Many people have probably experienced this:sudden appearance of red patches and small papules on the body, which are also itchy. Faced with such a situation, many people would quickly answer, “I guess I have eczema, right?”In fact, it may not be the case. There are some skin diseases that look very similar to eczema and are easily confused. Some of these diseases have similar treatment plans to eczema, while others require specialized treatment, and the treatment plans may be quite different.If treated as eczema by mistake, it may backfire, affect diagnosis, and even worsen the condition.
Whether adults or children,
eczema is very common, but
…
Indeed,whether adults or children, eczema is one of the most common skin diagnoses, which often refers to skin inflammatory reactions with a tendency to exude.
Acute eczema rashis polymorphic and can manifest asred patches, papules, vesicles, erosions, exudates, and crusts, often accompanied byitching.And if it persists untreated, it can develop into chronic eczema, with
fused and thickened rash. There is also a subacute form characterized bypapules, crusts, and scales.
In the treatment of eczema,the core is anti-inflammatory, and the core approach to anti-inflammatory is the use of topical corticosteroids, so for any eczema, if you’re unsure,applying some “Dermatological Balm” will usually show effects, pushing this type of medicine as a self-help miracle drug, but“one trick does not fit all situations”.
These skin diseases look like eczema,
and the treatment methods are also similar
Pruritic erythematous papules are far more than eczema, some rashes can be “muddled through” by treating them as eczema, such as:
Neurodermatitis is a chronic skin disease closely related to emotional tension and excessive stress, medically known as lichen simplex chronicus.The most obvious symptom is recurrent unbearable severe itching at specific skin sites, commonly on the neck, wrists, elbows, lower legs, and other areas prone to friction.
Neurodermatitis
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And this itching forms a vicious cycle of “itching leads to scratching, and scratching leads to more itching”. Long-term repeated scratching can cause changes in the skin, originally smooth skin will gradually become thicker and harder, with a rough texture resembling lichen on the surface.
The skin inflammation pathway is also a core link in the itching and skin thickening of neurodermatitis, so applying topical corticosteroid ointment like eczema can relieve itching and prevent skin from thickening and hardening.
Psoriasis is also a common chronic inflammatory skin disease with various clinical manifestations. The most common type iswell-defined red patches with rough scales on the red patches, known as plaque psoriasis. Psoriasis rashes often show layers of scales when scraped with a cotton swab, and small bleeding points can be seen under the scales.
Psoriasis
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For mild psoriasis, our treatment is also to use topical anti-inflammatory ointments to fight inflammation, which has some similarities with the treatment of eczema.However,psoriasis with large areas of rash and frequent recurrence still requires comprehensive assessment to develop a more accurate plan.
The above are some diseases that have similar symptoms to eczema, and it is not easy to make mistakes when treated with eczema plans.
However,there are some rashes,if only casually apply the common drugs for eczema,
it may make the situation worse.
The following are severalrashes that require our high attention, have a certain similarity with eczema, but need specialized treatment.
These skin diseases look like eczema,
but the response plans are quite different
Allergic Contact Dermatitis
Contact dermatitis, as the name suggests, isdermatitis caused by contact with allergens
, which is divided into irritant contact dermatitis and allergic contact dermatitis.
Among them,irritant contact dermatitis is caused by the direct cytotoxicity of the contact substance, such as strong acids and alkalis, which can cause dermatitis to anyone who comes into contact with them.And someallergic contact dermatitis is caused by allergies to contact substances in some people. A more typical example that we rarely confuse with eczema is the so-called “allergy” to adhesive plasters. It appears as red patches, papules, and vesicles that basically match the position of the adhesive tape, with very clear boundaries.
And some allergic contact dermatitis, such as allergies to hair dyes, cleansers, or fragrances, may not cause very regular red patches, which may be mistaken for eczema.
In treatment,if we simply treat the symptoms of eczema with anti-inflammatory,although it can briefly make the rash subside, but without avoiding contact with allergens, it will lead to recurrence and worsening of allergic contact dermatitis, giving us an illusion that the skin is “resistant” to steroid ointments.
So in the following cases, it is best to exclude the possibility of allergy before applying medicine by ourselves:the rash is relatively clear, and the corresponding position of the rash has recently come into contact with new substances.
The red patches on the scalp and behind the ears in the picture are due to an allergy to neomycin in the ear drops. If similar red patches appear near the hairline, we may also consider hair dyes and shampoos.
Image source Goodheart’s photoguide of common skin disorders, 2nd ed., Lippincott Williams & Wilkins, Philadelphia 2003. Copyright © 2003 Lippincott Williams & Wilkins.
Scabies is a skin infestation caused by mite infection. Typical scabies usually manifest as
multiple red papules, and the papules are often scratched and broken due to
itching.Commonly affected areas includethe sides and webs of fingers, wrists, armpits, areolas, and genitals.
In appearance, scabies and eczema are very easy to confuse, but several characteristics can warn us:
● Scabies is acontagiousdisease, often with a history of living in unclean conditions or wearing dirty clothes before the rash appears;● itching worsens at night;
● It can invade the genitals(such as papules and nodules appearing on the outer skin folds of the testicles).
If scabies is suspected, it is recommended to seek offline medical attention. Although the diagnostic standard ismicroscopic examinationto find mites, eggs, or their excretions, it is often difficult to obtain the most golden standard evidence because the number of mites on the patient is small, and sometimes it is not possible to get the best evidence.
And experienced dermatologists can find areas with mites or tunnels throug dermatoscopy, or make a presumptive diagnosis based on medical history and physical examination results.If scabies is not treated properly, the mites can comfortably settle and reproduce on the body, and they also spread from one to two,possibly causing a whole house of people to become a breeding ground for mites.
When it comes to skin fungal infections, we may be unfamiliar, but when it comes to names like tinea corporis, tinea cruris, or even tinea pedis, commonly known as “athlete’s foot” and “onychomycosis” or “gray nail”, our ears are quite familiar.Tinea pedis, especially the vesicular and hyperkeratotic types, is very easy to confuse with eczema in the eyes of many people.
And tinea corporis, especially in the early stages of development, before fully presenting the characteristics of clear red patches with slightly raised edges like petals, is also very easy to confuse with the acute eczema manifestations of the trunk and limbs, but its treatment is completely different from that of eczema.
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Eczema requires anti-inflammatory treatment, and we often use topical corticosteroid ointments for anti-inflammatory purposes, while fungal infectionsrequire corresponding antifungal treatment.
If a rash of fungal infection is mistakenly treated with corticosteroids, it may seem to subside in the short term, but recurrence and worsening will occur rapidly after stopping the medication, and this cycle may lead to the difficult-to-recognize ringworm that we often see in dermatology case discussions.
So when we have relatively clear red patches on the body, especially if there are pets like cats and dogs at home;blisters on the feet, often starting on one limb and with factors such as cohabitants having onychomycosis, it is recommended to consider offline medical consultation, to assess whether there is a fungal infection factor. If it’s really unclear, we can also perform a fungal smear test to confirm whether there are indeed fungi.
References
[1] Contact Dermatitis: Rashid RS, Shim TN. Contact dermatitis. BMJ 2016; 353:i3299.[2] Scabies, Tinea Pedis: Chosidow O. Scabies and pediculosis. Lancet 2000; 355:819.
[3] Fungi: Havlickova B, Czaika VA, Friedrich M. Epidemiological trends in skin mycoses worldwide. Mycoses 2008; 51 Suppl 4:2.
