Eczema

Eczema is a prevalent skin condition that affects millions of people worldwide. Eczema can affect individuals of all ages, and its symptoms can worsen when exposed to irritants or allergens. Understanding the causes and triggers of eczema is crucial for effective management and treatment of the condition. In this article, we will explore the stages, types, and treatment options of eczema.

What is Eczema?

Eczema, also known as dermatitis, refers to a group of inflammatory skin conditions characterised by dry, itchy, and scaly skin. It is a non-contagious condition that can appear anywhere on the body and can be triggered by various factors, such as allergens, irritants, and environmental elements. The most common symptom of eczema is intense itching, which can lead to scratching and further inflammation of the affected areas.

There are several types of eczema, each with its own unique set of causes, symptoms, and triggers. These include:

• Atopic dermatitis: The most common type of eczema, atopic dermatitis, is characterised by dry, itchy, and scaly skin. It often begins in childhood and can be associated with other allergic disorders, such as asthma and hay fever.

• Contact dermatitis: This type of eczema occurs when the skin comes into contact with an allergen or irritant, resulting in a rash and inflammation. Contact dermatitis can be further divided into irritant dermatitis and allergic dermatitis.

• Dyshidrotic eczema: Small, itchy blisters on the hands and feet are the hallmark of dyshidrotic eczema. Triggers for this type of eczema can include stress, humidity, and allergies.

• Neurodermatitis: Intense itching and scratching characterise neurodermatitis, which can lead to skin thickening and pigmentation changes. This type of eczema is often associated with stress and anxiety.

• Nummular eczema: Nummular eczema presents as round, coin-shaped patches of dry, itchy skin. It can be triggered by dry skin, insect bites, or skin injuries.

• Seborrhoeic dermatitis: This type of eczema primarily affects the scalp, face, and chest, causing red, scaly, and itchy patches. Seborrhoeic dermatitis is caused by an overgrowth of yeast that normally lives on the skin.

• Stasis dermatitis: Stasis dermatitis occurs when fluid accumulates in the lower legs due to poor circulation, leading to swelling, redness, and itching. This type of eczema is more common in older adults and those with varicose veins or blood clots.

• Itching and dryness of the skin

• Appearance of a red, scaly rash

• Rough, leathery patches on the skin

• Oozing or crusting of the affected areas, especially in infants

• Swelling or inflammation around the rash

Eczema symptoms can manifest differently depending on the individual and the specific type of eczema. Common symptoms include:

• Itchiness: The hallmark symptom of eczema is intense itching, which can be mild to severe and may worsen at night.

• Dry skin: Eczema often causes the skin to become dry, sensitive, and prone to cracking and bleeding.

• Inflamed skin: The affected area may appear red, swollen, and develop a rash that can ooze and crust over.

• Scaly patches: Rough, leathery, or scaly patches of skin may develop, particularly in chronic cases.

• Skin discolouration: Eczema can cause changes in skin colour, especially in people with darker skin tones.

• Blisters: Small, fluid-filled blisters may appear, particularly in dyshidrotic eczema, which affects the hands and feet.

How Eczema Affect Your Body?

Eczema primarily affects the skin barrier function, leading to increased water loss and reduced protection against irritants and allergens. The constant itching and scratching can cause the skin to thicken, become more prone to infections, and result in disrupted sleep and daily activities. Eczema can also have a significant psychological impact, causing stress, anxiety, and self-consciousness due to visible skin changes. In severe cases, the condition may extend beyond the skin, potentially exacerbating asthma or hay fever symptoms.

Eczema can be classified into three distinct stages, including:

• Acute eczema: This stage is marked by the sudden onset of symptoms, including redness, swelling, and intense itching. Triggers for acute eczema can include allergens, irritants, or infections.

• Subacute eczema: This transitional phase between acute and chronic eczema is characterised by dryness, scaling, and moderate itching.

• Chronic eczema: Persistent symptoms, such as dryness, scaling, and itching, define this stage. Chronic eczema can result in skin thickening and pigmentation changes.

While the exact cause of eczema remains unknown, several factors are thought to contribute to its development. These include:

• Genetic factors: Having a family history of eczema, asthma, or allergies increases the likelihood of developing the condition.

• Immune system dysfunction: Eczema may result from an overactive immune response to triggers, leading to inflammation.

• Environmental irritants: Exposure to soaps, detergents, fragrances, certain fabrics, and other irritants can trigger eczema flare-ups.

• Allergens: Substances like pollen, pet dander, and dust mites can worsen eczema symptoms in some individuals.

• Stress and hormones: Emotional stress and hormonal changes, such as during menstrual cycles or pregnancy, may exacerbate eczema.

Eczema in Children

Eczema, also known as atopic dermatitis, is a prevalent chronic skin condition that affects a significant proportion of children globally. It is characterised by dry, itchy, red and inflamed skin, which can cause considerable distress for both the child and their parents.

Eczema impacts around 10-20% of children worldwide, with most exhibiting symptoms within the first year of life. In infants, eczema commonly appears on the face, scalp, arms and legs. In older children, it tends to affect the creases of elbows and knees, as well as the hands and feet. Symptoms can worsen during flare-ups and improve during periods of remission. Various triggers like irritants, heat, sweating and allergens can exacerbate the condition.

Several factors can increase a child's likelihood of developing eczema, including:

• Children with a family history of eczema, asthma, or allergic rhinitis

• Environmental triggers (such as dry skin, irritants, heat, sweating, infections, and allergens like pet dander, pollen, and dust mites)

• Skin barrier issues (due to lack of proteins such as filaggrin)

While eczema primarily causes skin discomfort, it can also lead to serious complications. These include:

• Skin infections: Children with eczema are more prone to skin infections due to the compromised skin barrier. These infections can be bacterial or viral and may present with yellow or honey-coloured crusting, weepy or oozy skin, blisters, or pus bumps.

• Sleep disturbances: The intense itching associated with eczema can disrupt sleep, leading to fatigue and other related health issues. Poor sleep quality can affect a child's mood, behaviour, and overall well-being. Implementing a consistent bedtime routine and using eczema-friendly bedding can help alleviate sleep disturbances.

• Skin thickening and scarring: Frequent scratching and rubbing of the skin can lead to skin thickening (lichenification) and scarring. This can cause the skin to become rough, leathery, and discoloured. Keeping the skin moisturised and preventing excessive scratching can help minimise these long-term effects.

While there is no guaranteed way to prevent eczema, several measures can reduce the risk or severity of the condition. These include:

• Avoid triggers: Keep a diary to pinpoint specific triggers that worsen your child's eczema and take steps to minimise exposure to them. Common triggers include certain fabrics, soaps, detergents, stress, sweat, and environmental allergens.

• Maintain skin moisture: Apply fragrance-free moisturisers liberally and frequently to keep the skin hydrated and strengthen its barrier function. Moisturise, especially after baths and showers.

• Use gentle skincare products: Choose mild, fragrance-free cleansers and avoid harsh soaps that can dry out and irritate the skin. Opt for products specifically designed for sensitive or eczema-prone skin.

• Avoid extreme temperatures: Both hot and cold environments can dry out the skin and trigger flare-ups. Dress your child in breathable layers so they can adjust to temperature changes.

• Manage stress: Emotional stress can exacerbate eczema. Help your child find healthy ways to cope with stress, such as through relaxation techniques, breathing exercises, or counselling.

Diagnosing eczema typically involves a combination of clinical evaluation, medical history review, and sometimes additional tests to rule out other skin conditions. These include:

• Medical history: The diagnosis begins with a thorough medical history, where the doctor gathers details about the onset, severity, and triggers of symptoms. Family history of eczema, allergies, or asthma is also considered, as these conditions often have a genetic link.

• Physical examination: A physical examination involves inspecting the affected skin for signs of eczema, such as redness, swelling, and dryness. The distribution of symptoms is crucial; for example, atopic dermatitis commonly appears on the insides of the elbows and knees.

• Patch testing: Patch testing helps identify specific allergens that may trigger flare-ups. Small amounts of allergens are applied to the skin, and reactions are monitored after a few days.

• Skin biopsy: A skin biopsy may be performed if the diagnosis is uncertain or if the eczema appears severe or atypical. A small skin sample is analysed to rule out other conditions or infections.

• Allergy testing: Allergy testing can further identify potential triggers. Skin prick tests introduce allergens to the skin, while blood tests measure IgE levels to detect allergies.

The treatment of eczema is tailored to the severity and type of the condition, often involving a multi-faceted approach. For mild eczema, treatment may include:

• Topical corticosteroids: Over-the-counter or prescription creams, ointments, or lotions to reduce inflammation.
• Moisturisers: Products to keep the skin hydrated and reduce dryness, which can exacerbate eczema symptoms.
• Topical immunomodulators: Creams or ointments with medications that modify the immune system's response to reduce inflammation.

For moderate to severe eczema, your doctor may recommend:

• Oral antihistamines: To relieve itching and help with sleep disturbances caused by eczema.
• Oral corticosteroids: For short-term use to reduce severe inflammation.
• Phototherapy: Exposure to specific wavelengths of light under medical supervision to help control eczema symptoms.
• Systemic immunomodulators: Medications that affect the immune system to help manage severe cases.

Medications

Medications play a crucial role in managing eczema symptoms and preventing flare-ups. Some key types of medications used in eczema treatment include:

• Topical corticosteroids are the mainstay of eczema treatment, reducing inflammation and relieving symptoms. Examples include hydrocortisone, betamethasone, and clobetasol.
• Topical calcineurin inhibitors like tacrolimus and pimecrolimus help reduce inflammation and itching.
• Oral antihistamines like cetirizine, loratadine, and fexofenadine can help relieve itching and reduce allergic reactions that may trigger eczema flare-ups.
• Systemic immunosuppressants like cyclosporine, methotrexate, or azathioprine may be prescribed to suppress the immune system and control inflammation.

Living with eczema can be challenging, but there are several strategies that can help manage the condition:

• Maintain a consistent skincare routine, including regular moisturising

• Identify and avoid triggers, such as certain foods, irritants, or allergens

• Manage stress, as it can exacerbate eczema symptoms

• Avoid scratching, as this can worsen inflammation and lead to infections

• Use gentle, fragrance-free products on the skin

• Wear soft, breathable fabrics like cotton

• Keep the home environment cool and humid

• Consider using a humidifier, especially in dry or cold weather

• Participate in support groups or seek counselling to cope with the emotional impact of eczema

If you suspect that you or your child may have eczema, it's essential to consult with a doctor for an accurate diagnosis and appropriate treatment. You should also see a doctor if:

• Your eczema symptoms are severe or widespread.

• Your eczema is not responding to over-the-counter treatments.

• You develop signs of infection, such as fever, redness, or oozing from affected areas.

• Your eczema is significantly impacting your quality of life or causing emotional distress.

• Eczema is a chronic inflammatory skin condition that causes dry, itchy, and inflamed skin.

• Diagnosing eczema involves a clinical evaluation, medical history, and sometimes additional tests.

• Treatment for eczema depends on the severity and may include topical treatments, systemic medications, and lifestyle changes.

• Living with eczema can be managed by maintaining a consistent skincare routine, avoiding triggers, and seeking support when needed.

• Consult a doctor if eczema symptoms are severe, persistent, or causing significant distress.