What is Atopic Eczema/Dermatitis?
Atopic eczema is a very common skin condition, which causes a dry, itchy and inflamed rash. The term ‘eczema’ is used interchangeably with ‘dermatitis’ and refers to inflammation of the skin. Atopy is characterised by a tendency to develop a group of hypersensitivity disorders; namely eczema, asthma or hay fever, due to a genetic predisposition.
How does atopic eczema present?
Atopic eczema commonly presents in infancy and childhood, but can also occur for the first time in adults. It affects both sexes equally. In infancy, commonly affected areas include the face and outer side of the limbs. During childhood, it usually affects the skin folds such as the elbow bends, back of knees and neck. Eczema may also occur around the lips, eyes and other parts of the skin. In mild eczema, there is a dry, red and itchy rash, while in more severe cases, there may be oozing, crusting and bleeding. The main symptom is itch, which can be severe enough to interrupt sleep, causing tiredness and irritability.
What causes atopic eczema?
The cause of atopic eczema is not fully known. However, we do know that genes play an important part as atopic eczema often runs in families. Alterations in the immune system are also thought to play a role in the development of eczema. The immune system in atopic eczema overreacts to things that do not normally cause any harm, such as irritants (eg soaps, fragrances, detergent), and allergens (eg house dust mites, animal dander). In addition, the skin barrier in atopic eczema is also impaired, leading to dryness and increased skin penetration of allergens and bacteria/viruses. It is important to note that atopic eczema is not infectious and you cannot spread it to other people.
Can atopic eczema be cured?
At present, there is no cure for atopic eczema. However, the skin condition can certainly be improved and controlled with good skin care and the use of appropriate medications. In general, atopic eczema tends to improve as the child gets older and 50% may clear in the teens. However, the eczema may still occur on and off, even in adulthood.
How do I care for the skin?
The following are important in the skin care of people with atopic eczema:
Avoid scratching, rubbing and picking the skin. This aggravates the eczema and may also lead to unsightly pigmentation, open wounds and scars.
Avoid irritant soaps and detergents. Use gentle soaps or soap substitutes instead.
Moisturise the skin frequently. Moisturisers do not cause thinning of the skin and should be applied liberally and frequently throughout the day. Remember to apply moisturisers after swimming.
Certain clothing materials such as wool and linen tend to irritate the skin while materials like cotton are more comfortable for the atopic skin.
When in a dry and cold environment, it is important to keep the skin well moisturised to prevent flaring of the eczema.
Avoid taking hot showers as this may aggravate skin dryness. It is best to shower with lukewarm or cool water.
What makes atopic eczema flare up?
Environmental factors, such as heat, dust, pets and irritants (eg soap and detergents)
Dryness of skin
Being unwell (eg having the cold or flu)
Teething in babies
Skin infections with bacteria or viruses, eg infection with the cold sore virus (herpes simplex)
Food allergens (see below)
Stress
What treatments are available?
Treatments commonly prescribed for eczema include moisturisers and topical steroids. Topical steroids are useful in reducing skin inflammation. They are safe if used appropriately. Some possible side effects of prolonged use of steroids include skin thinning. Your doctor will advise you on the appropriate use of topical steroids.
More recently, steroid-free topical medications have been developed and are available for the treatment of eczema. These creams (e.g. tacrolimus, pimecrolimus, crisaborole) are costly and your doctor will assess the suitability and appropriate use of these medications.
Oral treatments for atopic eczema include oral antibiotics when the skin is infected.
Antihistamines are also commonly prescribed to reduce the itch. In severe cases of atopic eczema, other treatment options such as phototherapy, systemic immunomodulators or biologic treatment may be indicated. Your doctor will advise you accordingly.
Do certain types of food make atopic eczema worse?
It is rare for food allergies to cause eczema, although food allergies may make eczema worse in some people. Prevalence of food allergies is highest in young children with severe eczema. It may be present in about one third of children less than 3 years of age with severe eczema. In adults, food allergy is very uncommon. Common food allergens in children include cow’s milk, hen’s egg, peanut, tree nuts, shellfish, wheat and soy.
Screening tests for food allergy include skin prick test and specific IgE blood test. The results of these tests must be interpreted by an experienced dermatologist.
