Eczema

MD writing on board

Eczema or dermatitis is a dry, itchy, scaly skin disorder quite commonly affecting 8% of adults and approximately 20% of children with a considerable impact on quality of life. If were to think of a classification there are many types of eczema and  allergic eczema is one of them where it is associated with allergies. It is well known that eczema is a genetic condition and we usually encounter a family history of various atopic conditions like hay fever, asthma or eczema. Contact environmental allergens and sometimes food allergens can have an impact in the deterioration of eczema therefore proper allergy testing can help reduce traditional treatment with steroid creams. In addition to this, having eczema represents an additional risk factor for severe food allergy.

Eczema can be present anywhere on the body although in infants and children, it is more common observed on the face and creases whilst in teenagers and adults it will involve the wrists, hands and ankles together with facial and neck areas.

How does eczema look like?

Dry, scaly, red, itchy patches that can also weep, crust and bleed.

Eczema is a genetic skin condition due to a filaggrin mutation that induces an inflamed skin barrier, which is not able to actively maintain moisture in and germs out. Therefore, food allergies are not the underlying cause of eczema, but it has been shown that having eczema predisposes you to food allergies which in fact may contribute to worsening of eczema. So this can create a vicious circle which requires a dual management, optimum skin care topical therapy and precise identification of relevant allergies.

Diagnosis of eczema

Eczema is a clinical diagnosis, based on a detailed clinical history, the appearance of the skin lesions and how it has responded to treatment. If there is a suspicion of allergies, as a result of the eczema, or if allergies are thought to be contributory, then they may conduct tests such as patch testing to chemical substances for example within own toiletries or make up products, skin prick testing, specific IgE blood testing  or provocation challenges to identify relevant allergens.

 Doctors will also focus on modern management of eczema, including the use of topical creams, systemic treatments as well as non-steroid based anti-inflammatory creams such calcineurin inhibitors.

Treatments for eczema

Emollients will treat skin dryness in eczema by reducing water loss across the skin and help keep the skin hydrated. In addition to this, anti-inflammatory topical creams and ointments like topical steroids or non-steroid preparations like calcineurin inhibitors will calm down the inflammatory process in eczematous skin. In eczema resistant to topical treatments, there are other oral or injectable medications that may be useful although these are rarely required except for the most severe cases. Additional information brought by knowing what someone is allergic to might be useful for optimal control.

Any side effects?

Too much use of strong topical steroids, especially for extended periods carries the risk of skin thinning. On the other hand, fear of steroids can lead to undertreatment which is responsible for active eczema and thickening and depigmenting of the skin.