Eczema and Atopic dermatitis

Dr Christophe Hsu – dermatologist. Geneva, Switzerland

What are eczema and dermatitis?

• Eczema and dermatitis are now generally used to describe the same skin condition and can be used interchangeably. Eczema is one of the commonest reasons for dry, sensitive skin, taking its name from the Greek word ECZEMA, meaning to boil over. This is an a descriptive term of an inflamed rash, which is often accompanied by an intense itching, which makes scratching almost inevitable. One person in ten has eczema at some time in their life, and it affects all age groups.

Is there just one type of eczema?

• No, there are many, but everyone with eczema experiences similar, unpleasant symptoms. These are some of the main types of eczema:

1. Atopic Dermatitis It is possible to develop atopic eczema at any age but it is most commonly found in babies and young children. Atopic eczema is thought to run in families and it is part of a group of atopic conditions, which include eczema, asthma and hay fever.
2. Seborrhoeic Eczema There are two types of this condition: one is most commonly seen in babies; the second is fairly common in younger adults. Areas affected tend to be the oily parts of the body, such as the scalp, face, groin and chest. Seborrhoeic eczema is not normally itchy.
3. Discoid Eczema This condition is usually confined to the arms and legs and consists of scaly, itchy, coin-shaped patches that can blister and weep.
4. Varicose Eczema This is a condition of the legs, commonly found in the elderly and people with varicose veins.
5. Contact Dermatitis

• There are two types – irritant and allergic. Irritant is caused by exposure to substances such as soaps, detergents, engine oils, hair dyes and bleaches. Allergy is caused by specific sensitivity to a material such as nickel, chrome or rubber.

What is Atopic Dermatitis?

• Atopic Dermatitis or eczema is an itchy, dry hypersensitive skin disorder affecting many people.
• It is common in children but can occur at any age.
• It is not infectious or contagious.
• The exact cause of atopic eczema is unknown. It may be hereditary.
• The patient or some family members may have other hypersensitive conditions like asthma or hay fever.
• The rash may appear red, wet and weepy or dry, thickened and scaly.
• When the disease starts during infancy, it is sometimes called infantile eczema. This is an itchy, crusted rash that tends to be localized principally on the face and scalp, but can appear at the other sites.
• Scratching often aggravates the rash. The skin thickens and becomes darker. It is a chronic condition. It can affect any part of the body, particularly the elbow bends, back of the knees and the neck.

What are emollients?

• Emollients are basically simple moisturisers used to combat the dryness of eczema and to protect the skin from further water loss. There is a wide range of products of this kind and it may take you some time to find the one that is suitable for your skin.

Questions (Q) and Answers (A):

• Q. Since atopic dermatitis is sometimes associated with food allergies, can the elimination of certain foods be of help?
• A. Yes, but is not common. Although certain foods will sometimes provoke attacks, especially in infants and young children, elimination of foods rarely brings about a lasting improvement or cure. Nevertheless, when all else fails, avoidance of common offending foods such as cow’s milk and eggs may be tried for a few weeks.

• Q. Are the inhaled and contacted substances in the environment important causes, and should they be eliminated?
• A. Yes. Dust and dust-forming objects (for example, feather pillows and comforters, kapok pillows and mattresses, dust-forming carpet, drapes, toys and certain rough garments such as wool, coarse silk) worsen the rash. Try to wet mop or vacuum floors, rather than sweep. Reduce contact with animal furs.

• Q. Are skin tests, as done in patients with hay fever or asthma of value in finding the offending substances?
• A. Yes, at times. However, results can be misleading particularly when the tests are carried out by persons inexperienced with such tests.

• Q. We have had a cat for five years but our youngest child has developed atopic eczema and we have been advised to get rid of the pet. We are very worried about the effect this will have on the whole family. Is there anything else we can do to minimise the effects of the cats?
• A. The problem with furry pets comes mainly from the shed skin or “dander” in the coat. Saliva and urine can also cause problems. However, when a pet has been in the family for a long time its sudden removal may not be feasible. Restricting the cat’s movements within the house can be difficult but it is very important that the animal is not allowed to go into the child’s bedroom. It is also important to realise that people may transfer hair and dander via their clothing. It has been suggested that weekly bathing of cats can help to reduce their allergenic effects. However, anyone with a cat can anticipate the type of problems this may cause! A wipe down with a damp cloth may not have quite the same effect but is used by some families to reduce the problem.

• Q. My first child has severe eczema. What is the likelihood of our next child developing the condition?
• A. It is thought that people inherit the potential to develop an atopic condition such as eczema, asthma or hay fever. It will take a trigger of some kind to bring out the condition. There is no straightforward pattern of inheritance but it seems that if one of your children already has the condition then your next child has a one-in-four possibility of developing eczema. However, it is important to bear in mind that in the majority of cases, eczema is a fairly mild condition and another child may not necessarily be affected to the same extent as the first.

• Q. What should be done to treat atopic dermatitis?
• A. See your dermatologist. Try to relieve itching by eliminating these aggravating factors:

1. Rapid changes of temperatures, strenuous exercise and hot weather.
2. Rough, scratchy, tight & woollen clothings.
3. Frequent use of soaps, bubble bath, hot water and other cleansing procedures that tend to remove natural oil from skin. Use mild detergents for your clothes and rinse the clothes thoroughly during washing.
4. Emotional upsets.
5. Wear light, smooth, soft, non-binding clothing.
6. Do not increase the skin’s dryness by prolonged or frequent hot baths, or showers and soap. Use mild soaps or ‘soap-free” soaps or emulsifying ointment. Bathe or shower with luke warm (not hot) water. When necessary sponge gently under the arms, in the groins and in other areas where cleansing is imperative. At other times, cleanse the entire skin with non-greasy lotion. Avoid sudden changes of temperature for instance, coming to air-conditioned rooms from the hot outdoors.
7. Try not to rub or scratch. When the itching is severe, try to relieve it by dabbing or applying cloths soaked in iced water.
8. It is important to comply with treatment. Your dermatologist can usually help you by prescribing external remedies (corticosteroid creams are most effective). Use sparingly. Apply a thin layer of cream on the rash with your fingers. Rub onto the skin till it disappears. Apply at least twice a day, preferably after showering. Do not use strong steroid creams for long periods as over-use will harm the skin. Use weak steroid creams when your eczema is mild. Oral medication (sedatives, antihistamines and sometimes, antibiotics by mouth) to control the itching and baths with diluted potassium permanganate are helpful. Corticosteroids taken by mouth or given by injections should be avoided if possible. However, when all other measures have failed, your physician may prescribe systemic corticosteroids for short periods.
9. Generally 90% of children out-grow the condition by early teens, although some continue to have problems even as adults.

• Q. Would a change in environment be helpful?
• A. For reasons that are not yet known, a radical change of environment, like a cool environment, sometimes is the “best” cure for atopic dermatitis. Many patients get better rapidly in the hospital.

• Q. Are there any other problems?
• A. Bacterial infection (pus) and viral infection (eg. Herpes simplex) can occur. Antibiotics and antiviral treatment are needed.

Contributors

Dr Christophe HSU – dermatologist. Geneva, Switzerland

National Skin Centre. Singapore