Dermatology 101: recognizing eczema

In this video, you'll discover the telltale signs of eczema, why it can sometimes be difficult to diagnose, and important clues that will lead you to the right diagnosis every single time.

Paul Scheidegger, MD
Paul Scheidegger, MD
1st Jul 2021 • 5m read
Loading....

Eczema is one of the most common skin conditions you'll encounter in practise and yet MANY doctors misdiagnose it as psoriasis. So how do you tell them apart once and for all? In this video, from our Dermatology Mini: The 8 Foundational Principles course, you'll discover the telltale signs of eczema, why it can sometimes be difficult to diagnose, and important clues that will lead you to the right diagnosis every single time.

Join our Dermatology Mini: The Eight Foundational Principles course now!

Does dermatology scare you? We’ve all been there—is this flaky spot eczema or skin cancer?! Thankfully, this course will teach you what med school didn’t. You’ll master eight diagnostic principles to help you diagnose 80% of skin problems, without the help of a dermatologist, and also learn to recognize the conditions that need specialist attention ASAP.

Start the first chapter of our Dermatology Mini: The 8 Foundational Principles course for free

Start chapter 1 now

Video transcript

The most common dermatological condition that you will encounter in daily practice is eczema. In this Medmastery lesson you will learn how to recognize and treat patients with this condition. So what exactly is eczema? Well, eczema or dermatitis represents a group of non-infectious conditions in which the skin becomes inflamed, dry and scaly.

Clinically, eczema can be diagnosed according to the four following criteria: itchiness, red color, also called erythema, blister formation, and or scaling. Let's look at some typical clinical examples. Here are two images of eczema. Usually, a rash caused by eczema exhibits a reddish rough and scaling or blistering surface. However, it is important to know that on non-white skin, this red color can be more subtle.

In patients with brown or black skin, the rash caused by eczema tends to look darker brown, purple, or ashen gray in color. In the absence of characteristic redness, other symptoms, such as skin swelling, warmth, scaling, and itching may help to confirm your diagnosis. Unique forms of eczema may also be observed in those with darker skin. For example, African Americans more commonly develop small bumps on their legs, arms or torso. These bumps may develop around hair follicles and resemble goosebumps. This is known as follicular accentuation.

It is important to be aware of these differences when assessing your patients. In each case, taking a skin biopsy from a patient with a suspected eczema for histological analysis can help confirm your diagnosis. Here is a hematoxylin and eosin stained histological section of the skin. The skin is composed of two main layers, the epidermis and the dermis. in patients with inflammation causes damage to the epidermis resulting in a characteristic spongiotic tissue reaction pattern. Here, the epidermis appears to be full of bubbles, and this explains the rough surface or presence of small blisters that can be observed upon closer clinical inspection of patients with eczema.

It is this spongy surface appearance that dermatologists look for to support the diagnosis of eczema. That distribution of the patient's rash can also provide important clues for diagnosis. If you look closely, you will find a bilateral and more or less symmetrical distribution of the red scaling and itchy bumps in most cases of eczema. The severity may be different on the left and right sides of the body, but this is still considered to be a symmetrical pattern. Therefore, one sided or isolated rashes are typically not eczema.

Eczema also comes and then goes over several days or weeks, but it's typically a rather non-migratory condition. There are many causes of eczema, but the main cause is underlying inflammation induced by allergens, genetics, or environmental factors. The most common cause of eczema is a topic dermatitis, which is an inherited chronic inflammatory skin condition. It results in itchy, red, swollen and cracked skin. Clear fluid may also leak from the affected areas.

Explication dermatosis, is another common cause of eczema, it also comes and then goes over several days or weeks, but it's typically a rather non migratory condition. There are many causes of eczema, but the main cause is underlying inflammation induced by allergens, genetics, or environmental factors. This occurs after excessive exposure to water, and can develop when you wash your hands regularly or shower too often. Therefore, it is of utmost importance to regularly apply a moisturizer after washing and showering.

Eczema may look similar to other skin conditions. But there are some important tips and tricks that can help you recognize and diagnose patients with eczema without needing to refer them to a dermatologist. One key thing to remember is that eczema is the most common skin condition in ambulatory care. So if the patient's history is lacking, or non contributory, or the images are poor, then assume it's eczema until proven otherwise.

Also, it is a hallmark of eczema also comes and then goes over several days or weeks, but it's typically a rather non-migratory condition. There are many causes of eczema, but the main cause is underlying inflammation induced by allergens, genetics, or environmental factors. The This occurs after excessive exposure to water, and can develop when you wash your hands regularly or shower too often. Therefore, it is of utmost importance to regularly apply a moisturizer after washing and showering. excema may look similar to other skin conditions.

But there are some important tips and tricks that can help you recognize and diagnose patients with eczema without needing to refer them to a dermatologist. Why one key thing to remember is that eczema is the most common skin condition in ambulatory. So if a rash diagnosed as eczema does not itch, then you must reconsider your differential diagnosis.

Similarly, eczema is typically not seen together with a rash in the mouth, known as enanthema. So if your patient presents with both a rash on their skin and and nn enanthema, then you must consider a different diagnosis. Urticaria or hives is a common condition that is often confused with eczema. Both conditions cause the skin to appear red, are symmetrical and distribution and are very itchy.

But there are two key differences that can help you distinguish between them. First, Urticaria is a migratory skin condition. So it moves around within six to 12 hours, whereas eczema is a more stationary condition. Second, urticaria has a non scaling smooth surface, whereas a scaling or rough surface is a characteristic sign of eczema that is never found in patients with urticaria. Once you've reached a diagnosis of eczema, the next step is of course, treatment.

The most effective treatment of eczema is the use of topical steroids one to two times daily. You should also advise your patients to stop any prior treatment and care products because they can be sources of irritation or contact allergies. The patient should reduce their contact with water. And lastly, it might be useful to provide your patient with a fragrance free moisturizer without urea, which can potentially cause stinging, or skin irritation.

So there you have it. Keeping all of these important points in mind will help you recognize and treat eczema in the clinic. And remember eczema is the most common skin condition. So if your patient has a rash that you can identify, administer a trial of topical steroids twice daily for five days. Most skin conditions should improve or even disappear and if not, then call the dermatologist.