Eczema is an acute or chronic inflammation of the skin. The condition is also referred to as dermatitis, atopic dermatitis, vascular dermatitis, and contact dermatitis.

The causes of the condition may include: external irritation, allergic contact, reaction to exposure to certain microorganisms, and occupational, non-occupational, or chemical factors. The cause also may be familial or psychological. There may be a personal or family history of allergic conditions, e.g., asthma (see Diagnostic Code: 6602 Asthma, bronchial), allergic rhinitis (see Diagnostic Code: 6522 Allergic or vasomotor rhinitis), and atopic dermatitis. The condition affects all ages, genders and classes. Persons with thin, dry skin are more susceptible to the condition. The condition may go into remission from adolescence to early adulthood, and reoccur later in life.

The condition is characterized by erythematous, papular, vesicular, or pustular lesions, or eruptions on the face, neck, upper trunk, wrists, hands, bends of the elbow, and knees. There are scales, crusts, or scabs singularly or in combination. The lesions may be dry, or have a watery discharge with thickening, and infiltration into the tissue, and with severe, prolonged itching or burning. The skin is dry, leathery and lichenified. Invasion by pathogenic organisms may cause suppuration. The condition looks different at various ages and in people of different races.

Tests conducted include blood work, and a radioallergosorbent (RAST) to determine the source of potential allergies.

Treatment is highly individualized according to the cause, organism or condition. Avoiding foods that cause itching may need special dietary restrictions. Special soap may be required to prevent further drying of the skin. Treatment of local lesions may include the use of corticosteroids.

Persons should be monitored closely for proper use of the corticosteroids and observed for side effects. The condition is chronic; lesions may disappear and reoccur. The person may have an altered body image due to the appearance of the skin lesions, which would require counseling.

When 38 CFR 4.118 offers variable methods to evaluate a skin condition, assign a single evaluation using the criteria that results in the highest rating. 

• 38 CFR 4.118 (a) For the purposes of this section, systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin. 

• 38 CFR 4.118 (b) Two or more skin conditions may be combined in accordance with 38 CFR 4.25 only if separate areas of skin are involved. If two or more skin conditions involve the same area of skin, then only the highest evaluation shall be used.