Many of us experience dry skin in the winter months. This is easily treated with emollient creams to restore the moisture balance in the skin. However, for a person with eczema, dry skin is one of the stages of a vicious cycle that alternates between flares and periods of remission. The flares are red, oozing crusted rashes on different parts of the body. Eczema is a non-contagious, chronic and extremely itchy skin condition. It occurs mainly in children, often starting in the first year of life. The rash ALWAYS ITCHES. The itching often leads to an uncontrollable cycle of itching-scratching-itching. When this happens at night the child becomes sleep deprived and the restlessness impacts on the whole family. Fortunately most children have outgrown the problem by puberty.
The causes of eczema are complex. There is a definite genetic (family history) link. One of the barrier proteins responsible for maintaining a healthy skin is Falligrin which maintains the correct hydration and PH of the skin. It is estimated that 50% of people with atopic dermatitis have mutations in this FLG gene.
Environmental factors also play a big role. Most children with an early onset of eczema are sensitive to food allergens such as cow’s milk, eggs and peanuts. Cold weather can trigger a flare. Fresh fruits and fish protect against eczema whilst fast foods increase risk. Breast feeding (up till 3 months) protect the baby. Obesity, pollution and tobacco smoke increase risk. Exposure to normal childhood infections PROTECT against allergies. Children in day care facilities in their first two years of life may regularly pick up coughs and colds, but appear to have added protection against eczema. HOWEVER the antibiotics that we give them to treat these illnesses increase risk. Emotional stress plays a big role.
The main function of the skin is to provide a barrier between our body and the environment. The skin makes lipids and proteins that keep it healthy and “intact”. People with eczema don’t have enough lipids and this leads to gaps in the skin which in time allow environmental allergens to penetrate more easily. The impaired skin barrier also leads to a much higher level of water loss, resulting in an even drier skin.
Skin hydration is the key component in the management of eczema. Emollients are used as first line agents. They prevent water loss from the skin and also improve water binding in the skin. They are extremely effective in reducing the severity of the eczema and preventing the flare progression. Very importantly they also ease itching. Emollients are best applied immediately after bathing when the skin is well hydrated and should applied at least twice a day. The emollient selected should be according to the dryness of the skin as well as individual preference.
Things to avoid: hot showers and showering too often, exposure to scented soaps and detergents, emotional stress, wearing wool or fabrics of rough texture.
The unfortunate people who have severe eczema will need to be treated by a doctor who will prescribe strong cortisone and anti-inflammatory ointments and oral medications.