Eczema is a chronic skin condition that causes the skin to become red, inflamed and irritated. Eczema usually begins in early infancy, and is a long term illness. Often times eczema is the first presentation in patients who subsequently go on to develop food allergies and asthma. The prevalence of eczema has increased remarkably in recent times. The morbidity (incidence or prevalence of a disease) has also significantly increased. Atopic eczema (atopic dermatitis) is the commonest form of eczema.
Common places for eczema to occur is on the face, on the scalp, behind the knees, front of the elbows and side of the neck. Atopic eczema generally runs in families. It can vary in severity, and most people are only mildly affected and have small patches of occasionally itchy skin. However, not only is severe eczema a common sight, it can greatly affect the quality of life and cause significant personal and social impairment for the affected person.
Family history of allergies and asthma are almost often present in patients presenting with eczema. In some patients, environmental factors such as dust-mites, pet fur and pollen may also predispose an individual to develop eczema. Likewise, some food allergens that may cause eczema are cow’s milk, nuts, soya, eggs and wheat. Cold weather, frequent washing of skin, dampness, rough clothing and harsh soaps are also likely causative factors, especially in infants.
SIGNS AND SYMPTOMS
Symptoms of eczema are usually often present, and may worsen acutely during a flare-up. They first manifest early in infancy and maybe very worrisome. The skin is intensely itchy with red patches. Intense itching is the most debilitating feature of eczema; children often scratch themselves incessantly. The itch-scratch cycle matures around month 3 of life, which is when parents are more likely to notice it.
The following skin changes are usually observed in patients with eczema, especially during flare-ups:
wet, weepy and swollen (during flare-ups)
occasionally, secondary bacterial infections may also occur where the skin is broken. The commonest bacteria is Staphlococcus aureus, which is normally present on our skin.
Self care is a major factor in controlling symptoms of eczema, and preventing flare-ups. This includes reduced scratching (put mitts or soft cotton gloves on small children), avoiding triggers such as dust, cold and damp, and certain foods that might trigger the condition.
Medication used to control eczema varies from emollients to topical (skin use only) and oral steroids, depending on severity of symptoms. Emollients are highly dense petrolatum creams that form a barrier on the skin, reducing irritation of dry skin. Moisturizing of the skin is key to controlling flare-ups. Large amounts of emollient should be used at all times, especially between flare-ups. Important times to use an emollient include after baths (depending on the climate, patients usually benefit from 5-minute, lukewarm baths followed by the application of emollient) and before going to bed. It is best not to share emollient pots between patients.
Steroids for use on skin are used in flare-ups. These are generally very low strength and will reduce swelling and redness of the skin. Overuse of steroids may, however, increase the incidence of flare-ups, so must be prescribed and used with caution.
For severe itching, anti-histamines (medicines for controlling allergic factors) maybe used, and antibiotics maybe prescribed for suspected superimposed bacterial infection.