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What happens in eczema?
In eczema, the main problems occur in the epidermis where the keratinocytes become less tightly held together. As a result, they become vulnerable to external factors such as soap, water and more aggressive solvents such as washing up liquid, or solvents used as part of work or hobbies. These solvents dissolve some of the grease and protein that contribute to the natural barrier of the skin. Once this process has begun, the skin may become inflamed as a reaction to minor irritation such as rubbing or scratching. This, in turn, makes the eczema worse and a cycle of irritation, inflammation and deterioration of eczema becomes established.

In eczema the keratinocytes become less tightly held together, so becoming more vulnerable to external factors such as chemical solvents and water, which dissolve the natural protective barrier of the skin.

As part of this cycle, the skin becomes less effective as a barrier. It is less effective at preventing damage from solvents and abrasive materials acting from the outside, and it is also more likely to lose body moisture from within. In a small patch of eczema, this can mean just a few vesicles (very small bubbles in the skin) bursting and leaking water. As the eczema gets worse, the fluid may come from the dermis and include blood from broken capillaries. When severe eczema covers a large percentage of the body surface, it is possible to lose substantial amounts of body fluid, blood and protein through the skin. In addition to these materials, the body can lose heat from the skin, which can become important in people who are physically infirm.

The barrier function of the skin is reduced further when scratching occurs and breaks are gouged in the skin by fingernails. As with solvents, this fuels the eczema and is termed the ‘itch–scratch cycle’.

The skin affected by eczema may become inflamed and sore as a reaction to minor irritation. This causes the sufferer to rub and scratch the affected area, making the eczema worse, and a cycle of irritation (scratching), inflammation and deterioration of eczema sets in.

When skin becomes broken and there is a mix of blood, fluid and protein on the surface, there is a high chance of infection. This infection is usually bacterial and will add to the symptoms and severity of the eczema.

Eczema and the immune system
The epidermis is the place where the outside world meets the body’s immune system. Usually the im-mune system reacts only to parts of the outside world that present a danger, such as insect bites. In many people with eczema, however, the immune system reacts more vigorously than usual to a wider range of normally harmless influences such as animal dander (small particles of hair or feathers), pollen and house-dust mite. As these trigger allergic reactions, these substances are known as allergens.

The immune system tries to destroy allergens by releasing a mixture of its own irritant substances, such as histamine, into the skin. The result is that the allergen may be altered or removed, but at the expense of causing soreness and making the skin fragile so other problems can develop, such as bacterial infection or damage from scratching.