What is Eczema? 

Eczema, also called atopic dermatitis, is a chronic, inflammatory skin disease marked by intense itching, red rashes, dry skin and accompanying skin lesions.⁽¹⁾ It may go away for a while, then flare up again.

Eczema in Malaysia

Eczema is a common skin condition which afflicts 10-20% of children and 1-3% of adults worldwide, and two in every 10 individuals in Malaysia.⁽²⁾  

However, a survey conducted by LEO Pharma reveals low awareness of eczema in Malaysia.The study revealed that 75% of eczema patients knew little or nothing about eczema prior to diagnosis, while 15% had never heard of it prior to seeing a  healthcare professional. ⁽²⁾

It is very important to give eczema due medical attention at the onset of symptoms – the most common of which are constant itch, redness, and skin dryness. If untreated, eczema can lead to severe flare-ups, and even, serious infection.

Scratching damages the skin, and allows penetration and colonisation of Staphylococcus aureus bacteria, which is present on the skin of more than 95% of eczema patients.⁽³⁾ This leaves patients more at risk of dry and brittle skin, which becomes sensitive to chemical impact and entry of irritants and allergens.

When bacteria enter the defective skin barrier damaged by scratching, the secretion of its toxins causes further swelling, intense itching, and infection. Over time, the skin becomes thickened, scaly and crusty.

Patients Living with Eczema

For people suffering from eczema, the constant itch that they experience can put a damper on their daily lives. The intense itch is the most burdensome of them all. Some will even scratch until the skin bled, because when they feel the pain, they won’t fell the itch.

As eczema is highly visible on the skin, it can also have an emotional, psychological, and social impact on the person suffering from it and most patients are embarrassed about their condition. ⁽⁴⁾ For instance, a flaking rash on the hands or face can make a person feel self-conscious in public, thus making social interactions difficult while children who have eczema can be subject to bullying and teasing by peers, which can be traumatic for them.

On top of that, a patient’s productivity level at work or school also dips by 26% during an eczema flare-up.

Just imagine when a patient can’t sleep at nighttime and wakes up scratching himself all night long, it affects, significantly, his capability of coping, working and enjoying life.

What Causes Eczema?

The exact cause of eczema is unknown, but researches suggest its due to a combination of gene and environmental triggers.

Eczema is thought to be linked to an overactive response by the body’s immune system to an irritant. Some cells of the immune system release chemicals under the skin surface, which causes inflammation like red, itchy, and painful skin symptoms.

Meanwhile, eczema can be triggered by several factors, such as changes in climate,

pollution, house dust mites, dander from pets, pollens, detergent, sweating, certain food, stress, hormonal changes or infection.

What are the symptoms?

No matter which part of the skin is affected, eczema is almost always itchy. The rash most commonly appears on the face, skin folds such as back of the knees or elbows, hands, and feet. Rashes tend to come and go. With time, they can get crusty and scaly. An infection or too much scratching can make your symptoms worse. It can even make your skin thick and leathery.

In general, the term “Eczema” is broadly applied to recurring skin rashes that are characterized by one or more of the following symptoms:

• Intense Itching
• Redness & Inflamed
• Cracking
• Crusting or Oozing
• Blistering
• Swelling & Burning

Itchy Triggers

Many sufferers describe eczema as “the itch that rashes” because the itching starts, and then the skin rash follows as a result of scratching. Doctors often suggest patients to stop scratching the itch as it can make eczema worse. However, it is easier said than done as scratching provides instant relief.

Eczema flares are frequently triggered by the “itch-scratch cycle”. When patients scratch, it causes more inflammation. The itch causes the scratch, and the scratch causes more inflammation with more rash- and so the cycle continues.  The National Eczema Association says, “ Itch is a complicated symptom of eczema. Multiple nerve pathways and chemical mechanisms have been identified—as well as other contributing factors, including a defective skin barrier, external triggers and human nature.”

The Different Types Of Eczema

• Atopic eczema / atopic dermatitis

The most common type of eczema. A chronic, itchy inflammatory skin disease that occurs most frequently in children but can also affect adults. It is often associated with elevated serum immunoglobulin (IgE) levels.

• Contact eczema

Any skin lesions or inflammation arising from direct skin contact  to an irritants such as chemicals, detergents or soaps. Burning, itching, and redness occur. The inflammation goes away when the irritant is removed.

• Dyshidrotic eczema

An intensely itchy, chronic, and recurrent skin condition of unknown cause that typically presents with rash of small blisters filled with fluid on the palms and soles and sides of the fingers.

• Seborrheic eczema

Usually presents with itchy reddish or scaly patches affecting areas with a high density of sebaceous glands, such as the face and scalp. Dandruff of the scalp is a mild form of seborrheic dermatitis.

• Asteatotic eczema

Usually presents with itchy inflamed skin on lower limbs due to extreme skin dryness. Low environmental humidity (dry weather) and exposure to harsh detergents or irritants are the main factors.

How is eczema treated?

There is no cure for eczema. Does that mean sufferers will need to live with the itch forever?  Fortunately, there are ways to remedy the itch and effectively treat eczema symptoms to reduce frequent scratching. ⁽⁵⁾ Treatment for the condition aims to heal the affected skin and prevent flare-ups of symptoms.

Managing Daily Life and Complications of Eczema

Life with eczema can mean spending a lot of time and energy avoiding conditions and triggers that will cause your symptoms to flare up. Simply steps that you take in daily life can all help minimize symptoms.

• Wear light, cotton, loose-fitting clothing. 

Heat, wool and other rough-feeling fabrics can irritate or worsen itchy skin. Letting your skin breathe can reduce the intensity of that must-scratch feeling.

• Use a gentle body wash to minimize irritation.

You need to use the right cleanser. A mild, soap-free , free of dyes and perfumes option is less likely to strip your skin of its natural barrier and cause dryness.

• Apply a cold, wet cloth or ice pack to the skin that itches.

This often helps relieve irritated or itchy skin. The cold compress is applied to the affected area and held for five to ten minutes. The cool temperature can help reduce itching.

• Bathe with lukewarm – not hot – water. 

A steamy shower might seem soothing, but not for eczema. A long, hot shower can remove natural oils and moisture from the skin.  Try to limit your bath or shower to just 10 minutes and keep the water at a warm, not hot, temperature.

• Moisturize your skin at least twice a day. 

Hydrating regularly with moisturizer/ ointment can prevents dryness that can lead to itching and it acts as a barrier to block out potential irritants. It is best to apply moisturizer within 3 minutes of bathing to “lock in” moisture.

• Learn and avoid individual eczema triggers

Keep a trigger diary, where you can record your exposure to potential triggers, especially when your eczema starts to flare up.

• Avoid scratching and rubbing. 

Rather than scratching when you itch, try pressing on the skin. Cover the itchy area if you can’t keep from scratching it. Trim nails and wear gloves at night to minimize skin damage from scratching

• Stress and anxiety 

Worry can make your eczema flare up. Plus itchy, sore skin can also stress you out. It can be an endless cycle if you don’t break it.Find ways to relax in times of stress.  Aromatherapy, massage therapy, practice yoga, meditation, get enough sleep and listening to soothing music may help you ease tension.

• Try natural remedies 

Explore natural remedies to help reduce recurrent allergic reaction and reduce dependency on anti-allergic drug . Natural ingredients like Perilla Seeds and Quercetin has shown potential for relieving allergy symptoms, acting similar to antihistamines.

Eczema is very normal, very common, and very, very uncomfortable. It can affect your quality of life. At its worse it can keep you from sleeping, distract you and make you feel self-conscious in public. However, try to maintain a positive mindset, eat healthily and take good care of yourself can always help to reduce eczema flare-up and you can still enjoy your life.

References:

1. Atopic Dermatitis: Who Gets and Causes. American Academy of Dermatology.  http://www.aad.org/skin-conditions/dermatology-a-to-z/atopic-dermatitis/who-gets-causes/atopic-dermatitis-who-gets-and-causes
2. Atopic Dermatitis / Eczema. Allergy Centre Malaysia.http://www.allergycentre.com.my/atopic.html
3. Leung DY. The role of Staphylococcus aureus in atopic eczema. ActaDermatoVenereologica2008;(S216):21-7.
4. The Psychological Effects of Eczema. http://www.livingwithallergies.org/the-psychological-effects-of-eczema.
5. Thestrup-Pedersen K. Treatment principles of atopic dermatitis. Journal of European Academy of Dermatology and Venereology 2002;16:1–9.

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