ECZEMA & DERMATITIS
is eczema or dermatitis?
The term ‘eczema’ is used
interchangeably with ‘dermatitis’ and refers to inflammation of the skin. It is
a highly individual condition that varies from person to person and comes in
many different forms. In mild cases, the skin is dry, red and itchy; while in
more severe cases, the skin may ooze, crust or bleed. The skin may also become
infected following breaks in the skin caused by scratching.
Eczema affects 1 out of 10
people (10%) at some time in their life. Although most often seen in children, it
can affect all age groups.
Atopic eczema is the most common
type of eczema. However, there are many other types of eczema as well. Atopy is
characterised by a tendency to develop a group of hypersensitivity disorders; namely
eczema, asthma or hay fever, due to a genetic predisposition.
This is most commonly seen in
babies (where it often clears by 2 months of age) although it also occurs in
adults. It is seen on the oily areas of the body such as the scalp, face, upper
chest, back and groin. The cause of seborrhoeic dermatitis is not clear. In infants,
the condition is believed to be related to developing sebaceous (oil) glands;
while in adults, it is thought to involve an inflammatory reaction to an
overgrowth of malassezia yeasts. 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.
Seborrhoeic dermatitis on the face with greasy yellow scales.
This presents with itchy, scaly,
coin-shaped patches which tend to blister and weep. It commonly occurs on the
arms and legs of young adults. The cause is unclear, but it is associated with dry
skin, the use of irritants (eg soap, detergents) and previous atopic eczema.
Discoid eczema on
This form of eczema is due to
extreme dryness of the skin, especially the arms and legs of elderly people. It
presents with an itchy, scaly, red rash that looks like ‘cracked tiles on the floor’.
It is associated with a decrease in the natural oils produced by the skin, and
over-cleansing of the skin (especially with hot water).
Asteatotic eczema with appearance
of “cracked tiles on the floor”.
This is also known as varicose, gravitational
or stasis eczema. It is commonly seen in the elderly and people with varicose
veins in the legs. The pooling of blood in the leg veins due to gravity leads
to this form of eczema. The legs may become swollen, especially at the end of
the day or after prolonged standing. There may also be associated
discolouration of the skin, as well as skin tightening and thickening.
Venous eczema on the left leg due to varicose veins.
There are two types – irritant
and allergic. Irritant contact dermatitis is caused by exposure to irritant substances
such as soaps, detergents, bleach and engine oils. However, even excessive
exposure to water alone can cause irritant contact dermatitis. Allergic contact
dermatitis is caused by a specific hyper-sensitivity to substances such as
nickel, epoxy glue, hair dye and fragrance/perfume. A patch test is done to
identify any allergen. Avoidance of the irritant or allergen should lead to
improvement of this type of eczema.
Nickel allergy-contact dermatitis on the abdomen around the umbilicus due to belt buckle
do I care for the skin?
The following are important in
the skin care of people with atopic eczema:
1) Avoid scratching, rubbing and
picking the skin. This aggravates the eczema and may also lead to unsightly
pigmentation, open wounds and scars.
2) Avoid irritant soaps and detergents.
Use gentle soaps or soap substitutes instead.
3) Moisturise the skin
frequently. Moisturisers do not cause thinning of the skin and should be
applied liberally and frequently throughout the day. Remember to apply
moisturisers after swimming.
4) Certain clothing materials
such as wool and linen tend to irritate the skin while materials like cotton are
more comfortable for sensitive skin.
5) When in a dry and cold
environment, it is important to keep the skin well moisturised to prevent
flaring of the eczema.
treatments are available?
Treatments commonly prescribed for
eczema include moisturisers and topical steroids. Topical steroids are useful in reducing skin inflammation. They
are safe if used appropriately. Some possible side effects of prolonged use of
steroids include skin thinning. Your doctor will advise on the appropriate use
of topical steroids.
recently, steroid-free topical medications have been developed and are
available for the treatment of eczema. These new TCI creams (tacrolimus, pimecrolimus) are
costly and your doctor will assess the suitability and appropriate use of these
Oral treatments for eczema
include oral antibiotics when the skin is infected. Antihistamines are
also commonly prescribed to reduce
the itch. In severe cases of atopic eczema, other treatment options such as phototherapy or systemic immunomodulators may be indicated. Your doctor will advise you
certain types of food make 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 children include cow’s milk, hen’s egg, peanut, tree nuts, shellfish, wheat
Screening tests for food allergy
include skin prick test and specific IgE blood 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)