Always Itchy: Eczema

At some point in your life, you may have encountered people, especially children, who always have patchy reddish skin on their cheek, scalp, insides of the elbow or behind the knees. They often feel itchy and have the tendency to scratch them off, to the point that it seems to be an obsession.

It is easy to fall into the judgement that it is an outcome of their neglect of personal hygiene, thus, feeling inclined to keep a safe distance from them. If you have had such an encounter before, you may want to think twice about your judgement and reaction. These people might be victim of eczema.

A visible but not understood condition

If the term sounds alien to you, you are not alone. Although eczema is a common skin disease, the awareness about it is low in Malaysia. 10% – 20% of children and 1-3% of adults suffer from this skin disease. In Malaysian context, the rate is two out of ten individuals.

However, according to a joint survey by LEO Pharma and The Research Partnership in 2011, 75% of eczema patients had minimal or nil knowledge about eczema prior to diagnosis, while 15% had never heard of it ahead of a meeting with a healthcare professional. It is high time to learn more about this less well-known medical condition that may be afflicting people around us, and maybe yourself.

Atopic Dermatitis (AD) – the most common eczema

Eczema is a term describing a group of medical conditions that cause inflammation or irritation of the skin. The main external reflection of this condition is itchy, red, dry and cracked skin. The most common type of eczema is known as atopic dermatitis (AD), or atopic eczema. Atopic refers to a group of diseases with an often inherited tendency to develop other allergic conditions, such as asthma and hay fever (allergic reaction that triggers inflammation of the nose).2 The onset of AD is usually traceable to one’s childhood, especially during infancy.

According to Allergy Centre Malaysia3, 90% of AD patients develop the condition before age five. AD usually fades out gradually and clears completely by age 10. However, AD maybe a lifelong issue for some, with symptoms manifesting on and off throughout life.

How to diagnose it?

While AD is more common among kids, there is still possibility for developing it for the first time in adulthood. Therefore, if you suffer from itches for a continuous period of time which do not seem to show sign of ceasing, this checklist can help determine if AD is the culprit.

Besides having an itchy skin condition in the past 12 months, you should experience three or more of the following if you are carrying AD:

• inflamed red skin in the creases of your skin, like the insides of your elbows or behind the knees
• a history of skin inflammation occurring in the same areas mentioned above
• generally dry skin in the last 12 months
• a history of asthma or hay fever (allergic reaction to pollen, dust mite or dander that triggers cold-like symptoms)

Why does it happen?

There is no specific cause for atopic dermatitis, but rather a combinative one. Genetic factor is among the package. According to research, children with one or both parents having AD, or other siblings carrying AD, are more likely to develop it themselves.4 Dry skin also increases the chances of developing AD. This is due to its poor moisture retention ability. Barren of a cushioning layer, the skin is more vulnerable to certain triggers, and more likely to develop inflammation.

Common triggers include:

• Irritants – like soaps and detergents
• Environmental factors – ranging from cold and dry weather to specific items like dust mites, pet fur and pollen.
• Food allergies – like allergies to crab, eggs, peanuts, soya or wheat
• Certain materials covering the skin – like wool and synthetic fabrics
• Hormonal changes – women may experience worsening symptoms in the days before their period or during pregnancy.

It is noteworthy that AD is NOT infectious and cannot be spread from person to person.

Getting in peace with it

As it is a relatively inherent medical condition, there is no cure for this condition. However, there are ways to have a more harmonious relationship with it. One of the worst things you can do to keep the eczema under control is scratching it. No doubt scratching the itch away provides immediate gratification, but it is not a way you love your body. When you scratch, the dry skin patches are further torn, making it even more susceptible to more formation of AD flare-ups. The affected skin area eventually thickens into a crusty layer.

Deep scratching also leads to bleeding and exposes your skin to higher risk of infection or scarring. Eventually, you may end up with the annoying rashes all over the body. When the itch attack is too intense too bear with, gently rubbing your skin with fingers instead of poking it with fingernails. Besides, the following self-care tips could be of help in easing the symptoms and in many cases gradually putting an end to it.

• Moisturise the affected skin areas at least twice every day, using ointment (contains most oil), lotion (contains least oil) or cream (somewhere in between).
• Choose cotton or soft fabrics for clothing. Avoid rough, scratchy and tight garments.
• Have lukewarm shower, using mild soap or non-soap cleanser.
• When drying your body, pat it with a soft towel, not rubbing it.
• After shower, apply moisturiser within three minutes to retain the moisture.
• Try to avoid abrupt changes of temperature that make you sweat.
• Identify eczema triggers and avoid them. You may need help from a dermatologist for accurate diagnosis.
• Keep room humid using a humidifier in dry or cold weather.
• Remove carpets from home.
• Give pets dander treatments.

The unseen pains

If you are fortunate to have a healthy body free of eczema, you may not be aware that eczema could have significant mental toll on the patients besides the physical ones. As there is no cure, dealing with this non-temporary delicate skin condition requires much patience. Patients have to be constantly vigilant with the presence of triggers, be it when eating, shopping for clothes or going outdoors. Having such restricted freedom could be dismaying. Also, as a highly visible condition, the low awareness about eczema among the public further rubs salt in the wound.

Patients may suffer in their social life due to the unfortunate condition that many may mistakenly judge as a sign of ill care for personal hygiene. People may shun from people with eczema without understanding the underlying reason. All these could add up to a mentally debilitating experience.

Turning awareness into action

If you are having eczema, you are probably going through a painful journey, but remember that you are not alone. Supports are always there for you.