Eczema, a common chronic inflammatory skin condition, causes dry, itchy, and bumpy skin. A thorough physical examination is important for healthcare professionals to diagnose eczema, track its progression, and tailor treatment plans. During this examination, doctors carefully observe specific characteristics of the skin.
Key Visual Features
Observable characteristics of eczema lesions provide important information. Affected skin often appears red, known as erythema. On darker skin tones, this may appear as purple, brown, or gray discoloration. The skin frequently feels dry and may show scaling. Small, raised bumps, referred to as papules, can also be present.
In more active stages, fluid-filled blisters called vesicles might develop. These blisters can rupture, leading to oozing fluid that dries to form crusts. Over time, with persistent inflammation and scratching, the skin can become thickened and leathery, known as lichenification.
Distribution Patterns and Affected Areas
The location and spread of eczema on the body are important observations. Eczema can appear anywhere on the skin, but it often follows specific patterns depending on a person’s age. In infants, eczema commonly affects the face, especially the cheeks, scalp, neck, and the outer surfaces of the arms and legs. The diaper area is typically spared.
For older children and adults, eczema frequently appears in flexural areas, such as the inside of the elbows, behind the knees, and on the neck, wrists, and ankles. Hand and foot involvement is also common in adults. Healthcare providers also observe if lesions are symmetrical on both sides of the body and if they are localized to a small area or widespread.
Common Descriptive Terms
Healthcare professionals use specific vocabulary to precisely document eczema findings:
- Erythema refers to the redness of the skin, which can vary in color from pink or red on lighter skin to purple, brown, or gray on darker skin tones.
- Excoriation describes scratch marks on the skin, a common result of intense itching associated with eczema. These marks can indicate the severity of itch and the degree of scratching.
- Lichenification is the thickening and hardening of the skin, giving it a leathery appearance with exaggerated skin lines. This change typically results from chronic rubbing or scratching.
- Papules are small, raised bumps on the skin, usually less than 1 centimeter in diameter, and can be red, purple, or dark brown depending on skin tone. When multiple papules merge, they can form plaques, which are raised, flat-topped areas of affected skin.
- Vesicles are small, fluid-filled blisters that may be present, especially in acute eczema flares.
- Oozing describes the leakage of clear or yellowish fluid from the skin, often occurring when vesicles rupture or due to intense inflammation.
- This fluid can then dry to form crusts, which are yellowish or honey-colored layers on the skin surface.
- Desquamation refers to the peeling or flaking of the skin, a common sign of dry or healing eczema.
Assessing Severity and Impact
Healthcare providers evaluate the overall severity of eczema and its impact on daily life. One method involves estimating the Body Surface Area (BSA) affected by eczema, which helps quantify the extent of the condition. Assessing the intensity of symptoms like itching and sleep disturbance is also important, as these affect quality of life. Patients often report their itch intensity using numerical rating scales.
Doctors also look for signs of secondary infection, which can complicate eczema. These signs include increased redness and swelling, the presence of pus, warmth, and tenderness in the affected area, or yellow crusting. Sometimes, fever or flu-like symptoms may accompany a more severe infection. Eczema’s impact on quality of life, including mental health, social functioning, and daily activities, is also considered.