Dermatology
Typically developing in children as young as a few months, eczema is a chronic skin condition that can persist into adulthood in 10% of cases.
While it cannot be cured, it can be effectively treated.
Atopic dermatitis, loosely known as eczema, is a chronic, extremely itchy inflammation of the skin that while treatable, often comes with repeated relapses. “There's usually a family history of atopic allergic conditions, like sinus issues, allergic rhinitis, asthma, and eczema itself,” says Mediclinic Morningside dermatologist, Dr Mary Rouhani.
How eczema gets under your skin
Eczema causes a skin barrier issue, that occurs when the epidermis, the outer, protective layer of the skin, doesn’t act as it normally would. The epidermis generally acts as a protective barrier against the external environment . It also has immune cells which guard against bacteria.
Because the architecture and function of the skin is compromised due to an impaired skin barrier, patients lose the water in their bodies more easily than a typical person would, making it hard for the skin to stay hydrated. “This results in pathogens, allergens and elements that normally wouldn't, sticking to someone's skin, causing problems and wreaking havoc,” says Dr Rouhani. They are therefore more susceptible to multiple infections.
Eczema usually starts in babyhood in the form of rashes that appear on red cheeks, Dr Rouhani explains, later appearing on the outside of the elbows and the front of the knees. “By around the age of two, the rash drifts to the inside of the elbows and knees, and around the neck area. While 90% of children who suffer from eczema will outgrow it around the age of 19, 10% carry it into adult hood.” This group of adults will likely always have the condition.
Treating eczema
While not curable, eczema can be treated very successfully and very quickly, says Dr Rouhani. Depending on the strength and efficacy of the treatment, symptoms can literally disappear within a day or two, she explains.
Treatment, she says is multifactorial. It starts with asking what washing detergents are being used for the patient’s clothing, what soaps and creams are being applied to their bodies and what environment they live in in terms of dust mites, pollen and so on. “We then put them on the correct soaps, the correct emollients to build up the skin barrier, the correct washing powder and so on.”
“The most important thing is to control the triggers – the elements that cause the flare-up,” she continues. “We need to ensure that there aren't other nutritional deficiencies contributing to the skin barrier problem, so that they get a milder flare-up if they get one at all. There are so many fantastic things on the market, with new research being conducted on supporting the skin microbiome – making sure the skin barriers are working well, that the skin and the good bacteria, are balanced.” When this balance is maintained, bad flare-ups shouldn’t occur and if they do, they are treatable.
Medication is tiered, Dr Rouhani explains. It ranges from mild topical cream, to mild to moderate to stronger corticosteroids or steroid creams, to calcineurin inhibitor creams, to PDE5 inhibitor creams, to immunosuppressants as needed. Yet one must always treat the trigger, she adds. For example, if the child has an upper respiratory tract infection and you don't treat it, you'll end up putting that child on a very strong medication for the eczema, whereas all you needed to do was treat the infection.
While some of the modifications above are always the first port of call, there are stronger medications with anything from oral steroids to topical corticosteroids to biologics prescribed for severe cases. These however, can come with side effects depending on the duration of treatment and dosage prescribed.
Preventing eczema flare-ups
As Dr Rouhani says: “If we go through this process of finding out what the triggers are and eliminating them, supporting the skin barrier, treating any secondary infections, and educating patients about psycho-emotional triggers, very few need to go on heavier duty medication.
This also means that bad eczema flare-ups can be prevented if treated appropriately from the start, she adds. “In most patients I see, where I do a workup and make sure there's no other medical issues or deficiencies, they appear to be well controlled.”
She however stresses the need for a multidisciplinary approach with appropriate specialists brought in to treat patients who have an allergic march – where they go on to develop further allergies like allergic rhinitis or asthma.