Controlling itchy eruptions

Knowing that eczema is one of the most common skin conditions might not offer much consolation to someone suffering with it. However, a person with this condition can draw comfort from the fact that care and attention can keep the itchiness and rashes at bay. Here, Mediscene speaks to Dr. G.M.P. Sirimanna, Consultant Dermatologist, on a diverse range of queries arising from eczema.

Eczema, also known as dermatitis, is a condition marked by the inflammation of the skin. "Basically it is an itchy skin eruption," elaborates Dr. Sirimanna. Eczema is a general term used to describe inflammation of the skin attributable to a wide spectrum of causes. She is quick to add, "It is common and affects people of all ages."

The severity of the disease can vary. In the initial stages the most prominent feature is itching. However, in the acute stage, explains Dr. Sirimanna, redness, swelling, oozing and even blisters are common. "In the later stages (of the condition) there will be thickening, darkening and scaling of the skin," she adds. Despite its unappealing appearance, the condition is not contagious and is responsive to treatment. Some types of eczema can be cured. However, there is no complete cure for certain types of eczema; hence the patient's sensitive skin will always be prone to flare-ups.

The cause of eczema is not always easily identified, yet an observant patient may note that a flare up always follows exposure to a particular material. (e.g. flare up following contact with cement in construction workers).

The causes of eczema are as many as they are varied. However, depending on the history and clinical appearance of eczema an experienced doctor can make a logical guess as to what the probable cause is. Dr. Sirimanna explains that the causes of eczema can be divided into endogenous causes and exogenous causes. "Endogenous means arising due to causes within the body (such as varicose veins in the legs), while exogenous means arising due to causes outside the body (as in the case of contact with rubber)," she says.

Atopic Eczema: Atopic eczema is a common eczema of the endogenous type. Dr. Sirimanna reveals that it can be closely linked with either asthma or hay fever. Persistent and annoying itching is one of the characteristic symptoms. "Atopic eczema usually starts during infancy," she says adding that, "it can continue into early adulthood." A majority will be free of it by the time they become adults, though a few will have the condition throughout their adult lives.

Constant scratching can cause the skin to split, leaving it more vulnerable to infection. "Sometimes blisters arise and they rupture," says Dr. Sirimanna adding that "then there is an exudation of fluid." Known as 'weeping eczema', this is a very acute condition. Children in particular must be prevented from uncontrolled scratching.

Infantile Seborrhoeic Eczema: Common in babies under one-year-old, this type of eczema is first seen on the scalp and nappy area before it quickly spreads. Though this looks unsightly, the baby will not feel much discomfort, reveals Dr. Sirimanna, adding that it clears up quickly.

Adult Seborrhoeic Eczema: Most sufferers fall between the ages of 20 and 40. Characteristically appearing on the scalp as mild dandruff, the eczema can spread to the ears and chest. If the condition worsens, the skin becomes red, inflamed and starts to flake.

Varicose Eczema: Appearing in the later years, varicose eczema affects those with varicose veins in their legs, says Dr. Sirimanna. The skin around the ankles is affected, tending to become dark, itchy and inflamed. If left untreated, the condition will worsen, resulting in an ulcer.

Discoid Eczema: This type is characterised by itchy, reddish disc shaped areas which can later become thickened and pigmented, reveals Dr. Sirimanna. They have no apparent cause, and are normally located over the limbs, she adds.

Allergic Contact Dermatitis: As the name suggests, this type of eczema is caused by the immune system reacting unpleasantly to a substance coming into repeated contact with the skin.

Moreover, the eczema tends to develop at the spot of contact. For example, someone allergic to nickel will find a rash developing at the site where a nickel coated watch comes into direct contact with the skin, says Dr. Sirimanna.

Reactions may also occur after contact with other substances such as rubber.

Irritant Contact Dermatitis: Anyone could find their skin inflamed by sufficient contact with irritant substances, explains Dr. Sirimanna, adding that it commonly occurs on the parts of the body - such as the hands - that are most in contact with the substance. Housewives who spend much of their time with their hands immersed in detergents and house cleaning chemicals; hairdressers working with hair dyes and other chemicals or even nurses frequently working with strong antiseptic substances may fall victim to this type of eczema.

Treatment depends entirely on the cause of eczema. For instance if the cause is exogenous, avoiding further exposure to the causative substance will reduce the risk of a flare up. If the cause is endogenous, such as varicose veins, surgery can be used to improve the venous drainage and simultaneously do away with the eczema.

Frequent use of emollients, (the dermatological term for lubricants and moisturizers) is necessary to keep the skin from drying up. When there is oozing Condy's compresses can be applied to the skin to relieve the condition. Antihistamines might be prescribed to relieve itching.

In addition, a doctor may prescribe topical steroids. Dr. Sirimanna emphasises the importance of consulting a qualified medical practitioner before following a course of treatment. Uncontrolled application of potent steroid creams on delicate areas of the skin can result in irreversible side-effects, she warns.