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.
What is 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.
What causes eczema?
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),"
Types of eczema
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.
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
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
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.
Certain simple precautions can
help you keep your eczema under control, says
Dr. Sirimanna. Here are some suggestions:
- Prevent excessive drying
of skin - Hydrate your skin properly.
- Keep your skin clean and
avoid soaking it for long periods of time.
- Wear gloves to do your cleaning
and washing. Make sure you wear cotton gloves
under your rubber or plastic gloves to further
protect your skin.
- Prevent irritant fabrics
(for e.g. synthetic materials) from coming into
direct contact with the skin.
- Avoid stress, as it will
exacerbate the condition.
- Avoid harsh soaps, detergents
- Be aware of what environmental
factors trigger your allergies and avoid them.
- Be aware of any foods that
may cause an outbreak and avoid those.