The itch that rashes - Treating atopic eczema
Atopic eczema is a common inflammatory skin condition which tends to run in families with asthma, allergic rhinitis, and urticaria. It is known to make the skin very dry and itchy, so much so that it has been called 'the itch that rashes'.
It is more common in infants and children. Ninety per cent of affected individuals develop atopic eczema by age five. Most of them usually outgrow eczema by puberty. However, some carry the condition into adulthood while some individuals can notice the condition for the first time as an adult.
The exact cause is unknown but both genetic and environmental factors contribute to its development. In unaffected individuals, the outer layers of the skin provide a barrier to protect the skin from external substances and to prevent excessive loss of water from the skin.
In individuals with atopic eczema, there is a defect in this barrier and also a very reactive immune (defence) system in the skin. They are, therefore, more easily affected by several environmental factors which can trigger the condition in some cases.
- Certain foods (for example, milk, peanuts, seafood, eggs, soya)
- Very cold or hot climates
- House dust mite, smoke
- Soaps, detergents
- Infections (viral and bacterial)
There are different stages of eczema that vary with age and duration of the attack. In the early stages, the individual tends to have red bumps, water blisters and oozing, while in later stages, the skin tends to be dry, thickened and rough with increased creases.
In infants, commonly affected areas include the scalp, face, neck, chest, and outer aspects of arms and legs, whereas in older children and adults, it is more common on the inner aspects of elbows, knees, over the eyes and on the hands. Atopic eczema tends to be symmetrical, affecting both sides of the body.
ECZEMA CAN'T BE CURED
Unfortunately, eczema cannot be cured, though it resolves on its own in some persons. However, it can be effectively controlled with treatment.
Affected individuals should avoid any triggers identified. They do not all have to automatically change their diets, unless worsening of the eczema is observed after ingesting certain foods. They should ideally use fragrance-free products, avoid scratching and rubbing the area and should wear cotton clothes instead of fabrics made of wool.
Treatment approaches for this condition include moisturising soap substitutes and liberal use of moisturising (emollient) creams. Your doctor may prescribe steroid creams and ointments, immune suppressing (non-steroid) creams and ointments. Bandaging (wet wraps) may be recommended by your doctor. Light therapy may be offered where available.
Antibiotics may be necessary to prevent or treat any associated bacterial infection of affected skin. Oral antihistamines help with itching. Oral steroids (short-term) and oral immune suppressants may be needed in severe cases.
Hospitalisation may also be beneficial in severe cases. The disorder can lead to loss of work and school days, causing a financial burden to families. Atopic eczema can cause significant emotional problems, so psychological support can be helpful for affected individuals and their families.
- Dr Arusha Campbell-Chambers is a dermatologist and founder of Dermatology Solutions Skin Clinics & Medi-Spas. Email: firstname.lastname@example.org