WHAT IS ECZEMA?

Eczema is a general term for any type of dermatitis or “itchy rash”. Eczema includes the following

  • atopic dermatitis
  • contact dermatitis
  • dyshidrotic eczema
  • nummular eczema
  • seborrheic dermatitis

All types of eczemas cause itching and redness and some will blister, weep or peel.

ATOPIC DERMATITIS (AD)
Atopic dermatitis is the most severe and chronic (long-lasting) kind of eczema. Atopic dermatitis is a disease that causes itchy, inflamed skin. It almost always begins in childhood, usually during infancy. Physicians estimate that 65 percent of eczema patients are diagnosed in the first year of life and 90 percent of patients experience it before age five. Often the symptoms fade during childhood, though “most” will have AD for life.

It typically affects the insides of the elbows, backs of the knees, and the face but can cover most of the body. Atopic dermatitis falls into a category of diseases called atopy, a term originally used to describe the allergic conditions asthma and hay fever. Atopic dermatitis was included in the atopy category because it often affects people who either suffer from asthma and/or hay fever or have family members who do; but now have been genetically connected. Physicians often refer to these three diseases as the “atopy triad”. The disease by its very nature can be episodic. People with atopic dermatitis tend to have high staph levels on their skin, although atopic dermatitis is not infectious to other people.

CONTACT DERMATITIS (ALLERGIC OR IRRITANT)
Contact dermatitis is a reaction that can occur when the skin comes in contact with certain substances, which can cause skin inflammation. Irritants are substances that cause burning, itching or redness. Common irritants include solvents, industrial chemicals, detergents, fumes, tobacco smoke, paints, bleach, woolen fabrics, acidic foods, astringents and other alcohol containing skin care products, and some soaps and fragrances. Allergens are usually animal or vegetable proteins from foods, pollens, or pets. Contact dermatitis is most often seen around the hands or parts of the body that touched the irritant/allergen.

DYSHIDROTIC DERMATITIS (POMPHOLYX)
This is a blistering type of eczema, which is twice as common in women. It is limited to the fingers, palms and soles of the feet. Your hands may have itchy, scaly patches of skin that flake constantly or become red cracked and painful.

NUMMULAR DERMATITIS (DISCOID)
Dry skin in the winter months can cause dry non-itchy round patches. It can affect any part of the body particularly the lower leg. One or many patches appear, and may persist for weeks or months. Discoid eczema does not run in families, and unlike atopic dermatitis, it is not associated with asthma. It does not result from food allergy. It is not infectious to other people, although bacteria sometimes secondarily infect it. Discoid eczema is more common in males.

SEBORRHEIC DERMATITIS
Red, scaly, itchy rash in various locations on the body. The scalp, sides of the nose, eyebrows, eyelids, and the skin behind the ears and middle of the chest are the most common areas affected. Dandruff (as seborrheic, is caused by a fungal infection) appears as scaling on the scalp without redness. Seborrhea is oiliness of the skin, especially of the scalp and face, without redness or scaling. Seborrheic Dermatitis has both redness and scaling.

MANAGEMENT OF ECZEMA

  • Over-the-counter (OTC) medications are available without a prescription because they contain the lowest potency of active ingredients. They are not designed to treat the causes of a disease, but to give some relief of symptoms.
  • Consult a doctor if the eczema or rash last longer than a week or is a recurring problem. If you have associated asthma, allergic rhinitis or conjunctivitis, this should also be examined as you may be allergic to the same underlying allergen. Allergy tests may help identify the incriminating allergen.
  • In acute flare ups, steroids creams or tablets may be required for control. Occasionally, often there is superimposed bacterial or fungal infection, these will also need to be treated. Antihistamine at higher doses can help reduce the itching. Non sedating antihistamine is preferred in the day time.
  • Topical Immunomodulators are non-steroids that can reduce the skin inflammation
  • Moisterisaton of the skin is essential in maintaining a healthy skin. Creams that has a high potency ceramide ingredient can hep to retain moisture and encourage skin repair. This will need to be applied when when the skin appears normal. For a atopic individual, there is often a subclinical reaction that needs to be treated.
  • Use a soap replacement as soaps tend to be harsh on the skin.
  • Use sun blocks when exposed to the sun.

Consult Dr. YT Pang for assessment and treatment.