Eczema

Understanding Eczema

Eczema, also known as atopic dermatitis, is a chronic skin condition characterised by inflammation, redness, and irritation. It affects millions of people worldwide and can occur at any age, though it often begins in childhood. The condition is marked by flare-ups that can vary in severity and often become less severe with age, though some individuals continue to experience symptoms throughout their lives.

Symptoms

The primary symptoms of eczema include:

• Itchiness: This is often the most distressing symptom, leading to significant discomfort and disruption to daily life.
• Redness, inflammation: Affected areas can appear red and swollen, particularly in lighter-skinned individuals. In darker skin tones, the skin may look darker or ashy.
• Dry, scaly patches: The skin often becomes dry and flaky, which can lead to cracking and bleeding.
• Blisters: In some cases, small, fluid-filled blisters may develop.
• Thickened skin: Repeated scratching can cause the skin to thicken and become leathery, a condition known as lichenification.

Causes

Eczema is thought to result from a combination of genetic and environmental factors:

• Genetics: A family history of eczema, asthma, or hay fever increases the likelihood of developing the condition.
• Immune system: Eczema is associated with an overactive immune response, which leads to inflammation and skin damage.
• Environmental triggers: Common triggers include allergens (like pet dander or pollen), irritants (such as soaps or detergents), temperature extremes, and stress.
• Skin barrier dysfunction: A compromised skin barrier allows moisture to escape and irritants to enter, exacerbating the condition.

Diagnosis

Diagnosis of eczema is typically based on medical history and a physical examination. The patient’s family history, symptom patterns, and any potential triggers may be asked by dermatologists. In some cases, patch testing or other diagnostic tools may be used to identify specific allergens or irritants.

Treatment

Treatment for eczema aims to alleviate symptoms, prevent flare-ups, and improve the overall quality of life. It usually involves a combination of:

• Moisturisers: Regular use of emollients helps to keep the skin hydrated and protect the skin barrier.
• Topical steroids: These anti-inflammatory medications reduce swelling and itching. They should be used as prescribed by a healthcare provider to minimize side effects.
• Topical calcineurin inhibitors: These non-steroidal medications can be used for sensitive areas and long-term management.
• Antihistamines: Oral antihistamines may be prescribed to help control itching, especially if it disrupts sleep.
• Avoiding triggers: Identifying and avoiding known irritants or allergens is crucial for managing eczema effectively.
• Phototherapy: For severe cases, light therapy (exposure to ultraviolet light) may be recommended.
• Biologics: In recent years, non-steroid treatment using monoclonal antibodies has been very effective in reducing itch and rash of severe atopic dermatitis. Biologics have been a game-changer for severe atopic dermatitis, especially for patients who have been on long term oral steroids and immunosuppressive drugs.
• Janus Kinase (JAK) Inhibitors: This new class of drugs which block the intracellular signalling of inflammation have also been shown to effectively reduce itch and rash in severe atopic dermatitis. Some of these drugs have received FDA approval for this purpose. Before starting on oral JAK inhibitors, certain blood tests need to be performed including that to exclude tuberculosis. Regular blood testing is also needed for patients on this class of medications. Recently a prescription topical cream has also been approved by FDA for topical treatment of atopic dermatitis.

Prognosis

While eczema is a chronic condition, many people find that their symptoms improve with age or with appropriate management strategies. Regular follow-ups with a healthcare provider can help tailor treatments to individual needs and address any emerging issues.

Managing eczema requires a comprehensive approach that includes medical treatment, lifestyle adjustments, and ongoing care. At Skin Physicians, our dedicated dermatologists will use the right strategies to help make your eczema a little more manageable.