Dermatitis

Dermatitis

A moderate case of dermatitis of the hands
Classification and external resources
Specialty Dermatology
ICD-10 L20-L30
ICD-9-CM 692
OMIM 603165
MedlinePlus 000853
eMedicine Derm/38 Ped/2567
MeSH D004485

Dermatitis, also known as eczema, is inflammation of the skin. It is characterized by itchy, erythematous, vesicular, weeping, and crusting patches. The term eczema is also commonly used to describe atopic dermatitis[1][2] also known as atopic eczema.[3] In some languages, dermatitis and eczema are synonyms, while in other languages dermatitis implies an acute condition and eczema a chronic one.[4]

The cause of dermatitis is unclear.[5][6][7] One possibility is a dysfunctional interplay between the immune system and skin.[8]

The term eczema is broadly applied to a range of persistent skin conditions. These include dryness and recurring skin rashes that are characterized by one or more of these symptoms: redness, skin swelling, itching and dryness, crusting, flaking, blistering, cracking, oozing, or bleeding. Areas of temporary skin discoloration may appear and are sometimes due to healed injuries. Scratching open a healing lesion may result in scarring and may enlarge the rash.

Treatment is typically with moisturizers and steroid creams.[3] If these are not effective, creams based on calcineurin inhibitors may be used.[9] The disease was estimated as of 2010 to affect 230 million people globally (3.5% of the population).[10] While dermatitis is not life-threatening, a number of other illnesses have been linked to the condition, including osteoporosis, depression, and heart disease.[11][12]

Classification

Eczema
Dermatitis of the hand.
More severe eczema
A patch of eczema that has been scratched

The term "eczema" refers to a set of clinical characteristics. Classification of the underlying diseases has been haphazard and unsystematic, with many synonyms being used to describe the same condition.

A type of eczema may be described by location (e.g. hand eczema), by specific appearance (eczema craquele or discoid), or by possible cause (varicose eczema). Further adding to the confusion, many sources use the term eczema interchangeably for the most common type of eczema (atopic dermatitis) .

The European Academy of Allergology and Clinical Immunology (EAACI) published a position paper in 2001, which simplifies the nomenclature of allergy-related diseases, including atopic and allergic contact eczemas.[13] Non-allergic eczemas are not affected by this proposal.

Terminology

There are several different types of dermatitis. The different kinds usually have in common an allergic reaction to specific allergens. The term may describe eczema, which is also called dermatitis eczema and eczematous dermatitis. An eczema diagnosis often implies atopic dermatitis (which is very common in children and teenagers) but, without proper context, may refer to any kind of dermatitis.[14]

In some languages, dermatitis and eczema are synonyms, while in other languages dermatitis implies an acute condition and eczema a chronic one.[4] The two conditions are often classified together.

Common types

Some substances act both as allergen and irritant (wet cement, for example). Other substances cause a problem after sunlight exposure, bringing on phototoxic dermatitis. About three quarters of cases of contact eczema are of the irritant type, which is the most common occupational skin disease. Contact eczema is curable, provided the offending substance can be avoided and its traces removed from one's environment. (ICD-10 L23; L24; L56.1; L56.0)

Less common types

Signs and symptoms

Rash symptomatic of dermatitis

Dermatitis symptoms vary with all different forms of the condition. They range from skin rashes to bumpy rashes or including blisters. Although every type of dermatitis has different symptoms, there are certain signs that are common for all of them, including redness of the skin, swelling, itching and skin lesions with sometimes oozing and scarring. Also, the area of the skin on which the symptoms appear tends to be different with every type of dermatitis, whether on the neck, wrist, forearm, thigh or ankle. Although the location may vary, the primary symptom of this condition is itchy skin. More rarely, it may appear on the genital area, such as the vulva or scrotum.[16] Symptoms of this type of dermatitis may be very intense and may come and go. Irritant contact dermatitis is usually more painful than itchy.

Although the symptoms of atopic dermatitis vary from person to person, the most common symptoms are dry, itchy, red skin. Typical affected skin areas include the folds of the arms, the back of the knees, wrists, face and hands.

Dermatitis herpetiformis symptoms include itching, stinging and a burning sensation. Papules and vesicles are commonly present. The small red bumps experienced in this type of dermatitis are usually about 1 cm in size, red in color and may be found symmetrically grouped or distributed on the upper or lower back, buttocks, elbows, knees, neck, shoulders, and scalp.[17] Less frequently, the rash may appear inside the mouth or near the hairline.

The symptoms of seborrheic dermatitis on the other hand, tend to appear gradually, from dry or greasy scaling of the scalp (dandruff) to hair loss. In severe cases, pimples may appear along the hairline, behind the ears, on the eyebrows, on the bridge of the nose, around the nose, on the chest, and on the upper back.[18] In newborns, the condition causes a thick and yellowish scalp rash, often accompanied by a diaper rash.

Perioral dermatitis refers to a red bumpy rash around the mouth.[19]

Cause

Complex eczema treated with a combination of antifungal and corticosteroid creams at the same time.

The cause of eczema is unknown but is presumed to be a combination of genetic and environmental factors.[20]

Environmental

The hygiene hypothesis postulates that the cause of asthma, eczema, and other allergic diseases is an unusually clean environment. It is supported by epidemiologic studies for asthma.[21] The hypothesis states that exposure to bacteria and other immune system modulators is important during development, and missing out on this exposure increases risk for asthma and allergy.

While it has been suggested that eczema may sometimes be an allergic reaction to the excrement from house dust mites,[22] with up to 5% of people showing antibodies to the mites,[23] the overall role this plays awaits further corroboration.[24]

Genetic

A number of genes have been associated with eczema, one of which is filaggrin.[3] Genome-wide studies found three new genetic variants associated with eczema: OVOL1, ACTL9 and IL4-KIF3A.[25]

Eczema occurs about three times more frequently in individuals with celiac disease and about two times more frequently in relatives of those with celiac disease, potentially indicating a genetic link between the two conditions.[26][27]

Diagnosis

Diagnosis of eczema is based mostly on the history and physical examination.[3] However, in uncertain cases, skin biopsy may be useful. Those with eczema may be especially prone to misdiagnosis of food allergies.[28]

Patch tests are used in the diagnosis of allergic contact dermatitis.[29][30]

Prevention

There is no good evidence that a mother's diet during pregnancy, the formula used, or breastfeeding changes the risk.[31] There is tentative evidence that probiotics in infancy may reduce rates but it is insufficient to recommend its use.[32]

People with eczema should not get the smallpox vaccination due to risk of developing eczema vaccinatum, a potentially severe and sometimes fatal complication.[33]

Management

There is no known cure for eczema, with treatment aiming to control symptoms by reducing inflammation and relieving itching.

Lifestyle

Bathing once or more a day is recommended.[3] It is a misconception that bathing dries the skin in people with eczema.[34] Soaps and detergents should not be used on affected skin because they can strip natural skin oils and lead to excessive dryness. It is not clear whether dust mite reduction helps with eczema.

There has not been adequate evaluation of changing the diet to reduce eczema.[35][36] There is some evidence that infants with an established egg allergy may have a reduction in symptoms if eggs are eliminated from their diets.[35] Benefits have not been shown for other elimination diets, though the studies are small and poorly executed.[35][36] Establishing that there is a food allergy before dietary change could avoid unnecessary lifestyle changes.[35]

People can also wear clothing designed to manage the itching, scratching and peeling.[37]

Moisturizers

Moisturizing agents (also known as emollients) are recommended at least once or twice a day.[3] Oilier formulations appear to be better and water-based formulations are not recommended.[3] It is unclear if moisturizers that contain ceramides are more or less effective than others.[38] Products that contain dyes, perfumes, or peanuts should not be used.[3] Occlusive dressings at night may be useful.[3]

Medications

There is little evidence for antihistamine and they are thus not generally recommended.[3] Sedative antihistamines, such as diphenhydramine, may be tried in those who are unable to sleep due to eczema.[3]

Corticosteroids

If symptoms are well controlled with moisturizers, steroids may only be required when flares occur.[3] Corticosteroids are effective in controlling and suppressing symptoms in most cases.[39] Once daily use is generally enough.[3] For mild-moderate eczema a weak steroid may be used (e.g. hydrocortisone), while in more severe cases a higher-potency steroid (e.g. clobetasol propionate) may be used. In severe cases, oral or injectable corticosteroids may be used. While these usually bring about rapid improvements, they have greater side effects.

Long term use of topical steroids may result in skin atrophy, stria, telangiectasia.[3] Their use on delicate skin (face or groin) is therefore typically with caution.[3] They are, however, generally well tolerated.[40]

Topical steroid addiction (TSA) has been reported in long-term users of topical steroids (users who applied topical steroids to their skin over a period of weeks, months, or years).[41][42] TSA is characterised by uncontrollable, spreading dermatitis and worsening skin inflammation which requires a stronger topical steroid to get the same result as the first prescription. When topical steroid medication is lost, the skin experiences redness, burning, itching, hot skin, swelling, and/or oozing for a length of time. This is also called "red skin syndrome" or "topical steroid withdrawal" (TSW). After the withdrawal period is over the atopic dermatitis can cease or is less severe than it was before.[43]

Immunosuppressants

Tacrolimus 0.1%

Topical immunosuppressants like pimecrolimus and tacrolimus may be better in the short term and appear equal to steroids after a year of use.[44] Their use is reasonable in those who do not respond to or are not tolerant of steroids.[9] Treatments are typically recommended for short or fixed periods of time rather than indefinitely.[3] Tacrolimus 0.1% has generally proved more effective than picrolimus, and equal in effect to mid-potency topical steroids.[31]

The United States Food and Drug Administration has issued a health advisory a possible risk of lymph node or skin cancer from these products,[45] however subsequent research has not supported these concerns.[9] A major debate, in the UK, has been about the cost of these medications and, given only finite NHS resources, when they are most appropriate to use.[46]

When eczema is severe and does not respond to other forms of treatment, systemic immunosuppressants are sometimes used. Immunosuppressants can cause significant side effects and some require regular blood tests. The most commonly used are ciclosporin, azathioprine, and methotrexate.

Light therapy

Light therapy using ultraviolet light has tentative support but the quality of the evidence is not very good.[47] A number of different types of light may be used including UVA and UVB;[48] in some forms of treatment, light sensitive chemicals such as psoralen are also used. Overexposure to ultraviolet light carries its own risks, particularly that of skin cancer.[49]

Alternative medicine

There is currently no scientific evidence for the claim that sulfur treatment relieves eczema.[50] It is unclear whether Chinese herbs help or harm.[51] Dietary supplements are commonly used by people with eczema.[52] Neither evening primrose oil nor borage seed oil taken orally have been shown to be effective.[53] Both are associated with gastrointestinal upset.[53] Probiotics do not appear to be effective.[54] There is insufficient evidence to support the use of zinc, selenium, vitamin D, vitamin E, pyridoxine (vitamin B6), sea buckthorn oil, hempseed oil, sunflower oil, or fish oil as dietary supplements.[52]

Other remedies lacking evidential support include chiropractic spinal manipulation and acupuncture.[55] There is little evidence supporting the use of psychological treatments.[56] While dilute bleach baths have been used for infected dermatitis there is little evidence for this practice.[57]

Prognosis

Most cases are well managed with topical treatments and ultraviolet light.[3] About 2% of cases however are not.[3] In more than 60% the condition goes away by adolescence.[3]

Epidemiology

Globally eczema affected approximately 230 million people as of 2010 (3.5% of the population).[58] The lifetime clinician-recorded prevalence of eczema has been seen to peak in infancy, with female predominance of eczema presentations occurring during the reproductive period of 15–49 years.[59] In the UK about 20% of children have the condition, while in the United States about 10% are affected.[3]

Although little data on the rates of eczema over time exists prior to the 1940s, the rate of eczema has been found to have increased substantially in the latter half of the 20th Century, with eczema in school-aged children being found to increase between the late 1940s and 2000.[60] In the developed world there has been rise in the rate of eczema over time. The incidence and lifetime prevalence of eczema in England has been seen to increase in recent times.[3][61]

Dermatitis affected about 10% of U.S. workers in 2010, representing over 15 million workers with dermatitis. Prevalence rates were higher among females than among males, and among those with some college education or a college degree compared to those with a high school diploma or less. Workers employed in healthcare and social assistance industries and life, physical, and social science occupations had the highest rates of reported dermatitis. About 6% of dermatitis cases among U.S. workers were attributed to work by a healthcare professional, indicating that the prevalence rate of work-related dermatitis among workers was at least 0.6%.[62]

History

from Ancient Greek ἔκζεμα ékzema,[63]
from ἐκζέ-ειν ekzé-ein,
from ἐκ ek "out" + ζέ-ειν zé-ein "to boil"

(OED)

The term "atopic dermatitis" was coined in 1933 by Wise and Sulzberger.[64] Sulfur as a topical treatment for eczema was fashionable in the Victorian and Edwardian eras.[50]

The word dermatitis is from the Greek δέρμα derma "skin" and -ῖτις -itis "inflammation" and eczema is from Greek: ἔκζεμα ekzema "eruption".[65]

Society and culture

The terms "hypoallergenic" and "doctor tested" are not regulated,[66] and no research has been done showing that products labeled "hypoallergenic" are in fact less problematic than any others.

References

  1. ↑ "Eczema". ACP medicine. Retrieved 9 January 2014.
  2. ↑ Bershad, SV (1 November 2011). "In the clinic. Atopic dermatitis (eczema)". Annals of Internal Medicine 155 (9): ITC51–15; quiz ITC516. doi:10.1059/0003-4819-155-9-201111010-01005 (inactive 2015-01-12). PMID 22041966.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 McAleer, MA; Flohr, C; Irvine, AD (23 July 2012). "Management of difficult and severe eczema in childhood". BMJ (Clinical research ed.) 345: e4770. doi:10.1136/bmj.e4770. PMID 22826585.
  4. 1 2 Ring, Johannes; Przybilla, Bernhard; Ruzicka, Thomas (2006). Handbook of atopic eczema. Birkhäuser. p. 4. ISBN 978-3-540-23133-2. Retrieved 4 May 2010.
  5. ↑ "Mayoclinic, Dermatitis". Mayoclinic. Retrieved January 27, 2015.
  6. ↑ "Causes of Eczema". Retrieved January 27, 2015.
  7. ↑ "About Eczema". Retrieved January 27, 2015.
  8. ↑ "Vising expert offers new hope for eczema sufferers" (PDF). Dermcoll.edu.au. May 2014. Retrieved January 27, 2015.
  9. 1 2 3 Carr, WW (Aug 2013). "Topical calcineurin inhibitors for atopic dermatitis: review and treatment recommendations". Paediatric drugs 15 (4): 303–10. doi:10.1007/s40272-013-0013-9. PMC 3715696. PMID 23549982.
  10. ↑ Hay, RJ; Johns, NE; Williams, HC; Bolliger, IW; Dellavalle, RP; Margolis, DJ; Marks, R; Naldi, L; Weinstock, MA; Wulf, SK; Michaud, C; J L Murray, C; Naghavi, M (28 October 2013). "The Global Burden of Skin Disease in 2010: An Analysis of the Prevalence and Impact of Skin Conditions.". The Journal of Investigative Dermatology 134 (6): 1527–34. doi:10.1038/jid.2013.446. PMID 24166134.
  11. ↑ "Eczema linked to other health problems". WebMD. Retrieved January 27, 2015.
  12. ↑ "Eczema woes more than skin deep". PsychCentral. January 18, 2015.
  13. ↑ Johansson SG, Hourihane JO, Bousquet J, et al. (September 2001). "A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force". Allergy 56 (9): 813–24. doi:10.1034/j.1398-9995.2001.t01-1-00001.x. PMID 11551246.
  14. ↑ ICD 10: Diseases of the skin and subcutaneous tissue (L00-L99) – Dermatitis and eczema (L20-L30)
  15. ↑ "Balsam of Peru contact allergy". Dermnetnz.org. 28 December 2013. Retrieved 5 March 2014.
  16. ↑ "Neurodermatitis". Retrieved 2010-11-06.
  17. ↑ "Contact Dermatitis Pictures". Retrieved 2010-11-06.
  18. ↑ "Dermatitis". Retrieved 2010-11-06.
  19. ↑ "Symptoms". Retrieved 2010-11-06.
  20. ↑ "Atopic dermatitis". National Institute of Health. Retrieved 27 September 2011.
  21. ↑ Bufford, JD; Gern JE (May 2005). "The hygiene hypothesis revisited". Immunology and Allergy Clinics of North America 25 (2): 247–262. doi:10.1016/j.iac.2005.03.005. PMID 15878454.
  22. ↑ Carswell F, Thompson S (1986). "Does natural sensitisation in eczema occur through the skin?". Lancet 2 (8497): 13–5. doi:10.1016/S0140-6736(86)92560-2. PMID 2873316.
  23. ↑ Henszel Ł, Kuźna-Grygiel W (2006). "[House dust mites in the etiology of allergic diseases]". Annales Academiae Medicae Stetinensis (in Polish) 52 (2): 123–7. PMID 17633128.
  24. ↑ Atopic Dermatitis at eMedicine
  25. ↑ Paternoster, L; et al. (25 December 2011). "Meta-analysis of genome-wide association studies identifies three new risk loci for atopic dermatitis.". Nature Genetics 44 (2): 187–92. doi:10.1038/ng.1017. PMC 3272375. PMID 22197932.
  26. ↑ Caproni, M; Bonciolini, V; d'Errico, A; Antiga, E; Fabbri, P (2012). "Celiac Disease and Dermatologic Manifestations: Many Skin Clue to Unfold Gluten-Sensitive Enteropathy". Gastroenterol. Res. Pract. (Hindawi Publishing Corporation) 2012: 1–12. doi:10.1155/2012/952753. PMC 3369470. PMID 22693492.
  27. ↑ Ciacci, C; Cavallaro R; Iovino P; Sabbatini F; Palumbo A; Amoruso D; Tortora R; Mazzacca G. (June 2004). "Allergy prevalence in adult celiac disease". J. Allergy Clin. Immunol. 113 (6): 1199–203. doi:10.1016/j.jaci.2004.03.012. PMID 15208605.
  28. ↑ Atkins D (March 2008). "Food allergy: diagnosis and management". Primary Care 35 (1): 119–40, vii. doi:10.1016/j.pop.2007.09.003. PMID 18206721.
  29. ↑ Jeanne Duus Johansen, Peter J. Frosch, Jean-Pierre Lepoittevin (2010-09-29). Contact Dermatitis. Retrieved 2014-04-21.
  30. ↑ Alexander A. Fisher. Fisher's Contact Dermatitis. Retrieved 2014-04-21.
  31. 1 2 Torley, D; Futamura, M; Williams, HC; Thomas, KS (Jul 2013). "What's new in atopic eczema? An analysis of systematic reviews published in 2010–11". Clinical and experimental dermatology 38 (5): 449–56. doi:10.1111/ced.12143. PMID 23750610.
  32. ↑ Kalliomäki, M; Antoine, JM; Herz, U; Rijkers, GT; Wells, JM; Mercenier, A (Mar 2010). "Guidance for substantiating the evidence for beneficial effects of probiotics: prevention and management of allergic diseases by probiotics". The Journal of Nutrition 140 (3): 713S–21S. doi:10.3945/jn.109.113761. PMID 20130079.
  33. ↑ "CDC Smallpox | Smallpox (Vaccinia) Vaccine Contraindications (Info for Clinicians)". Emergency.cdc.gov. 2007-02-07. Retrieved 2010-02-07.
  34. ↑ "Daily Skin Care Essential to Control Atopic Dermatitis article at American Academy of Dermatology's EczemaNet website". Retrieved 2009-03-24.
  35. 1 2 3 4 Bath-Hextall, F; Delamere, FM; Williams, HC (23 January 2008). Bath-Hextall, Fiona J, ed. "Dietary exclusions for established atopic eczema". Cochrane database of systematic reviews (Online) (1): CD005203. doi:10.1002/14651858.CD005203.pub2. PMID 18254073.
  36. 1 2 Institute for Quality and Efficiency in Health Care. "Eczema: Can eliminating particular foods help?". Informed Health Online. Institute for Quality and Efficiency in Health Care. Retrieved 24 June 2013.
  37. ↑ Ricci G, Patrizi A, Bellini F, Medri M (2006). "Use of textiles in atopic dermatitis: care of atopic dermatitis". Current Problems in Dermatology. Current Problems in Dermatology 33: 127–43. doi:10.1159/000093940. ISBN 3-8055-8121-1. PMID 16766885.
  38. ↑ Jungersted, JM; Agner, T (Aug 2013). "Eczema and ceramides: an update". Contact dermatitis 69 (2): 65–71. doi:10.1111/cod.12073. PMID 23869725.
  39. ↑ Hoare C, Li Wan Po A, Williams H (2000). "Systematic review of treatments for atopic eczema". Health Technology Assessment 4 (37): 1–191. PMID 11134919.
  40. ↑ Bewley A; Dermatology Working, Group (May 2008). "Expert consensus: time for a change in the way we advise our patients to use topical corticosteroids". The British Journal of Dermatology 158 (5): 917–20. doi:10.1111/j.1365-2133.2008.08479.x. PMID 18294314.
  41. ↑ Nnoruka, Edith; Daramola, Olaniyi; Ike, Samuel (2007). "Misuse and abuse of topical steroids: implications.". Expert Review of Dermatology 2 (1): 31–40. doi:10.1586/17469872.2.1.31. Retrieved 2014-12-18.
  42. ↑ Sanjay, Rathi; D'Souza, Paschal (2012). "Rational and ethical use of topical corticosteroids based on safety and efficacy.". Indian Journal of Dermatology 57 (4): 251–259. doi:10.4103/0019-5154.97655. Retrieved 2014-12-18.
  43. ↑ Fukaya, M; Sato, K; Sato, M; Kimata, H; Fujisawa, S; Dozono, H; Yoshizawa, J; Minaguchi, S (2014). "Topical steroid addiction in atopic dermatitis.". Drug, healthcare and patient safety 6: 131–8. doi:10.2147/dhps.s69201. PMID 25378953.
  44. ↑ Shams, K; Grindlay, DJ; Williams, HC (Aug 2011). "What's new in atopic eczema? An analysis of systematic reviews published in 2009–2010". Clinical and experimental dermatology 36 (6): 573–7; quiz 577–8. doi:10.1111/j.1365-2230.2011.04078.x. PMID 21718344.
  45. ↑ "FDA Issues Public Health Advisory Informing Health Care Providers of Safety Concerns Associated with the Use of Two Eczema Drugs, Elidel and Protopic". FDA. 10 March 2005. Archived from the original on 2007-09-17. Retrieved 2007-10-16.
  46. ↑ "Pimecrolimus cream for atopic dermatitis". Drug and Therapeutics Bulletin 41 (5): 33–6. May 2003. doi:10.1136/dtb.2003.41533. PMID 12789846.
  47. ↑ Gambichler, T (Mar 2009). "Management of atopic dermatitis using photo(chemo)therapy". Archives of dermatological research 301 (3): 197–203. doi:10.1007/s00403-008-0923-5. PMID 19142651.
  48. ↑ Meduri, NB; Vandergriff, T; Rasmussen, H; Jacobe, H (Aug 2007). "Phototherapy in the management of atopic dermatitis: a systematic review". Photodermatology, photoimmunology & photomedicine 23 (4): 106–12. doi:10.1111/j.1600-0781.2007.00291.x. PMID 17598862.
  49. ↑ Stöppler MC (31 May 2007). "Psoriasis PUVA Treatment Can Increase Melanoma Risk". MedicineNet. Retrieved 2007-10-17.
  50. 1 2 "Sulfur". University of Maryland Medical Center. 1 April 2002. Retrieved 2007-10-15.
  51. ↑ Armstrong NC, Ernst E (August 1999). "The treatment of eczema with Chinese herbs: a systematic review of randomized clinical trials". British Journal of Clinical Pharmacology 48 (2): 262–4. doi:10.1046/j.1365-2125.1999.00004.x. PMC 2014284. PMID 10417508.
  52. 1 2 Bath-Hextall, FJ; Jenkinson, C; Humphreys, R; Williams, HC (15 February 2012). Bath-Hextall, Fiona J, ed. "Dietary supplements for established atopic eczema". Cochrane database of systematic reviews (Online) 2: CD005205. doi:10.1002/14651858.CD005205.pub3. PMID 22336810.
  53. 1 2 Bamford, JT; Ray, S; Musekiwa, A; van Gool, C; Humphreys, R; Ernst, E (30 April 2013). Bamford, Joel TM, ed. "Oral evening primrose oil and borage oil for eczema". The Cochrane database of systematic reviews 4: CD004416. doi:10.1002/14651858.CD004416.pub2. PMID 23633319.
  54. ↑ Boyle RJ, Bath-Hextall FJ, Leonardi-Bee J, Murrell DF, Tang ML (2008). Boyle, Robert John, ed. "Probiotics for treating eczema". Cochrane Database of Systematic Reviews (4): CD006135. doi:10.1002/14651858.CD006135.pub2. PMID 18843705.
  55. ↑ Eldred DC, Tuchin PJ (November 1999). "Treatment of acute atopic eczema by chiropractic care. A case study". Australasian Chiropractic & Osteopathy 8 (3): 96–101. PMC 2051093. PMID 17987197.
  56. ↑ Ersser, SJ; Latter, S; Sibley, A; Satherley, PA; Welbourne, S (18 July 2007). Ersser, Steven J, ed. "Psychological and educational interventions for atopic eczema in children". The Cochrane database of systematic reviews (3): CD004054. doi:10.1002/14651858.CD004054.pub2. PMID 17636745.
  57. ↑ Barnes, TM; Greive, KA (Nov 2013). "Use of bleach baths for the treatment of infected atopic eczema.". The Australasian journal of dermatology 54 (4): 251–8. doi:10.1111/ajd.12015. PMID 23330843.
  58. ↑ Vos, T; et al. (15 Dec 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMID 23245607.
  59. ↑ Osman M, Hansell AL, Simpson CR, Hollowell J, Helms PJ (February 2007). "Gender-specific presentations for asthma, allergic rhinitis and eczema in primary care". Primary Care Respiratory Journal 16 (1): 28–35. doi:10.3132/pcrj.2007.00006. PMID 17297524.
  60. ↑ Taylor B, Wadsworth J, Wadsworth M, Peckham C (December 1984). "Changes in the reported prevalence of childhood eczema since the 1939–45 war". Lancet 2 (8414): 1255–7. doi:10.1016/S0140-6736(84)92805-8. PMID 6150286.
  61. ↑ Simpson CR, Newton J, Hippisley-Cox J, Sheikh A (2009). "Trends in the epidemiology and prescribing of medication for eczema in England". J Roy Soc Med 102 (3): 108–117. doi:10.1258/jrsm.2009.080211. PMC 2746851. PMID 19297652.
  62. ↑ Luckhaupt, SE; Dahlhamer, JM; Ward, BW; Sussell, AL; Sweeney, MH; Sestito, JP; Calvert, GM (June 2013). "Prevalence of dermatitis in the working population, United States, 2010 National Health Interview Survey". Am J Ind Med 56 (6): 625–634. doi:10.1002/ajim.22080. PMID 22674651.
  63. ↑ Henry George Liddell, Robert Scott. "Ekzema". A Greek-English Lexicon. Tufts University: Perseus.
  64. ↑ Textbook of Atopic Dermatitis. Taylor & Francis. 2008-05-01. p. 1. ISBN 9780203091449.
  65. ↑ "Definition of ECZEMA". www.merriam-webster.com. Retrieved 2016-02-15.
  66. ↑ Murphy LA, White IR, Rastogi SC (May 2004). "Is hypoallergenic a credible term?". Clinical and Experimental Dermatology 29 (3): 325–7. doi:10.1111/j.1365-2230.2004.01521.x. PMID 15115531.

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