Updated 07 August 2014

Eczema: ditch the itch

Unpredictable, unsightly and often unbearable, eczema can make your life a misery. Here’s how to get this skin condition under control.

Like all brides Nadia Slabbert (24) dreamt of an unforgettable wedding day – one on which everything would be perfect and she would be at her most beautiful.

She pulled out all the stops, planning every detail. Weeks before the big day the bridesmaids’ dresses were ready and hanging in a wardrobe, the venue, décor and flowers had been organised and the guests invited.

Then, unexpectedly, her beautiful strapless gown no longer seemed the right choice – because one thing Nadia couldn’t control was an outbreak of the eczema she’d had since primary school days.

Wedding nerves caused a serious flare-up and this time it spread to her face as well. An ugly, flaky red inflammation covered her body and itched constantly. A cortisone injection rescued Nadia from this dermatological nightmare and with clever make-up she was a beautiful bride on the day. But Nadia’s battle with the skin condition was far from over.

“I’ve been struggling with eczema for 13 years and it’s horrible,” she says. “I have it all over my body – arms, legs, neck and face, even my ears. It itches and I scratch myself to pieces, especially at night. It’s worse in winter because I’m wearing thicker clothes. I get hot, perspire more and the itch intensifies. Woollen jerseys also irritate my skin and make the itching worse.

“I’m very self-conscious about it. I don’t wear shorts and avoid short-sleeved blouses because I’m so sensitive about the appearance of my arms and legs – I’ve got scars from all the scratching. The cortisone cream I use helps but it thins my skin. A slight bump and I bleed.”

Nadia takes antihistamines for the itching. “Other than that, I just have to live with it. But I have learnt to be clever about eczema so that it doesn’t take over my life.”

What is eczema?
Eczema is the collective noun for inflammation of the skin. It has a red appearance and itches severely. Eczema can be moist and runny or dry and flaky. After a time your skin thickens, especially if you scratch a lot. The thickening is unsightly, can cause scarring and may even limit movement of your limbs because your skin no longer stretches.

Between 10% and 20% of people develop eczema at some point in their lives and it manifests differently in different age groups. Babies can get it anywhere but particularly on the cheeks, arms and legs. Fortunately it seldom flares up on the buttocks or in the groin.

Children from two to 12 commonly get eczema in folds of the skin (such as the crooks of the arms and legs), the neck, wrists and ankles. In adolescents and adults it usually occurs in the folds of the skin and on the neck, face, hands and feet – although it can sometimes flare up all over the body, as in Nadia’s case.

Are there different kinds of eczema?
There are many types of eczema. For example, when you get it on the skin under your watch or around an earring, it’s called contact eczema. If you have serious varicose veins, you get stasis eczema, which causes your legs to swell. Seborrhoeic eczema appears on the scalp, eyebrows and beard.

By far the most common is atopic eczema. Some people call atopic dermatitis congenital eczema or child eczema but adults can get it too. It’s most common in children and there’s usually a family history of eczema, asthma or allergies.

What causes eczema?
The cyclical pattern can probably be ascribed to hormonal changes, triggers such as some types of food or stress, or changeable environmental factors such as smoke or a new washing powder. Common triggers include dust mites, certain foods such as peanuts, eggs, milk and grains, and perfumed products.

The medical fraternity doesn’t really understand exactly why eczema appears and disappears. It’s the nature of the disease. It could have something to do with the environment – for example if you move to a drier climate, undergo lifestyle changes such as washing more often so your skin dries out, or take up a new hobby that involves something that irritates the skin.

Hormones can play a role but no one knows precisely how. Eczema can also flare up with normal physiological changes. Even changes in posture can cause friction to various parts of the body, for example a baby who has grown from spending most of the time lying down to a toddler who crawls and then walks.

One person may have a variety of eczema triggers. It could be a particular type of food but chemicals, smoke and washing powder or fabric softener might also activate it. That’s why it’s important to look at the entire picture and for all potential triggers.

What are the causes?
There’s no clear answer as to what causes eczema but research shows it has to do with a genetic defect in the protective function of the skin.

The protective function is like a safety net stretched over your body. If you have a thick safety net – in other words, good protective function – the skin can protect the body from germs and allergens. If however the protective function has a defect the net allows things that cause a reaction through more easily.

Experts know that one of the genes is abnormal in people with eczema and it’s found in the ‘cement’ that keeps the cells of the skin together. In eczema patients, this ‘cement’ doesn’t exist or it’s loose or weak.

The cells aren’t packed together tightly and this means it’s easier for something to get in or out. It’s also easier for water to escape from the skin, which is then much drier.

Atopic dermatitis in children almost always has to do with allergies. Atopic actually means allergic. And – if the child doesn’t already have it – there’s a good chance a food allergy or hay fever will develop and vice versa.

Will it clear up?
Atopic eczema can be chronic or it can heal but keep recurring. It usually appears for the first time in children from two months to two years old. The first sign is a dry skin. Then red, itchy patches appear.

But it’s unpredictable. Most children outgrow the eczema by the time they reach school-going age but about half of them get it again as adults and often in different forms, such as contact eczema.
Some sufferers get it for the first time as adults.

Eczema often follows a cyclical pattern. Some people will get it a few times a year, others only now and then. In extreme cases it never disappears.

(Health24, October 2013)


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Skin expert

Dr Suretha Kannenberg holds a degree in Medicine and a Masters in Dermatology from the University of Stellenbosch. She is employed as a consultant dermatologist by Stellenbosch University and Tygerberg Academic Hospital, where she is involved in clinical duties and the training of medical students and dermatology residents. Her areas of interest and research include vitiligo, eczema and acne. She also performs limited private practice work in the Northern suburbs of Cape Town in general and cosmetic dermatology.

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