Be eczema aware

IT is estimated that the prevalence of atopic eczema is about 20% in Malaysia, with 90% of sufferers developing the condition before age five, said consultant dermatologist Dr Tarita Taib.

Although the cause is still unknown, seeking medical treatment and avoiding trigger factors could help, she said.

What are the causes of eczema? What age group does it most hit?

Eczema or dermatitis is a term used to describe skin inflammation. There are many types of eczema, including atopic eczema, contact eczema, seborrheic eczema and discoid eczema.

Atopic eczema is a chronic itchy inflammatory skin disease that usually starts in early childhood. Atopic eczema affects 15% to 30% of children and up to 10% of adults.

Are those with eczema born with it?

Although the exact disease origin is still unknown, various studies have shown that it is a result of a mix of genetic and environmental factors.

Abnormal protein and lipid content in the skin’s upper layer impairs the skin barrier and this leads to skin inflammation. This is due to an abnormal immune response.

Food could trigger atopic eczema in 20% to 30% of moderate to severe cases of atopic eczema. These include milk, egg and soy, among others.

Strong family history or personal history of atopy disease (the genetic tendency to develop allergic diseases) such as asthma and allergic rhinitis is associated with atopic eczema.

Other trigger factors include house dust mites, wool clothing and fragrance used in soap.

What are the treatments for eczema?

Treatments include moisturisers and medications – topical (steroid) or non-steroidal (topical calcineurin inhibitor), with or without oral treatment.

For oral medication, immunosuppressive drugs such as cyclosporine and the new drug dupilumab are reserved for moderate-to-severe cases.

Some cases may respond to phototherapy.

Patient education is also important to enable patients to understand their illness and achieve better compliance to medications when required.

They should also use moisturisers on their skin regularly and avoid trigger factors such as dust and animal dander.

Patients are often given creams containing steroids to relieve the itch. Wouldn’t that be harmful in the long run? Are there other alternative treatments that patients can use to relieve the itch?

Topical steroids, either in cream, ointment or lotion form, remain the main option of treatment during disease flares.

It is rather safe to use provided that the patient is supervised by doctors to ensure that the appropriate potency and amount required is applied directly to the correct and confined areas of the affected skin.

Overusage of topical steroid can cause, among others, thinning of the skin.

In a stable disease, a hypoallergenic moisturiser could relieve skin symptoms such as itch.

Non-steroidal anti-inflammatory topical creams could also be used on more sensitive areas such as the face.

Some have postulated that leaky gut syndrome is often associated with autoimmune disease. Is eczema in any way linked to a leaky gut?

Leaky gut syndrome is not associated with atopic eczema. The concept of skin barrier dysfunction implicated in atopic eczema cannot be applied to the gut mucosal outer layer.

Is detoxification important for those with eczema?

There is no clear clinical evidence to advocate detoxification as part of atopic eczema treatment.

Do probiotics help with reducing eczema?

Clinical data remains elusive on the usage of Lactobacillus sp probiotics in preventing atopic eczema in infants and children.

Are there any supplements or food that those suffering from eczema can take to cope with their condition?

Fish oil supplements may relieve the symptoms, but the clinical data is limited.

Do you have any other observations, thoughts, comments and advice about eczema that you would like to share?

Complementary treatment should not totally replace standard medical treatment in atopic eczema. Meanwhile, there are also support groups for atopic eczema worldwide which patients could tap into. — Loh Foon Fong

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