and pain.

Fig. 11

Stasis dermatitis happens in people who have blood flow problems in

their lower legs. If the valves that normally push blood up through
your legs toward your heart malfunction, blood can pool in your
legs. Your legs can swell up and varicose veins can form.
It can be caused by aging, but it can also signal a serious underlying
medical condition, such as heart or kidney disease.

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RELATED CONDITIONS
When two chronic diseases or illnesses exist in your body at the
same time, they are called “comorbidities” or “related health
conditions.” People with eczema, in particular atopic dermatitis, have
several known comorbidities, such as -- asthma, allergic rhinitis, food
allergies, infections, and mental health conditions. Research also
shows that adults with atopic dermatitis may have a higher risk of
developing heart disease, high blood pressure and stroke.

Asthma
About 20% of adults with atopic dermatitis also have asthma, an
allergic condition which causes a person’s airways to become
inflamed, swollen and narrow, makings it difficult to breathe, leading
to tightness in the chest, coughing and wheezing. Asthma commonly
first appears in childhood and can continue throughout a person’s
lifetime. Some people with asthma only experience it from time to
time, while others need ongoing treatment in order to keep it under
control.

Allergic Rhinitis
Sometimes also called “hay fever,” allergic rhinitis is inflammation in
the nose and sinuses caused by allergens like pollen, dust mites and
pet dander. Symptoms for hay fever can include:
• an itchy nose, mouth, eyes or skin
• a runny or stuffy nose
• sneezing
• watery eyes
• sore throat

Food Allergies
Up to 15% of children aged 3 to 18 months with atopic dermatitis
have an allergy to one or more types of food. The most common food

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allergies in children are milk, eggs, peanuts, wheat and soy.
Symptoms of food allergies typically appear within 30 minutes of
eating or breathing in a food allergen and can include:
• itchy mouth and swelling of the lips
• vomiting, diarrhea, painful stomach cramps
• hives, rash or reddening of the skin
• blood pressure drop

Infections
Due to problems with the skin barrier and an increase of bacteria on
the skin, people with eczema are prone to skin infections from both
bacteria and viruses, especially staph and herpes.
Symptoms of a skin infection include redness, skin that is warm/hot
to the touch, pus-filled bumps (pustules), and cold sores or fever
blisters.

Mental Health Conditions

Research suggests that people with eczema, particularly atopic
dermatitis, have higher rates of depression, anxiety and conduct
disorders. Much remains unknown about the relationship between
these conditions.

STATISTICS
Most surveys and known statistics are on atopic dermatitis, which is
the most common form of eczema.
The prevalence of AD is estimated to be 15-20% in children and 1-
3% in adults worldwide. The incidence has increased by 2 to 3-fold
during the past decades in industrialized countries.

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The following graph shows the incidence of different types of atopy
by age; AD is considered as the first manifestation of the atopic
march.

Fig. 12

The following map shows the global age-standardized prevalence of

atopic dermatitis in all individuals per 100,000 persons. Blue areas
indicate low prevalence and red areas indicate high prevalence.

Fig. 13

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METHODOLOGY - CASE STUDY

The aim of this case study is to

❖ observe and analyse the symptoms and triggers of eczema
in a patient who is diagnosed with the same.
❖ examine the types of eczema present, treatment plans,
family and other medical history, and prevalence in
everyday life.

PATIENT INFORMATION:-
Name: Sapna Harilal Age: 17 years
Sex: Female Month/Year: August/2021
Occupation: Student Ethnicity: Indian
Weight: 48 kg Height: 159 cm

Medical history:
➢ symptoms of eczema first observed a year prior to this study
➢ persistent allergic rhinitis since childhood
➢ dry skin conditions as an infant
➢ allergic symptoms to antibiotic Augmentin in childhood

Current diagnosis: Atopic dermatitis, allergic contact dermatitis

(Symptoms present on skin folds of both left and right upper limbs,
and above right knee)

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ANALYSIS OF SYMPTOMS

The symptoms have shown recurrence in different parts of

the body since their first onset a year prior.
At most times, the patient experiences a combination of one
or more of the symptoms.

This is described as follows.

1. Left and right axilla (armpits)

• dry, darkened (brownish-grey) skin

• slightly thickened skin due to repeated scratching
• when not exposed to trigger, mild itching occurs only
when the skin is not moisturized or is in contact with
rough fabrics
• when exposed to trigger, intense itching and
inflammation occurs, and scratching leads to scaley skin
and red patches
• further scratching of irritated skin leads to small cuts
which cause burning sensation and possible bleeding
• once intense flare up occurs, itching subsides only on
application of medication
• mild flare ups can be alleviated by applying cold
compresses and moisturising
• itching is more prominent during the night

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 2. Right cubital fossa (inner elbow fold)

• symptoms do not always appear immediately after

exposure to triggers
• flare up starts as small blisters and bumps, and progresses
to a red patch if left untreated
• when flare up is mild, itching is intermittent
• when flare up is at full strength, intense itching is
observed at all times
• once red patch is formed, it subsides only on application
of medicine
• once skin is cleared, itching does not occur again till
exposure to trigger

Following are some pictures (taken over two weeks) depicting the
flare up at different stages:

Stage 1: Minute, almost invisible bumps and slight discolouration.

Tingling sensations and very slight itching.

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Stage 2: Blister(s) appear more prominent and red patches begin to
appear. Intermittent mild itching occurs.

Stage 3: More blisters and bumps appear and red patches grow.

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Stage 4: Blisters become more scattered and ares of patch increases.
Itch becomes more frequent.

Stage 5: Consistent red patch is formed. Constant itching that

continues till medicated.

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3. Left cubital fossa (inner elbow fold)

• has only shown major symptoms once since onset

• slight itching when exposed to trigger and very small
patch formed
• no blisters
• does not require medication to clear

(The pictures were taken two weeks apart)

4. Above right knee

• circular, red patch of raised skin

• no itch unless forcefully irritated
• does not require medication
• fades naturally over time
• unknown trigger

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 The patch has
faded naturally
over time.

(The pictures were taken over the

course of a month )

The symptoms point to the following:

➢ Atopic dermatitis of the axilla
➢ Allergic contact dermatitis of the cubital fossa
➢ Possible nummular dermatitis above right knee

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TRIGGERS AND IRRITANTS

Exposure to certain substances and materials tends to trigger

inflammation in different regions at different times.
The most potent trigger is dust, which the patient had a negative
reaction to in the form of allergic rhinitis, even prior to the onset of
atopic dermatitis.
The patient has experienced skin irritation and flare ups on coming
in contact with the following chemicals:

Perfumes Air fresheners Fabric softeners

It has been observed that the consumption of dairy, mainly milk, can
aggravate already existing symptoms. However, this does not occur
at every instance and dairy intake also does not in itself trigger a
flare up. Hence, it cannot be concluded that the patient is reacting to
the dairy products.
No other food allergies have been observed.
Periods of stress have also shown to further aggravate the patient’s
existing symptoms.

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Contact of areas which are usually triggered, with certain types of
fabrics can also cause or worsen inflamation and itching. Some of
these are pictured below:

Rough textures Polyester

Cotton-polyester blends
present
inside sweaters

Chains, earrings, bangles, bracelettes and other miscellanoeus

jewellery of unknown metal alloys also cause irritation and rashes,
especially when worn for extended periods.
Excessive sweating, especially caused by prolonged periods of
exercise, also acts as a trigger or worsen existing symptoms.
Drying of skin due to loss of moisture in air due to air conditioning,
is also a factor that contributes to the condition.

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TREATMENT AND MANAGEMENT

To treat an eczema flare up, the patient uses the following

medication as per prescription of their dermatologist.
The prescription has been attached below:

(The information about the medication given next is taken from the
package leaflets)

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1) Protopic 0.1% ointment
Instructions:
Apply to affected areas of skin
once a day (before sleep) for 14
days.
Once eczema has cleared, apply
twice weekly (once each day) for
maintenance.
(Topical)

The active substance in Protopic, Tacrolimus monohydrate, is an

immunomodulating agent.
It is used to treat moderate to severe atopic dermatitis in adults and
adolescents (age 16 and above) who are not adequately responsive to
or are intolerant of conventional therapies such as topical
corticosteroids.

2) Fucidin H cream (Antibiotic/corticosteroid)

Instructions:
Apply to affected areas of skin
twice a day for 10 days.
Long-term continuous use
should be avoided.
(Topical)

The active ingredients in Fucidin, Fusidic acid 20 mg/g and

Hydrocortisone acetate 10 mg/g, have antibacterial and anti-
inflammatory properties, respectively.

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It is used for the treatment of dermatitis, including atopic dermatitis,
where an infection with bacteria sensitive to Fusidic acid is suspected
or confirmed.

3) Desloxan 5 mg
Instructions:
Take 1 tablet, once a day (before sleep) for
10 days.
It should be taken during or in between
meals.
(Oral)

The active ingredient in Desloxan, desloratadine, is an antihistamine.

It is an anti-allergy medicine that does not make you drowsy. It
helps control allergic reactions and symptoms.
It can relieve symptoms associated with allergic rhinitis
(inflammation of the nasal passage) and allergic urticaria (a skin
condition caused by an allergy). Urticaria symptoms include itching
and hives.

Management of eczema includes prevention of flares by

avoiding triggers, and alleviating mild symptoms without
medication.

The following is a prevention plan provided by a

dermatologist:

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32
The patient avoids dust, fabric softeners, sprays and wool.
The food items mentioned were avoided for a month and slowly
reintroduced to check for allergies, however, the results were
inconclusive. So, the patient continues to consume them.
The soap-free wash from Bioderma is used to reduce further drying
of skin.

QV Cream is used as moisturizer. It is

suitable for the treatment and relief of
dry skin conditions such as eczema, by
helping to prevent loss of moisture.
The moisturizer is applied for a
minimum of three times a day – in the
morning, after a bath, and before sleep.
It is applied immediately after the bath
to lock-in moisture.
It can be applied as many times as
necessary throughout the day to
irritated skin to relieve itching.

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To relieve a mild flare up, a cold compress is used, by filling a zip
lock bag with ice and wrapping it with a cloth, and applying it to the
irritated skin. The ice is not to be directly applied to skin since it can
cause more drying.
If proximity to dust cannot be avoided, the patient wears a mask and
long sleeved clothing to prevent contact.

The following is an illustration of how inflammation occurs:

For people such as the patient, with a genetic predisposition to dry

skin, there is inadequate oil production by the sebaceous glands.
This results in the outermost epithelial layer to not be continuous,
leading to gaps in the skin barrier.
Allergens are able to enter the skin through these gaps and can cause
inflammation in the body.

(as explained by a dermatologist)

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FAMILY HISTORY AND RELATED CONDITIONS

The patient has the following family medical history related

to their atopic dermatitis:
➢ Father is suspected to have allergic rhinitis
➢ Brother was diagnosed with childhood asthma and allergic
rhinitis.
➢ Mother was diagnosed with rosacea, another inflammatory skin
condition that affects the face.
The patient themselves also has a history with allergic rhinitis and
dry skin.

This signals towards the patient having atopy, which

is a genetic tendency to develop allergic diseases such
as allergic rhinitis, asthma and atopic dermatitis
(eczema).

Prevalence in everyday life:

The patient experiences irritation and itching on a daily basis, which
is further exacerbated during periods of mental and physical
exertion, due to stress and perspiration respectively. The patient
finds it hard to manage the condition without open access to
moisturizer, especially during the night. Expressing the irritation
when in public and outdoors also poses an issue.

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DISCUSSION
The following section details and gives abstracts of research
works related to eczema, particularly atopic dermatitis and
contact dermatitis.

1) Topic: Epidemiology of atopic dermatitis

Scientist: H. C. Williams
First published: 07 July 2008

Abstract:
Although research into atopic dermatitis (AD) has been dominated
by the study of cells and chemical mechanisms over the last 40 years,
the last 7 years has witnessed a respectable growth within the field
of AD epidemiology.
Significant advances include valid disease definitions that can be used
in epidemiological studies, global prevalence studies, and studies
which quantify the morbidity and economic cost of the disease.
These have all helped to argue the case for more research into AD.
Epidemiological studies demonstrating that AD is more common in
wealthier families, linkage with small family size, increased
prevalence in migrant groups, and the increasing prevalence of the
disease all argue strongly towards an important role for the
environment in determining disease expression.
Future research gaps include evaluation of gene–environment
interactions, better studies of the natural history of AD, and better
clinical trials that answer questions that are important to physicians
and their patients.

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2) Topic: Atopic dermatitis and the atopic march
revisited
Scientists: S. C. Dharmage, A. J. Lowe, M. C.
Matheson, J. A. Burgess, K. J. Allen, M. J. Abramson
First published: 14 October 2013

Abstract:
Atopic dermatitis (AD) has become a significant public health
problem because of increasing prevalence, together with increasing
evidence that it may progress to other allergic phenotypes. While it
is now acknowledged that AD commonly precedes other allergic
diseases, a link termed ‘the atopic march’, debate continues as to
whether this represents a causal relationship.
An alternative hypothesis is that this association may be related to
confounding by familial factors or phenotypes that comanifest, such
as early-life wheeze and sensitization. The hypotheses on plausible
biological mechanisms for the atopic march focus on defective skin
barrier function and overexpression of inflammatory mediators
released by the skin affected by AD (including thymic stromal
lymphopoietin).
Both human and animal studies have provided evidence supporting
these potential biological mechanisms. Evidence from prevention
trials is now critical to establishing a causal nature of the atopic
march.
An emerging area of research is investigation into environmental
modifiers of the atopic march. Such information will assist in
identifying secondary prevention strategies to arrest the atopic
march.
Despite much research into the aetiology of allergies, little progress
has been made in identifying effective strategies to reduce the burden
of allergic conditions. In this context, the atopic march remains a
promising area of investigation.

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3) Topic: Eczema and sleep and its relationship to
daytime functioning in children
Scientists: Danny Camfferman, John D. Kennedy,
Michael S. Gold, Alfred J. Martin, Kurt Lushington
First published: 17 December 2009

Abstract:
Chronic childhood eczema has significant morbidity characterised by
physical discomfort, emotional distress, reduced child and family
quality-of-life and, of particular note, disturbed sleep characterised
by frequent and prolonged irritation.
Sleep disturbance affects up to 60% of children with eczema,
increasing to 83% during exacerbation. Even when in
clinical remission, children with eczema demonstrate more sleep
disturbance than healthy children.
Notably, disturbed sleep in otherwise healthy children is associated
with behavioural and neurocognitive deficits. Preliminary evidence
suggests that disturbed sleep in children with eczema is also
associated with behavioural deficits while the impact on
neuropsychological functioning remains unexplored.
In conclusion, a disease which affects up to 20% of children in some
countries and may produce long-term behavioural and
neurocognitive deficits merits further evaluation using standardised
tests of sleep, behaviour and neurocognition.

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4) Topic: Association of Perceived Stress with Atopic
Dermatitis in Adults: A Population-Based Study in Korea
Scientists: Hyejin Park, Kisok Kim
First published: 27 July 2016

Abstract:
Atopic dermatitis (AD) is a widely prevalent skin disease that affects
both children and adults. The aim of the study was to assess the
association of perceived stress (single-item, self-reported) with AD
(self-reported) in a sample of Korean adults using a cross-sectional
research design.
A cross-sectional study was conducted using data from 33,018 adults
aged 20 years and older collected in the 2007–2012 Korea National
Health and Nutrition Examination Surveys (KNHANES).
An increased level of self-reported stress was positively associated
with an increased prevalence of AD in Korean adults. The study
found that perceived stress was strongly associated with AD in
Korean adults.
Given that stress interferes with several physiological and
pathological processes, the results emphasize that stress may play an
important role in the etiology and prognosis of AD. Because AD
affects the physical, psychological, psychosocial, and occupational
outlook of the patient, at great cost not only to the patient but also
to society, broad social policies and interventions are required to
mitigate psychological stress in adults.
In addition, an assessment of psychological factors would be
important to identify a high-risk subpopulation, which would allow
earlier intervention and thereby prevent the onset and exacerbation
of AD.

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5) Topic: Recent advances in understanding and
managing contact dermatitis
Scientists: Stefan F. Martin, Thomas Rustemeyer, Jacob
P. Thyssen
First published: 20 June 2018

Abstract:
About 20% of the general population is contact-sensitized to
common haptens such as fragrances, preservatives, and metals. Many
also develop allergic contact dermatitis (ACD), the clinical
manifestation of contact sensitization.
ACD represents a common health issue and is also one of the most
important occupational diseases. Although this inflammatory skin
disease is mediated predominantly by memory T lymphocytes
recognizing low-molecular-weight chemicals after skin contact, the
innate immune system also plays an important role. Along that line,
the presence of irritants may increase the risk of ACD and therefore
ACD is often seen in the context of irritant contact dermatitis.
This article discusses the recent progress in basic research that has
dramatically increased our understanding of the pathomechanisms of
ACD and provides a basis for the development of novel diagnostic
and therapeutic measures. It also discusses current methods for
diagnosis as well as treatment options of ACD.

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CONCLUSION

The case study has foremost shown that eczema, particularly atopic
dermatitis, can onset in adolescence and not just in early childhood as
is common.
Using photographic documentation of a flare up over a period of two
weeks, the study has corroborated the official diagnosis of atopic
dermatitis and allergic contact dermatitis, as well as discovered the
possible onset of nummular eczema.
We have observed the patterns and intensity of symptoms the
condition can have in a person of the given age, sex, ethnicity,
medical history, and family background. The study has also shown
how an individual can have different types of eczema simultaneously,
and how eczema often occurs in cycles where the symptoms worsen
and then improve or clear up, and does not have a real cure.
The study has documented some of the different triggers and irritants
an eczema patient can encounter in everyday life. These have been
found to be mostly in line with the common eczema triggers
mentioned earlier – dust, fragrances, cleaning chemicals, dairy
products, nickel-containing jewelry, rough fabrics, perspiration,
stress, etc.
Descriptions of medication such as immunosuppressants, antibiotics,
corticosteroids and antihistamines, that are often prescribed for the
treatment of eczema, along with a detailed plan for the prevention
and management of symptoms have been included in the study.
The patient’s medical and family history have been drawn to show
how both genetic and environmental factors are responsible for the
inflammation that is characteristic of eczema.
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The study corroborates the observation that having family or
personal history of atopic disorders, increases the risk factor for
atopic dermatitis.
Lastly, people with eczema have reportedly higher rates of mental
health conditions like depression and anxiety. This could be due to
the impact of the disorder on everyday life including productivity and
sleep cycles, along with the social and financial burden it poses.

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SUMMARY

▪ The topic chosen for this project is ‘Eczema – Atopic and Contact
Dermatitis’

▪ The methodology used is a case study, with photographic

documentation of symptoms, and analysis of triggers, treatment
plans and family history.

▪ The research works discussed are the following:

- Epidemiology of atopic dermatitis
- Atopic dermatitis and the atopic march revisited
- Eczema and sleep and its relationship to daytime functioning in
children
- Association of Perceived Stress with Atopic Dermatitis in Adults: A
Population-Based Study in Korea
- Recent advances in understanding and managing contact dermatitis

▪ Conclusions:
- Eczema can onset in adolescence, not just in childhood.
- An individual can simultaneously have different types of eczema.
- There is no real cure, and symptoms tend occur in cycles.
- Caused by both genetic and environmental factors
- It can be controlled by avoiding triggers and with usage of
moisturisers, corticosteroids and antihistamines.
- The condition can contribute to negative mental health.
- Atopic dermatitis is the most common form of eczema and is part of
the ‘Atopic March’ along with asthma and allergic rhinitis.

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BIBLIOGRAPHY

1. https://nationaleczema.org/eczema/types-of-eczema/
2. https://www.medicalnewstoday.com/articles/14417
3. https://www.healthline.com/health/eczema?c=1312212509433
4. https://www.healthline.com/health/types-of-eczema?c=1312212509433
5. https://www.medicinenet.com/atopic_dermatitis/article.htm
6. https://nationaleczema.org/eczema/related-conditions/
7. https://www.karger.com/Article/FullText/370220
8. https://www.aaaai.org/Tools-for-the-Public/Allergy,-Asthma-Immunology-
Glossary/Atopy-Defined

PICTURE SOURCES

1. Ulrich Zillmann/Getty Images (Fig. 1)

2. https://www.naetdubai.com/eczema-unlocking-the-truth/ (Fig. 2)
3. https://www.mayoclinic.org/diseases-conditions/atopic-dermatitis-
eczema/symptoms-causes/syc-20353273 (Fig. 3)
4. https://emedicine.medscape.com/article/1049085-overview (Fig. 4)
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causes/syc-20352742 (Fig. 5)
6. https://nationaleczema.org/eczema/types-of-eczema/ (Fig. 6, 7, 8, 10, 11)
7. https://www.webmd.com/skin-problems-and-treatments/eczema/picture-of-
nummular-eczema (Fig. 9)
8. Barnetson RS, Rogers M: Childhood atopic eczema. BMJ 2002;324:1376-1379 (Fig.
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9. Global Burden of Disease project 2017 data, Institute for Health Metrics and
Evaluation, University of Washington, Seattle, WA, USA. (Fig. 13)

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