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Eczema/Dermatitis

Dr Vivian Oputa

Eczema, also known as Dermatitis, is an inflammation of the skin and generally describes swollen, itchy and reddened skin. It is a very common skin condition that may occur in many forms and has many causes. It is not life threatening and not contagious. Eczema is aggravated by stress, infection, illness, hormonal change and change in weather. Extremes of weather is bad for eczema ranging from the hot and humid to the cold and dry.

The several forms of eczema which include Atopic dermatitis, Contact dermatitis, Seborrheic dermatitis, Perioral dermatitis, Dishydrotic eczema and Nummular eczema each have distinct signs and symptoms.
Atopic Dermatitis describes a common often hereditary form of eczema. The tendency to develop atopic dermatitis is present on the same gene as that for the development of asthma and hay fever and it is possible to have all 3 conditions. This condition usually starts in infancy or early childhood and it is most commonly located in the skin folds of the neckline, behind the knees and in front of the elbows where the arms bend. The palms of the hands and soles of the feet are often involved but it should be noted that eczema can develop in any area. A common cause of flare-ups among children is due to bacterial infection by Staphylococcus aureus.

Dishydrotic Eczema affects the hands and feet and in this condition, tiny fluid filled blisters form beneath the surface of the skin. This is often associated with intense itching, painful cracks and scaling and is a chronic condition that occurs periodically throughout adulthood.

Contact Dermatitis is as a result of direct contact with allergens or irritants such as detergent, cleaning products, soap, rubber, nickel (commonly found in costume jewellery), cosmetics, weeds like poison ivy, hair dye and neomycin (a common topical antibiotic). Patch testing may be done by your dermatologist to determine the offending irritant or allergen. In this condition, the skin becomes rough, red and may possibly scale, crack or weep.

Seborrheic Dermatitis is commonly hereditary and is often seen in individuals with oily skin and hair. In this condition, the turnover in skin cell production is faster than normal in affected areas. When this occurs, a lot of extra skin is shed resulting in the flakes seen. It may be aggravated by stress, may occur in neurological conditions like Parkinson’s disease and may be seasonal.
Perioral Dermatitis describes inflammation around the mouth which may be caused by cosmetics and some dental products.

Nummular Eczema shows up as round, coin-like patches seen on the skin.
Pityriasis Alba commonly seen in childhood shows up as light or white patches which remain usually on the face after eczema has resolved. This discolouration is a response to inflammation and usually resolves without treatment. This condition may be avoided by controlling eczema and keeping the skin well moisturised and hydrated.

Diagnosis is made from the history and physical examination. In cases of contact dermatitis, your doctor may carry out a patch test on your skin to determine the offending allergens. The test used presently is the T.R.U.E. Patch test kit. In this test, 23 of the most common allergens are contained in separate wells embedded on two pieces of tape which are applied to the upper back and left in place for 48 hours, is reapplied and finally analysed 96 hours after the first application. A positive reaction is indicated by redness, puffiness and sometimes blistering. The patch test is different from the scratch test performed by allergists for the purpose of identifying systemic allergens as the patch test is to identify allergic reactions limited to the skin.

Skin Changes in Eczema:  Since eczema is an itchy condition, the constant scratching may lead to changes in the skin that may be temporary or permanent. The skin may thicken and become leathery and changes in colour may occur as well. Cracks and fissures may become secondarily infected leading to cellulitis which could be potentially life threatening in the immunosuppressed.

Treatment

Out of control eczema had hitherto been treated with topical and systemic steroids. Steroid therapy though effective has side effects such as bruising, development of stretch marks, increased skin fragility and blood vessel weakness with the use of topical preparations. Systemic Steroids can lead to weight gain, raised blood sugar and increase blood pressure. As a result of these side effects, steroid usage should be minimised and dosage tapered off to avoid the rebound phenomenon where the condition gets worse once the steroids have been cleared from your system.

Non-steroidal treatments are now available for the treatment of eczema. Topical Immunomodulators (TIM’s) such as Protopic (Tacrolimus) and Elidel (Pimecrolimus) are steroid free and stop immune cells responsible for allergic reactions from causing inflammation thus slowing down or halting eczema. These TIM’s are prescribed for cases of eczema that are unresponsive to steroids and antihistamines.
Triceram and Nouriva Repair are moisturisers that help to repair and restore the skin’s protective barrier which is disrupted by eczema. These creams contain the exact molecular ratio of 3 fats found in the epidermis namely ceramides, cholesterol and fatty acids that are necessary to repair and restore barrier function. These creams are safe for long term use in children and adults alike. E45 Cream is beneficial as it contains refined lanolin which keeps the skin well moisturised. Tar may help control itching, redness and scaling. It doesn’t smell pleasant but is a great alternative when all else fails. Your dermatologist could prepare a mixture of 10% liquid coal tar distillate, 2% salicylic acid and 3% lactic acid in an ointment base.

Light Therapy may be employed when eczema is resistant to all forms of treatment. Topical Psoralen plus ultraviolet A (PUVA) is carried out by applying psoralen to the affected skin and placing the patient under artificial UVA light. The Psoralen sensitises the skin thus allowing the light waves to decrease the activity of the white blood cells responsible for inflammation. Short term side effects of this treatment include severe sunburn, blistering and hyperpigmentation (too much darkening) and long term side effects include cancer.

Alternative Remedies

The essential fatty acid gamma linoleic acid (GLA) may help control eczema and high levels are seen in Evening Primrose Oil, Borage seed oil and Blackcurrant-seed oil. GLA helps stimulate the production of Prostaglandin E1 (PGE1) which has anti-inflammatory properties. Nuts, seeds and vegetable oils also contain GLA.

Care for Eczematous Skin

Because the skin of such individuals is very sensitive to common skincare ingredients, I recommend fragrance-free products such as E45 cream, Eucerin, Vanicream and Free & Clear. Detergents should be fragrance free. Bath Soap should be mild such as Cetaphil, Dove and Aveeno and if possible fragrance free. If there are cracks and fissures present, 1% hydrocortisone and antibacterial Polysporin ointment should be applied twice a day (avoid ointments containing neomycin).
It is important to moisturise immediately after bathing as keeping the skin well hydrated creates the much needed barrier to prevent flare-ups.

A study confirms that household bleach can also be used to give relief to children with eczema. The results of the research found that bathing kids with eczema twice a week for 5 to 10 minutes in diluted bleach can greatly reduce the associated itching, rashes and discomfort. People with eczema often get patches of the bacteria Staphylococcus aureus on their skin because of scratching which can make their symptoms worse. The bleach kills the bacteria thus reducing the symptoms in children with moderate or severe eczema.


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