Two weeks ago I was requested to give a brief overview regarding eczema/dermatitis to a group of pharmacists. Since eczema/dermatitis is commonly seen in practice I would like to shed some light regarding this condition.
What is eczema/dermatitis?
The terms eczema and dermatitis are synonymous. Therefore they can be used interchangeably. For the rest of this post I will be using the term eczema. It essentially refers to a group of skin condition characterized by inflammation and itchiness.
Examples of eczema/dermatitis:
- Seborrheic eczema (due to overgrowth of malasezzia yeast)
- Atopic eczema (common in childhood)
- Allergic contact dermatitis (eg. allergy to nickel)
- Irritant contact dermatitis (eg. prolonged, repeated exposure to harsh detergents)
- Discoid eczema (Coin shaped)
I will elaborate more on atopic eczema since it is one of the most commonly encountered skin conditions among Malaysian children.
Atopic eczema
Atopic eczema is a chronic inflammatory itchy skin condition that develops in early childhood. It typically cycles between remission and exacerbation. It is closely associated with allergic rhinitis and asthma.
The exact mechanism underlying atopic eczema still remain to be fully elucidated. Numerous mechanisms have been proposed, all of which lead to dysfunction of skin barrier. This results in water evaporation from the skin and increased penetration of allergens and microorganisms, resulting in immune response.
Management of atopic eczema includes the avoidance of trigger factors. Certain foods have higher likelihood of causing allergic reactions and hence worsen atopic eczema. However not all of these food need to be avoided. It depends on whether the child develops exacerbation on these food. Allergic skin prick test may be warranted if it is uncertain which food results in exacerbation.
Other common trigger factors:
With regards to bathing, there are different recommendations given by different guidelines. Essentially it boils down to patient lifestyle.One of the main concern of frequent bathing is that it will lead to increased water loss from the skin. However, bathing helps with the removal of dead skin flakes, microorganisms, and sweat. Therefore, if a patient is leading an active lifestyle frequent bathing is advised. However, apply moisturizer afterwards to prevent water loss. Gentle, non-perfumed cleanser is recommended to prevent excessive moisture loss from skin.
Since one of the main issue in atopic eczema is excessive water loss away from skin, moisturizers is the mainstay treatment for this skin condition. Moisturizers should be non-perfumed. There are many forms available, ranging from creams to ointments to prescription emollient devices. However there is no significant difference in terms of efficacy between the different formulation. The most effective moisturizer would be the one that the patient prefers to use.
Management of atopic eczema includes the avoidance of trigger factors. Certain foods have higher likelihood of causing allergic reactions and hence worsen atopic eczema. However not all of these food need to be avoided. It depends on whether the child develops exacerbation on these food. Allergic skin prick test may be warranted if it is uncertain which food results in exacerbation.
Other common trigger factors:
- Wool clothing
- Animal dander
- House dust mites
- Sweating
- Perfumed products
- Exposure to cigarette smoke
One of the common symptoms in eczema is itchiness, which lead to scratching. Scratching, in turn leads to perforation of the skin, leading to increased water loss, increased allergen penetration, and secondary bacterial infection. Affected patient has to make sure their fingernails are kept short. Additionally, patients need to be advised on the methods to reduce itching; pinch, press, apply cold.
With regards to bathing, there are different recommendations given by different guidelines. Essentially it boils down to patient lifestyle.One of the main concern of frequent bathing is that it will lead to increased water loss from the skin. However, bathing helps with the removal of dead skin flakes, microorganisms, and sweat. Therefore, if a patient is leading an active lifestyle frequent bathing is advised. However, apply moisturizer afterwards to prevent water loss. Gentle, non-perfumed cleanser is recommended to prevent excessive moisture loss from skin.
Since one of the main issue in atopic eczema is excessive water loss away from skin, moisturizers is the mainstay treatment for this skin condition. Moisturizers should be non-perfumed. There are many forms available, ranging from creams to ointments to prescription emollient devices. However there is no significant difference in terms of efficacy between the different formulation. The most effective moisturizer would be the one that the patient prefers to use.
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