Eczema is a strange disease. If you have it, the frustrating itching and scratching starts and then just never seems to go away. The number of people with eczema is increasing. One in five now develops it in childhood. Many factors, such as early weaning, chemicals (preservatives and pesticides) in the human diet, perfumes and pollution, have been blamed. The fact is no one really knows the cause of eczema, but we do know that exclusively breast-fed infants are less prone to it.
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Eczema appears as red, itchy, dry and flaky skin, with or without small pustules. A few months of constant itching may make the skin permanently rough, thick and hyperpigmented.
The classification of eczema is not very clear. It can be due to atopy (tendency to develop allergy), allergic contact, infantile seborrhoea (dandruff-like condition of the head that occurs in infants) or varicose veins.
Atopic eczema is the commonest form. It usually occurs in childhood as an itchy rash distributed on the head and scalp, neck, inside of elbows, behind the knees and on the buttocks. It has a hereditary component and runs in families.
Infants can develop an eczema variant called cradle cap — with a greasy, itchy flaky scalp. This can extend to the eyebrows, face and the trunk. Although the condition is self limiting and harmless, the physical appearance can be distressing to the family.
Irritant contact eczema can be distinguished from the atopic form by the typical distribution and family history. It occurs as an immediate or delayed reaction to contact with an allergen. It may be nickel in the safety pins used on clothes, fashion jewellery containing unacceptable metals or colouring, plants in the garden or chemicals in the workplace. Makeup or face powder can cause an idiosyncratic reaction. Sometimes the contact eczema may be photosensitive and flare up only when the skin is exposed to sunlight. Eczema caused by a specific chemical or disease process can be cured if the underlying factor is removed.
Bacterial, viral or fungal infection of the skin, or infestations with skin parasites like scabies or body lice can cause secondary itching and eczema. Poor blood circulation to the legs as a result of varicose veins can lead to itching and discolouration, particularly near the ankles. These forms are totally curable and tend to disappear forever when the infection is treated or the blood circulation is improved.
Unfortunately most varieties of eczema do not fall into the curable category. They recur time and again, and sometimes become self perpetuating as scratching and picking the skin becomes a habit.
Dry skin aggravates eczema. Therefore it pays to keep the skin moist and oiled. Coconut oil can be applied to the skin half an hour before a bath. A teaspoon can also be added to the bath water. Mild and non-perfumed soaps should be used. The body should not be scrubbed with a loofah. The skin should be patted dry, and not wiped. After the bath a non-greasy oil or lotion can be applied.
There are several baby oils, aloe vera preparations, ceramide (a natural oil in the skin) and vaseline-based creams available in the market. If it says “non greasy” it means that it is unlikely to stain your clothes. Traditional oils, like coconut, stain the clothes and that is why they need to be applied before a bath.
Salt water reduces eczema. People who immerse themselves regularly in the sea improve gradually over a period of time.
Detergents are widely used to wash clothes. Most contain chemicals like sodium lauryl sulphate, which remain behind in the clothes in small quantities. They can penetrate the skin when sweating occurs, aggravating eczema. Commercially available “hypoallergic” or “doctor tested and recommended” detergents have unsubstantiated claims and have not been proven safer. Since clothes have to be washed and kept clean, it is preferable to use non-allergic soaps made from neem oil. They are marketed in India by the government run chain of khadi stores.
Eczema disappears when steroid creams are applied. These should be used under medical supervision for a short period, till the symptoms subside. After that antihistamines (to control itching) and moisturisers should be continued. Patients, unfortunately, purchase and apply the ointments themselves. Prolonged use of topical corticosteroids causes side effects like thinning of the skin and secondary bacterial or fungal infection. Small quantities of the more potent steroid creams can become absorbed in the body through the skin. If they are inadvertently applied to the eye, cataracts and glaucoma can result.
Specific pinprick allergy testing can be done to identify allergens. Without this, drastic potentially harmful changes should not be made to the diet (particularly a child’s) presuming that the eczema is precipitated by allergies to milk, fish or certain vegetables.