Atopic dermatitis (eczema) is one of the most common conditions we see in Dermatology clinics. It is genetically inherited and forms part of the allergic triad that includes eczema (skin allergy), rhinitis (nose allergy) and asthma (airway allergy). While one member of the family may have nose allergy for example, another member may have eczema or asthma, or a combination of all three.
Eczema usually starts in early childhood and tends to improve with age. 50% of children outgrow their eczema by puberty. Eczema may however, persist or even start in adulthood. It presents with itchy, red, dry patches on the face, arms and legs. It is associated with dryness of the skin, and therefore usually flares in the winter season. In adults, it can present solely with itching, dryness and redness over the hands or eyelids.
Treatment of eczema may be frustrating since it is a chronic disease with frequent recurrences. Maintenance therapy with a special daily routine is highly important to minimize recurrences. Patients with eczema should avoid allergens and triggering factors. In children, foods such as milk, eggs, soy, wheat and peanuts can trigger eczema, while in adults allergens are usually external such as wool, dust, pollen, and cats. Patch testing can be done to exclude possible contact allergens. Excessive hand washing with the use of hand gels and antiseptic soaps should be avoided as this worsens the dryness. Gloves should be worn during house work or any exposure to detergents. Daily hydration of the skin with a thick cold cream directly after shower is key. Contrary to popular belief, drinking lots of water is not enough to keep the skin hydrated. Moderate sun exposure is beneficial.
Despite proper skin care, eczema will at times flare in response to allergens, illness, weather changes, or stress. When this happens on limited areas of the body, steroid creams or tacrolimus are the primary treatment. At times flare-ups can be strong and diffuse requiring steroid tablets. These should be given for only a short period of time and discontinued once the exacerbation is better so as to avoid side effects. Only a minority of patients have a bad form of eczema with frequent severe exacerbations. Such patients can benefit from long term treatment with immunosuppressive medications or phototherapy.
Although eczema is a chronic condition, patients should focus on optimizing preventive measures by avoiding triggers and using daily hydration. By doing so, the condition can remain under control with infrequent exacerbations that respond to a week’s treatment with steroid creams.