Scalp Eczema

Scalp Eczema presents as a group of non contagious acute or chronic scalp conditions characterised by erythema (inflammation), oozing, skin thickening, formation of papules, vesicles (blisters) and crust. Pruritis (itching, often severe) may well leads to self manipulation which can lead to bleeding and secondary infection. A burning sensation often accompanies scalp conditions such as scalp eczema. All ages can be affected.

Scalp Eczema in most cases can be controlled and with the correct treatment may well go into remission however, affected skin is susceptible to flare ups. Scalp Eczema is categorised into environmental and internal.

Environmental Eczema (scalp conditions)
Irritant Contact Dermatitis/eczema
 Allergic Contact Dermatitis/eczema
Herpeticum eczema

Internal Eczema (scalp conditions)
Atopic Dermatitis/eczema
Seborrhoeic Dermatitis/eczema
Nummular Dermatitis/eczema
Dishydrotic/Pompholyx (blistering) Dermatitis/eczema
Varicose Eczema/dermatitis
Asteototic (dry) Dermatitis/eczema
Madidans eczema
Pustulosum eczema
Rubrum eczema

Herpeticum Eczema
Eczema Herpeticum develops when eczema becomes infected with the herpes simplex virus (HSV). Atopic patients are more likely to be affected (those who have a pre-existing dermatitis/eczema). Considered serious in infant, chronically ill or elderly patients.

Both Herpes Simplex and Atopic Dermatitis are common conditions however, Eczema Herpeticum is rare. Symptoms include, high temperature, an erythematic rash containing vesicles filled with yellow pus. Tightening of the scalp may present itself along with discomfort.

Herpes Simplex Virus (HSV) Highly Contagious!
HSV presents as vesicles or sores that may affect most regions of the skin. Mostly affects the genital region (classed as type 2) or the mouth, nose, chin, cheeks and lips (classed as type 1). The sores can be painful and restricting. Transmitted through contact i.e. kissing, sharing of towels and sharing knives, spoons etc.

Herpes describes eight related human viruses. Simplex refers to the viruses that cause chicken pox, shingles and Mononucleosis (Epstein - Barr virus).

Type 1 presents as cold sores or small vesicles around the mouth and lips. Wounds are susceptible to infection where sores or blisters (approx 10% of cases) may be a factor. Primary cases present symptoms 2 - 20 days after exposure lasting for approx 8 – 10 days. Symptoms include one or several blisters which may rupture causing the fluid to be released. The skin will crust.  The underlining healing skin presents erythema. Scaring in primary infections is rare. The herpes virus remains in the body in nerve cells.  Reoccurrence may well occur although unpredictable, close to or at the primary infection site. Reoccurrences tends to be milder. Sun exposure, menstrual period or fever may cause reoccurrence.

Type 2 tends to produce sores on the penis, vagina, cervix or buttocks 2 – 20 days after contact. Reoccurrence is common. Symptoms include a pruritic rash, fever, muscle fatigue and or a burning sensation. Type 2 may affect other areas below waist level. Initial onset may be undetectable. Reoccurrence which may occur years later may be mistaken for primary infection. Sun exposure, menstrual period or fever may cause reoccurrence.

Due to its appearance herpes is simple to diagnose. However a skin biopsy may be required for type 2 as some cases show similarities to syphilis and other ailments. Herpes may affect the eyes which may lead to cicatrix and damage to sight. Ophthalmologist should be sought if eye herpes is suspected. Herpes may be transmitted from mother to baby during child birth (type 2). Primary infections can cause serious damage to the infant. Effective methods are available to prevent this.
There is no medication to date that prevents herpes. Acyclovir, Famciclovir and Valacyclovir (all anti viral medications) are effective prescribed treatments.  Approx 80% of genital herpes is transmitted where no symptoms were apparent. Resting phase herpes bare no risk to the new born.

Varicose Eczema

Varicose eczema (aka Statis) affects thrombosis (blocked veins), varicose and ulcerated vein regions e.g. the ankles. Tends to affect later in life, showing no affiliation to skin colour, type or sex. Excess vein pressure causes blood vessels to release Fibrin (a fibrous insoluble protein – basic component of a blood clot). Fibrin forms a barrier preventing Oxygen and nutrients penetrating the skin causing eczema.

Skin discoloration is caused by the release of red blood cells. Varicose Veins cause slow blood flow, poor oxygen and nutrient supply to surrounding tissue, back pressure increase, fatigue, and heaviness in the legs. Accumulation of waste in the veins may result in skin colour change (status dermatitis).

Symptoms
Scales, skin dryness, pruritis and hyperpigmentation (brown/purple). Manipulation leads to soreness and swelling. Secondary infection is common, evident when inflammation is apparent. Ulcers tend to affect the inside leg, developing a yellow membrane that produces an offensive odour. They may surround the leg if not treated. Reoccurrence is common if varicose veins or thrombosis are not treated. Although rare, cancerous change may occur.

Treatment
Varicose eczema is considered curable. Treating thrombosis and varicose veins assist remission. Steroids tend to assist recovery however they may cause skin dryness exacerbating the condition. They should be used with an emulsifying agent or aqueous (watery) cream. Emollient creams tend to prove effective in reducing erythema and pruritis.

Bathing ulcers in salt water assists the removal of infected membrane. Powders, pastes, creams and dressing are available treatments.

Oxipentifylline is a prescribed medication used to break down the barrier caused by fibrin.Antibiotics (erythromycin) combat secondary infection. Kalmaderm (hyper allergenic cream) may be effective. In severe cases a skin graft may be required.

Hyperpigmentation may increase in severity despite treatment.