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WHAT IS ECZEMA?

The word ‘eczema’ is from the Greek word that means ‘to bubble or boil over’. Eczema, also commonly referred to as atopic dermatitis, appears as an itchy, red rash anywhere on the body. Many people have it on their elbows or behind their knees. Babies often have eczema on the face, especially the cheeks and chin. They can also have it on the scalp, trunk (chest and back), and outer arms and legs. Children and adults tend to have eczema on the neck, wrists, ankles, and in areas that bend, like the inner elbow and knee.

WHO GETS ECZEMA?

If you suffer from eczema you are not alone. It is estimated that 10-20 % of children and 1-3 % of adults around the world suffer from eczema. Eczema usually starts in childhood – about 90 % of people get eczema before their 5th birthday. Eczema affects people of all races.

WHAT CAUSES ECZEMA?

Eczema is not contagious, so you do not need to worry about catching it or giving it to someone.

Eczema tends to run in families, which means you will probably have one or more family members that suffer from eczema, asthma or hay fever. This implies that genes play a role in causing eczema. You are more likely to develop eczema if one or both of your parents have eczema, asthma or hay fever. Doctors think that eczema is linked to other allergies because about 80 % of children with eczema will develop hay fever and/or asthma. This is often referred to as the allergic triad.

WHAT ARE THE SYMPTOMS OF ECZEMA?

Eczema skin is usually dry and sensitive. In the initial stages, your skin may look as if it has been boiled, with a red appearance and tiny blisters. This is usually followed by dryness and scaling. It is at this stage that eczema may be mistaken for psoriasis. Another feature of eczema is the intense itch, often causing people to scratch until it bleeds. This can make the rash even worse, leading to more inflammation and more itching. This cycle is referred to as the itch-scratch cycle.

Summary of the signs and symptoms of eczema:

  • Dry, sensitive skin
  • Intense itching
  • Red, inflamed skin
  • Recurring rash
  • Scaly areas
  • Rough, leathery patches
  • Oozing or crusting
  • Areas of swelling
  • Dark coloured patches of skin

Eczema can affect your life beyond just having symptoms. The intense itch and continuous scratching may interfere with your normal activities and sleep, or leave you with unsightly skin lesions. These factors can have a profound impact on your quality of life

WHAT IS THE DIFFERENCE BETWEEN ECZEMA AND PSORIASIS?

As mentioned earlier, eczema can sometimes be mistaken for psoriasis and vice versa. Treatments for the conditions are different, so it is important to determine which one you are suffering from. Your doctor should be able to provide you with an accurate diagnosis.

WHAT ARE THE COMMON TRIGGERS FOR ECZEMA?

There are many triggers that can cause your eczema to flare or make it worse. These are best avoided, so find out what your potential triggers are.

FIRST STEPS IN TREATING ECZEMA – PREVENTING FLARES

The best line of defence against any form of eczema is to prevent acute flares. Although flares can never be prevented completely, certain treatments remain critical for all people with eczema regardless of the severity of their condition. Every person suffering from eczema needs to moisturise their skin daily and avoid potential triggers. This is fundamental to the treatment of eczema and cannot be over emphasized.

Tips to keep your skin moisturised:

  • Bath in warm water
  • Use a mild, fragrance-free, dye-free soap
  • Gently pat your skin dry with a soft towel, do not rub
  • Apply a moisturising agent to the skin within 3 minutes of towelling off to lock in moisture and keep applying moisturiser several times throughout the day.

While identifying and avoiding potential triggers is an important preventative measure, keep in mind that certain conditions such as stress, sudden changes in temperature or humidity, and sweating, can start an itch-scratch cycle and progress into a flare.

MANAGING ACUTE FLARES

Topical corticosteroids

Topical steroids remain one of the most valuable treatments for eczema and have been used extensively for over 50 years. If used properly, topical steroids can control your symptoms and improve your quality of life. When eczema flares up, topical steroids will ease soreness, reduce itching, and relieve the need to scratch, allowing your skin to heal.

Topical steroids are available in different potencies

Topical steroids vary in potency, depending on the formulation and the type of steroid, and range from super potent (class 1) to least potent (class 7). Medium- to high-potency steroids are effective for eczema. While sometimes more expensive, your doctor may prescribe a branded steroid if they want you to use a steroid in a particular formulation for a variety of reasons.

Topical steroids are available in different formulations

Topical steroids are available as ointments, creams, lotions, gels, foams, mousses or shampoos. Ointments are greasy and provide more lubrication. They are most useful for treating dry or thick lesions but should be avoided in hairy areas and skin folds. Creams are less potent than ointments and easily vanish into the skin. They are useful in skin folds where ointments cannot be used and have a drying effect. Lotions and gels are least potent of all formulations. They are the least greasy and useful in hairy areas because they penetrate easily and leave little residue. Gels dry quickly and can be applied to the scalp or other hairy areas and do not cause matting. Foams, mousses and shampoos are also effective for treating the scalp.

Tips for using topical corticosteroids

  • Use the least potent steroid possible to control the inflammation
  • Do not use it as a moisturizer – apply it only to areas affected by eczema
  • It is most effective if applied immediately after bathing
  • Do not use the steroid more than twice daily – for many steroids a once daily application is sufficient
  • Wherever possible, avoid using large quantities for long periods of time
  • Certain areas absorb more steroid than others, e.g. face, genitals, raw skin, thin skin and folded skin, such as beneath the breasts or between the buttocks
  • Applying dressings over the area treated with a steroid increases the potency and absorption of the steroid – use dressings only if prescribed by your doctor
  • Reduce or stop the steroid once inflammation is under control – remember that proper bathing and moisturising helps prevent flare-ups.

How much topical steroid should be applied?

Your doctor will decide which steroid, what strength and how much is best for you. The amount of steroid is usually determined by using the fingertip method. A fingertip unit is the amount that can be squeezed from the fingertip to the first crease of the finger. One hand-size area (i.e. the size of one side of the hand) requires half a fingertip unit.

WHAT ABOUT THE SIDE EFFECTS OF TOPICAL CORTICOSTEROIDS?

Thinning of the skin is a well recognised and possible side effect, mostly caused by using potent steroids over a long period of time. Prolonged use can also cause stretch marks. These side effects are uncommon when steroids are used properly. Steroids are safest when used intermittently, in an appropriate quantity, and for an appropriate length of time. Keep in mind that under-treatment of eczema results in skin thickening and darkening, which is the skin’s response to rubbing and scratching.

ARE THERE OTHER TREATMENT OPTIONS FOR ECZEMA?

  • Yes, other treatment options include:
  • Oral antihistamines and cool wet dressings applied to affected areas may offer further relief of itch4F
  • Topical immune modulators are prescription eczema drugs that do not contain steroids1H
  • Oral steroids
  • Ultraviolet light therapy
  • Coal tar
  • Oral immunosuppressants*

         *These are options to treat severe eczema 

INFECTED ECZEMA

People with eczema may scratch their skin up to 1000 times a day. Scratching damages the skin, allowing bacteria to enter and cause infection. Staphylococcus aureus is a common cause of infection, also referred to as a “staph” infection. Depending on the severity of the infection, a topical or oral antibiotic may be prescribed to clear the infection.

YOUR TREATMENT PLAN

Your doctor will devise a treatment plan to reduce and control the number of flares that you experience. Every eczema treatment has its place. There will be times where your doctor will prescribe steroids to treat your flares and other times where you may not need steroids. Most important, you need to keep your skin moisturised and avoid any possible triggers. Talk with your doctor and devise a treatment plan that works for you. The good news is that if a basic treatment plan is followed as prescribed, complete or near complete resolution of a flare can be achieved within 10 days – 2 weeks.

In conclusion, a sound understanding of eczema and confidence in using prescribed treatment will help you achieve optimal benefit from your treatment and improve your quality of life.