Sunday April 20, 2014
BY DR SABEERA BEGUM KADER IBRAHIM
While eczema (dermatitis) can be a difficult disease, it is a manageable one.
With proper treatment and care, people with eczema can lead fulfilling lives and participate fully in school, work and family activities.
Eczema is an inflammation of the skin that flares up from time to time.
Atopic dermatitis is the most common type of eczema, and usually strikes before the age of five.
In eczema, moisture is easily lost from the skin, causing it to dry out and flake.
Symptoms include red to brownish-gray patches, itching, tiny raised bumps and vesicles that may leak fluid and crust over, and thickened or scaly skin.
Proper skin care and management of inflammation can usually ease the symptoms and keep the situation under control.
Moisturise!
For people with mild eczema, keeping their skin soft and moisturised by frequent and generous use of emollients may be all that is needed to improve and manage symptoms.
Emollients are non-cosmetic moisturisers that come in the form of creams, ointments and lotions. They keep skin moist and help prevent cracks, making it more comfortable and less itchy.
The type of emollient used depends on the condition of your eczema, the body part involved, and any sensitivities to the emollient.
Creams contain a mixture of water in fat, and have a light and cool effect on the skin. Due to this, many people with eczema prefer creams for daytime usage.
However, they may contain preservatives and might cause sensitivity, although such occurrences are rare.
Ointments do not contain preservatives, but they can be very greasy and may be cosmetically unappealing to some.
However, they are very effective at retaining moisture in the skin, and are useful for very dry and thickened skin.
Lotions contain more water and less fat than creams, but evaporate quickly and are not the most effective means to keep skin moisturised. However, they are easy to apply, especially over hairy regions of the body.
Regular use of emollients may be all that you need in keeping mild eczema symptoms in check. However, people with more severe eczema may require medications to help control their flare-ups.
Medications for eczema control
Prescription corticosteroid creams or ointments can ease inflammation and relieve itching.
Some low-potency corticosteroid creams are available over-the-counter, but always consult your doctor before using any topical corticosteroid.
They are very effective and safe if used correctly. Despite this, many people are concerned about potential side effects from topical steroids.
The trick is to use the correct strength of steroid for the severity of the eczema, and be prepared to change treatment as the severity of the eczema changes.
Topical steroids are usually discontinued when the symptoms disappear and resumed when new patches arise.
The side effects of long-term use include skin irritation or discoloration, thinning of the skin, infections and stretch marks.
You may require antibiotics if you have added-on bacterial skin infection. The signs of bacterial infection include weeping, crusting, pustules or painful swelling.
Often, only a short course of antibiotics is needed, although rarely, hospital admission is necessary for intravenous treatment.
Oral antihistamines may help with severe itching. However, some antihistamines can make you sleepy.
If your skin cracks open, your doctor may prescribe mildly astringent wet dressings to prevent infection.
For more severe cases, oral corticosteroids, such as prednisone, may be prescribed to reduce inflammation and manage symptoms.
These medications are effective, but often used in the short term only. They cannot be continued for more than a few weeks at a time without significant side effects.
Managing lifesyle factors
Flares-up may be associated with lifestyle factors such as stress, physical activity, contact allergy and temperature changes.
Stress management is vital in controlling eczema. Often, it involves making time for rest and relaxation, and managing your reaction if the situation is unavoidable. Getting adequate sleep is also important.
Patients should try to avoid known allergens such as dust mites, pollen, animal dander and clothing materials like wool and synthetics.
Food allergies affect a third of children with eczema, and can cause flare-ups, especially in children less than two years old. Common foods that cause flare-ups include milk, eggs, wheat, soy and peanut products.
People also flare up when they experience a sudden change in temperature. So, try to anticipate weather changes, especially when travelling abroad, and arm yourself with effective treatments.
Lastly, try to avoid hot baths, and don’t scratch if you are itchy.
A few ways to control itchy eczema include rubbing, applying emollient or a bag of ice to the affected areas and gently pinching the skin around the eczema to divert the itch sensation.
It may also help to keep your fingernails short to prevent injuries from scratching.
Seek advice from your doctor if you have any doubts.
