By Smriti Daniel

Eczema affects people of all ages but the age at which it strikes can provide a hint of what’s to come. “Eczema is an inflammation of the skin due to various chemical mediators that act within the skin,” says Dr. Chalukya Gunasekera, a Consultant Dermatologist at the National Hospital, explaining that the condition manifests as reddening, scaling and particularly itching with some patients develop oozing sores and blisters as well. In the long term, eczema can leave the skin darker and thickened. However, there are many types of eczema – discovering what is causing yours can help your doctor treat it. Many patients who develop the condition as children subsequently outgrow it, for others who discover they have eczema as adults; it may instead be about learning how to manage the symptoms.

The good news with atopic eczema is that those who develop it as children generally find themselves improving as time passes. Constant scratching can cause the skin to split, leaving it more vulnerable to infection. This can lead to an acute form of eczema known as weeping eczema. Children, in particular, need to be kept from scratching themselves. However, there are the late onset types and some of these patients will never be able to fully overcome their eczema, instead the disease fluctuates, subsiding and flaring up at intervals.

Another type of endogenous eczema known as Seborrhoeic eczema can also develop in babies under a year old, appearing in the scalp and nappy area first. Though upsetting for parents, the child often doesn’t appear to feel intense discomfort and the eczema itself typically clears up quickly.

Exogenous eczema can be understood as an allergic reaction of the skin. The main type is known as contact dermatitis. Contact with a number of substances has been known to trigger an episode. For some patients, it’s wearing nickel jewellery with eczema developing in places where the cosmetic jewellery comes in contact with the skin such as the ears and throat. For others it is on the scalp secondary to the use of hair dye which has a chemical component known as PPD. For some it might be something as a common as rubber slipper, with lines of eczema forming where the straps touch the foot.

The eczema might appear the very first time you use the product, when exposed to a particular allergen but it can also take years. This often confuses patients who resist when asked to stop using products they’ve used over a long period of time, but curtailing your exposure might be the best way to manage your symptoms.

Eczema can also be triggered by the excessive use of harsh soaps or by allowing your skin to become very dry explains Dr. Gunasekera, adding that woollen clothing, animal fur and dander (the tiny flakes of skin that come off animals), a lot of dust in the air and even the house dust mite are known irritants. Psychological stress is also one of the triggers and can aggravate an eczema attack.

When it comes to cases of contact dermatitis, your doctor will simply suggest you avoid contact with the irritant, but sometimes that is easier said than done. “It can be hard to identify the cause,” says Dr. Gunasekera, pointing out that the environment in modern cities is rife with pollutants. Some patients who present with odd, bizarre patches of eczema must be put through a patch test. Taking 48 hours, the test allows doctors to see how the skin responds to possible allergens and to identify exactly what is causing the problem. In some cases, there’s no clear answer, complicating the management of even contact dermatitis.

“There is no cure for eczema, it is a matter of learning how to control it,” she says. Simple measures can help alleviate symptoms. Dermatologists often prescribe soap substitutes. These maintain the natural acidity of the skin unlike soaps that have a tendency to make the skin alkaline. Moisturisers also help as moisturising is a good process for the skin. More serious treatment involves steroids. Antihistamines might be prescribed to relieve itching.  When used as prescribed, in the right quantity for a limited duration, steroid treatments are highly effective. However, patients should take care not to misuse the drug or to continue using it after their prescription has lapsed. Further treatments vary depending on the kind of eczema and its symptoms.

Preventing an outbreak

• If your skin is dry, use moisturizers. Keep your skin hydrated.
• Avoid soaking it in water for long periods of time.
• Keep your skin clean but take care not to over-wash.
• Wear gloves to do your cleaning and washing. Make sure you wear cotton gloves under your rubber or plastic gloves to further protect your skin
• Prevent irritant fabrics from coming into direct contact with the skin
• Try to manage or avoid stress
• Avoid harsh soaps, detergents and solvents
• Be aware of what environmental factors trigger your allergies and avoid them

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