Dealing with eczema

Eczema, also called dermatitis, is a chronic inflammatory skin condition that is often accompanied by dry skin, with patches that are red and intensely itchy. These patches may ooze, become scaly, crusted, or hardened. Eczema can occur anywhere on the skin but is commonly found on the flexors (bends of the arms, backs of the knees). Symptoms can range from mild to severe.

There are many types of eczema, with the most common being atopic dermatitis. Atopy refers to a hereditary tendency toward eczema, asthma, and allergic rhinitis (hay fever). People with eczema may suffer with one of the other atopic diseases.

Eczema affects millions of people, mainly infants and children. Ten per cent to 20 per cent of all infants have eczema, but nearly half of them outgrow the condition. It usually appears in children between six months and five years old. Rashes usually begin on the face, scalp, hands and feet. The problem can last throughout childhood and into adulthood.

Symptoms and causes

The exact cause of eczema is unknown, but there are genetic, immunological and environmental factors that play a role. Eczema can come and go, and can migrate around the body; just as one patch clears up, another may develop. This is the chronic nature of the disease.

Symptoms include dry, sensitive skin; red, inflamed skin; intense itching; scaly areas; recurring rash; oozing and crusting; rough, leathery patches; swelling; dark-coloured patches of skin. Symptoms can flare or worsen when exposed to specific triggers.

Risk factors

People are more at risk of developing eczema if they have relatives with eczema, asthma, or seasonal allergies. Environmental factors are also known to bring out the symptoms of eczema. These include:

Irritants: soaps, detergents, shampoos, disinfectants, juices from fresh fruits, meats or vegetables.

Allergens: dust mites, pets, pollens, mold, dandruff.

Microbes: bacteria such as Staphylococcus aureus, viruses, certain fungi.

Hot and cold temperatures: hot weather, high and low humidity, perspiration from exercise.

Foods: dairy products, eggs, nuts and seeds, soy products, wheat.

Stress: it is not a cause of eczema but can make symptoms worse.

Hormones: women can experience worsening of eczema symptoms at times when their hormone levels are changing, for example during pregnancy and at certain points in their menstrual cycle.

Environmental factors, such as low humidity, can make the skin dry and itchy.

Contact with harsh soaps, chemicals, perfumes and skin care products that contain fragrance or alcohol may irritate the skin, as will some fabrics, such as wool, and tight clothing.

Types of eczema

There are many different types of eczema.

-The most common type is the atopic dermatitis.

-Allergic contact eczema (dermatitis) – a reaction where the skin has come into contact with a substance that the immune system recognises as foreign.

-Contact eczema – a localised reaction where the skin has come into contact with an allergen.

-Dyshidriotic eczema – irritation of skin on palms of hands and soles of feet, characterised by blisters

-Neurodermatitis – scaly patches of skin on head, forearms, wrists, lower legs caused by localised itch such as an insect bite

-Nummular eczema – circular patches of irritated skin that can be crusted, scaling and itchy.

-Seborrheic eczema – oily, scaly yellowish patches of skin, usually on scalp and face.

-Stasis dermatitis – skin irritation on lower legs, usually related to circulatory problems.

Tests and diagnosis

There is no single test that is used in order to diagnose eczema. Skin allergy testing is often carried out when investigating potential eczema cases. The doctor may need to see a patient multiple times in order to make an accurate diagnosis. This is because people with eczema experience very individual combinations of symptoms, which tend to fluctuate in severity over time. Diagnosis is based primarily on the patient’s symptoms, but medical history is also important, such as your family history, other atopic diseases such as asthma and hay fever, possible exposure to irritants, whether any foods are related to flare-ups, sleep disturbances, past treatment for skin symptoms and the use of steroids or other medications.

Your doctor may refer you to either an allergist or dermatologist for further evaluation. They may also attempt to rule out other conditions that can cause skin irritations. This can involve the following tests:

Patch testing: substances are placed onto the surface of the skin to test for skin allergies.

Skin prick testing: a needle containing a small amount of a suspected allergen pricks the skin to test for allergies that do not necessarily occur on the skin, such as pollen or food.

Supervised food challenges: foods are eliminated and then introduced into the diet to determine whether a food allergy is present.

Coping with eczema

Avoiding triggers and minimising scratching go a long way toward coping with eczema.

Effective home care can include:

Applying cold compresses to reduce severe itching.

Cutting children’s fingernails short to curtail scratching.

Taking shorter baths or showers.

Wearing gloves for jobs that require putting hands in water.

Applying moisturiser within three minutes of bathing or showering to “lock in” moisture.

Moisturising every day.

Wearing cotton and soft fabrics.

Avoiding rough, scratchy fibres and tight-fitting clothing.

Using mild soap or a non-soap cleanser when washing.

Air drying or gently patting skin dry with a towel, rather than rubbing skin dry after bathing or showering.

Avoiding rapid changes of temperature and activities that make you sweat.

Using a humidifier in dry or cold weather.

Treatment

This mostly involves treating the symptoms to alleviate the discomfort. These include:

-The use of corticosteroid creams

-Medications to control viral, bacterial and fungal infections

-Phototherapy

-Repair moisturisers

-Antihistamine

Even though the condition itself is not presently curable, there should be a particular treatment plan to suit each case. Even after an area of skin has healed it is important to keep looking after it, as it may easily become irritated again

Contact Dr Maxwell at 363-1807 or 757-5411