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What is Eczema
It is basically a term to describe a condition where the skin is inflamed and angry looking. It is a group of condition which causes skin redness, itchiness, dryness, skin peeling and sometimes pain and infection.
Types of Eczema
Eczema which are due to allergy and are most common in children.
Eczema which are due to dryness and are very common in elderlies.
Eczema which occurs upon contact with something which you are allergic to or irritated by.
Eczema which tends to occur on your scalp, eyebrows, face and causes bad dandruff.
This article will focus more on atopic eczema, which is a very common condition in children.The exact cause and mechanism of atopic eczema is still not fully understood.
However, it seems that this condition affects patients who
- have a family history of eczema
- or who are concurrently suffering from other allergic conditions like allergic rhinitis or asthma or allergic red eye issues.
Atopic dermatitis typically begins in childhood, usually in the first year of life.
Most patients tend to outgrow them - about 70% of children outgrow atopic dermatitis by puberty. Unfortunately about 10-20% of atopic dermatitis persists into adulthood.
Patients with atopic eczema develop intensely itchy rashes, usually on parts of the body that folds, such as the inner part of our elbow, the back of our knees and the neck.
The itch is persistent and the skin is red and inflamed. It makes the patient scratch intensely and, as a result of the prolonged inflammation and scratching, the skin often discolours and thickens. Bacterial infection is common too, as the protective barrier of the skin is damaged due to the inflammation.
Triggers of Eczema and Atopic dermatitis
Stress, dryness of skin, heat and sweat, dirt and dust, allergens like dust mites, pollens and mould, even chemicals like detergents, fragrances and preservatives.
Management of Eczema and Atopic dermatitis
The condition can be extremely uncomfortable and disabling to patients, not to mention the impact it can have on the growth and development of a young child.
1) Avoiding Triggers
- To the best of your ability, keep the environment as clean as possible. Avoid having items that trap dust around the patient like soft toys.
- Vacuum your house and bedroom regularly.
- Constantly wash the pillow and bolster casings and sun the mattress every 2 weeks to get rid of dust mites.
- Opt for gentle and hydrating body wash and avoid using fragrances and harsh detergents.
- Avoid clothing made of wool or nylon fabrics.
Moisturizing the patient’s skin helps reduce dryness and itch, reduce inflammation and restore the protective skin barrier. Choose moisturisers that are hypo-allergenic, without fragrances.
Some of the ingredients that are beneficial includes ceramide, Urea, Glycerin, paraffin and hyaluronic acid. Application of moisturisers can be done liberally up to 2-3 times a day when required.
3) Topical steroid creams
Steroid creams are helpful to reduce inflammation and calm down the skin.
They help with the itch and the redness.
However prolonged steroid cream usage comes with side effects like skin thinning, discolouration of skin and may even affect the growth of the child if used in large amounts. As such, always seek a medical doctor’s opinion on what type of steroid creams to use and for how long.
When to see a doctor for Atopic dermatitis?
- If you are unsure of the diagnosis of the itchy rash - please see a doctor.
- If you have removed all potential triggers and have already applied plenty of moisturiser to your child but the condition is still worsening - please see a doctor as soon as you can.
- If there is a sudden worsening of the skin condition or even signs suggestive of infection like increasing pain, increasing redness or swelling or even blistering then you will need to see a doctor urgently as antibiotics may be necessary to treat bacterial infections.
Understand that eczema is long term skin condition. The skin may go through good times and bad times like a roller coaster.
However, remember that treatment is always available and the objective is to keep the skin in the good conditions most of the time. Seek help from your friendly Family physician or dermatologist if the situation goes beyond your control.
By : Dr Chen Yiming
Family Physician, MBBS (Singapore), GDFM (NUS), GDFP Dermatology (NUS)