Eczema & Dermatitis

What is eczema or dermatitis?
The term “eczema” is used interchangeably with “dermatitis” and refers to inflammation of the skin.
Eczema is one of the commonest causes of dry, sensitive skin. This is an itchy, red inflamed rash and the affected person scratches persistently. 

Eczema affects 1 out of 10 persons (10%) at some time in their life, and it can be present in all age groups.

Atopic eczema is the commonest type of eczema. However, there are many other types of eczema as well. Almost everyone who has eczema experiences similar unpleasant symptoms. The following are some of the other types of eczema.

Seborrhoeic Dermatitis
This is most commonly seen in babies and clears by 2 months old. It also occurs in younger adults. It is seen on the oily areas of the body like the scalp, face, groin, upper chest and back. Seborrhoeic dermatitis is either not itchy or just mildly itchy. There is a greasy, yellow scaly rash on the affected areas. When the scalp is affected, dandruff is seen.

Discoid Eczema
It presents with itchy, scaly coin-shaped patches which tend to blister and ooze. It is common on the arms and legs of young adults

Asteatotic
This form of eczema is due to extreme dryness of the skin, expecially the arms and legs of elderly people. It presents with an itchy, scaly red rash that looks like “cracked tiles on the floor”.

Venous Eczema
It is commonly seen in the elderly and people with varicose veins on the legs. The pooling of blood in the leg veins due to gravity leads to this form of eczema.

Contact Dermatitis
There are two types - irritant and allergic. Irritant contact dermatitis is caused by exposure to irritating chemical substances such as soaps, detergents, bleach or engine oils. Allergic contact dermatitis is caused by a specific hyper sensitivity to a material such as nickel, epoxy glue, rubber and fragrance/perfume. A patch test is done to identify any allergen. Avoidance of the irritant or allergen leads to rewhitening of the contact dermatitis.

How do I care for the skin?

• Avoid scratching, rubbing and picking the skin. This aggravates the eczema and may also lead to unsightly pigmentation, open wounds and scars.
• Avoid irritating soaps and detergents. Soaps used should include gentle soaps or soap substitutes.
• Moisturise the skin frequently. Moisturisers do not cause thinning of the skin and should be applied liberally and frequently. The best time to apply moisturisers is right after a bath. Remember to apply moisturisers after swimming.
• Certain clothing material such as wool fabric and linen often irritate the skin and materials such as cotton are more comfortable for the sensitive skin.
• When in a dry or cold environment, it is important to keep the skin well moisturised to prevent aggravation of the eczema

What treatments are available?
Treatments commonly prescribed for eczema include moisturisers and topical steroids. Topical steroids are useful in reducing the inflammation. They are safe if used appropriately. Some possible side effects of prolonged use of steroids include skin thinning and atrophy. This may occur with prolonged and inappropriate use of topical steroids. Your doctor will advise you on the appropriate use of the topical steroids.

More recently, steroid-free topical medications have been developed and are available for the treatment of eczema. These new treatments are costly and your doctor will assess the suitability and appropriate use of these medications. Oral treatments for eczema include oral antibiotics when the skin is infected. Antihistamines are commonly prescribed to reduce the itch.

In severe cases of eczema, other treatment options such as phototherapy or systemic immunomodulators may be indicated. Your doctor will advise you accordingly.

Do certain types of food make the eczema worse?
It is rare for food allergies to cause eczema, although food allergies may make eczema worse in some people. Prevalence of food allergies is highest in young children with severe eczema. It may be present in about one third of children less than 3 years of age with severe eczema. In adults, food allergy is very uncommon. Common food allergens in childhood include cow’s milk, hen’s egg, peanut, nuts, shellfish, wheat and soy. Screening tests for food allergy include skin prick test and specific IgE test called RAST test. The results of these tests must be interpreted by an experienced dermatologist.

DEDICATED TO EXCELLENCE IN DERMATOLOGY
By National Skin Centre (Singapore)
Copyright (C) 1995 - National Skin Centre (Singapore)