Eczema and how to deal with it

The National Eczema Association defines Eczema as “the name for a group of conditions that cause the skin to become red, itchy and inflamed.” Having eczema on the skin can be embarrassing and causes discomfort but experts say it can be managed. Dr. Shakirat Gold-Olufadi, Senior Registrar Dermatology and Genitourinary Medicine Unit Lagos University teaching hospital enlightens on eczema and how to deal with it. GERALDINE AKUTU reports.

What is the main cause of eczema?
ECZEMA refers to inflammation of the skin usually accompanied by redness, itching and some rashes. The classification varies, depending on the duration. Acute eczema is the early presentation characterised by itching, redness, rashes-like blisters, skin irritation, oozing and fluid discharge.

Without resolution, acute eczema can become sub-acute, where there is less oozing and now has scaling and this can also go on to become chronic eczema, when it becomes longstanding.

Chronic eczema is characterised by itching, dryness, scaling, cracking and thickening of the skin with exaggeration and darkening of skin markings called lichenification.

The causes of eczema are widely varied. This can, however, be simplified into endogenous and exogenous causes. Regardless of the cause of eczema, the presentation and symptoms are usually the same. 

Endogenous means there is something precipitating the eczema from in the patient, while exogenous refers to eczema precipitated by an external factor or stimuli. The prototype of endogenous eczema is atopic dermatitis, while that of exogenous eczema is contact dermatitis. 
 
Atopic dermatitis is an eczema that often starts in infancy or childhood that has genetic factors at play, which makes an individual more sensitive to environmental conditions like household mites, dust and pollen, among others. Heat, dryness of the skin, breaks in skin barrier and skin infections can also make atopic dermatitis worse.

Some patients with atopic dermatitis may also have food allergies though not common. Implicated foods include soy, seafood, cow’s milk, eggs and wheat. It is important to note that unnecessary restriction of food is not encouraged to prevent nutrient deficiency, except the individual has shown allergies to any of the foods mentioned above. 
 
Contact dermatitis can be in the form of an irritant or allergic contact dermatitis to an external stimulus, which then leads to the eczema.

In irritant dermatitis, repeated exposure to the external leads to the eczema without activating the immune system. Examples of irritants include repeated exposure to water in people that wash hands often, solvents, chemicals, soaps or detergents.

In allergic contact dermatitis, the immune system reacts to a specific environmental factor, which the individual has been exposed to at least once such as allergic dermatitis to latex gloves. 

Does the sun have any effect on eczema?
Ultraviolet light from the sun may aggravate any of the dermatitis. So, it is best to avoid the sun and use sun protective measures, such as sunscreen with sun protective factor (SPF) of at least 30.

How is it diagnosed?
The diagnosis of most eczema is usually clinical, after a good history and examination by the dermatologist. Allergic contact dermatitis may require a test called patch test.

What are the best treatments for eczema?
The treatment of eczema depends on the cause. The most important thing is to eliminate any external precipitants (as mentioned earlier) if identified. There is need for regular and judicious moisturising of the skin with use of such drugs as antihistamines to relieve itching. It is also important to treat any superimposed infections.

Use of personal protective materials may be necessary to prevent contact with the precipitants. Drugs such as steroids or those that modify the immune system may also be used when needed.

Most patients loosely use the term eczema to describe pityriasis versicolor, a fungal infection of the skin. It is important to correct this, as pityriasis versicolor is not synonymous with eczema.