Eczema- ‘the itch that rashes’- is a common, but particularly frustrating, condition for those it affects. Characterized by an itch that intensifies at night, people with eczema may experience significant impact on sleep and quality of life. Once the eczema ‘rashes,’ it can produce red and weepy patches, dry and scaly areas or in the long term thickened and darkened skin that may be cause of social embarrassment. Ongoing itching may break the skin allowing infections to develop which then worsen the eczema. It is very understandable that those with eczema may go to considerable lengths (and expense) to try to cure their skins. Maddeningly, eczema also tends to have a very fluctuating course – there are good periods followed by episodes of deterioration which are known as flares. This may lead individuals with eczema to attribute cure erroneously to the treatment they were using during the good period.
Can eczema really be cured? To answer this question we need to look at some of the basic facts about eczema
Eczema is also referred to as atopic dermatitis or atopic eczema which may produce confusion. Eczema and dermatitis are in fact synonyms for inflammation of the skin, whilst atopic refers to the genetic tendency of the immune system to produce the antibodies of allergy- immunoglobulin E. Thus, atopic eczema is an inflammatory skin condition with strong tie to allergy. Many individuals who have atopic eczema have other allergic conditions such as asthma and allergic rhinitis.
Next let’s consider how eczema develops. This is a complex question that has generated much research, many hypotheses and many more questions. There most certainly has been some head scratching! What we do understand is that inheritance, the environment and an immune system with allergic tendencies interact to result in a dry, defective skin. The skin loses its ability to act as ‘barrier’ that keeps moisture in and the bad stuff out. A vicious cycle of dry skin, itching and infection and allergen and irritant exposure is set up, all of which worsen skin inflammation.
Eczema typically develops in babies and often improves on its own at school-going age. Many individuals do in fact go on to ‘grow out’ of their eczema and this may be due to many factors, including a maturing immune system. However, some individuals do not outgrow their eczema and some people develop eczema at later stages in their lives. Some people experience long periods without symptoms before their eczema inexplicably recurs. It is difficult to predict which children will outgrow their eczema but those with more severe affectation and those whose eczema began very early on in life, tend to have a more persistent course.
Is their any treatment available that could cure eczema? The answer is that there is much that can be done to control skin inflammation but there is no fail-safe cure. When we understand that the key problems in eczema are dry skin, irritant and allergen exposure and infections, we can manage the skin on each of these fronts.
Dry Skin needs to have moisture replenished. This is done by using oil-in water creams, ointments and lotions called emollients. These replace moisture in the skin and help to restore its barrier function. Emollients may need to be applied multiple times a day, especially in severe eczema. Emollients really do work! Look at the bridge of the nose in someone with eczema of their face. This area will remain smooth and moisturized because of the numerous glands there that are continually secreting oily substances. This is true, even in severe eczema. Emollients applied regularly can mimic this effect and are the mainstay of eczema management.
Sometimes skin inflammation needs to be managed by additional anti-inflammatory medications that are applied to the skin. These are needed particularly during flares. These medications work to ‘quiet’ the skin and are used for as short a duration as possible as rescue treatment. Examples include corticosteroid creams, ointments and lotions.
Irritants are factors that worsen the inflammation in eczematous skin. These may be heat, sweat, scratchy clothing or chemicals in soaps, bubble baths and washing powders. Dressing in light cotton clothing and using products designed for those with eczema can improve eczema control.
Allergen exposure causes an immune response in those who are allergic to that particular substance (allergen). Allergen avoidance is thus an individualized strategy that may be used in those who have been proven to have a clinically important allergy. Allergen avoidance should not be used as a blanket strategy. Foods should not be eliminated from the diet without guidance from a healthcare practitioner experienced in food allergy. This is because food allergy uncommonly manifests with worsening of eczema alone. It is far more common for food allergy to cause an immediate reaction that can be seen in the skin as flushing, itching, swellings and hives. Certain foods, such as citrus fruits, may cause a rash around the mouth when eaten but this is due to irritation of the skin and not true food allergy. In this scenario it is not imperative to avoid the offending food and barrier creams or Vaseline around the mouth can be used to prevent the irritation.
Finally, preventing infection is important in controlling eczema. Many different microorganisms exist on our bodies without any harmful effects. In those with eczema there may be too many of certain types of bacteria which adds to skin inflammation. When the skin is broken by scratching infection can occur which further worsens the rash. Those with eczema are also vulnerable to infection with certain viruses and fungi which can cause a rapid deterioration in eczema control. It is important to practice good hygiene and avoid scratching to help prevent infections. A rapid loss of eczema control associated with fever or feeling unwell could signal an infection that may need to be treated by your healthcare practitioner.
Eczema can not be cured but it can be controlled. Whilst a quick fix would be welcome, at present there isn’t a treatment that successfully targets all the factors that contribute to causing eczema. However, understanding has greatly empowered the control of eczema and those with eczema can enjoy healthy skin and excellent quality of life.