Eczema (also known as atopic dermatitis) is a very common, chronic, itchy and non-contagious skin condition. The onset of eczema is usually during infancy to early childhood but can manifest at any age.
Those with eczema usually have an ‘atopic tendancy’ meaning they are likely to develop these three closely linked conditions:
- Eczema (atopic dermatitis)
- Hay Fever (allergic rhinitis)
These conditions are usually familial. A family history of these conditions is usually helpful in diagnosing eczema in a young child.
There are multiple factors involved in the pathogenesis of eczema. Genetically impaired skin barrier making the skin more susceptible to environmental factors such as soap/detergents and dry weather. Airborne allergens (including house dust mite), surface microorganisms (Staphylococcus aureus and Malassezia), stress hormones, immunological factors and autoinflammatory factors can all play a role. Whilst food allergies (a separate condition) often coexist, they do not usually play a role in causing eczema. Allergic contact dermatitis is a separate condition that can often get mixed up with eczema (atopic dermatitis). Usually they can be distinguished clinically but may sometimes require allergen patch testing to further establish diagnosis.
There is no single cause for atopic dermatitis. There are many theories about the pathophysiology that are undergoing research. Current theory is that it is primarily a disease of the immune system. The imbalance of cytokines (proteins involved in cell signaling) leads to barrier defects and inflammation seen in atopic dermatitis.
Unfortunately, the complex pathogenesis of this condition makes it difficult for patients and parents to understand the reason for the disease. Therefore, many people will search tirelessly for a single causative factor in an attempt to cure the condition. These often lead to significant financial costs whilst neglecting simple treatment that can improve the condition. In addition, there is a lot of misinformation from different areas in the community that makes compliance to evidence based management difficult.
Long-term treatment may be required for symptom control and often involve a combination of treatments.
- Lifestyle changes: minimize exposure to triggers, regular emollients
- Antihistamines: to reduce the itch
- Steroids: to reduce inflammation. Often intermittent topical use, oral corticosteroids if moderate to severe flare.
- Antibiotics: for secondary infections
- Topical Calcineurin inhibitors: reduce the release of cytokines
- Immunosuppressive agents (methotrexate, ciclosporin, azathioprine): to suppress the immune system to reduce inflammation in longstanding and severe eczema
- Biologics (dupilumab): target specific cytokines in the skin inflammation pathway. Many medications in this class currently undergoing trials.
Our dermatologist can help you understand the various factors involved in you or your child’s eczema. We can tailor simple and effective management to suit your need. Apart from specific medical treatment, we also include general advice and non-pharmacological measures to assist with your case.