What is Eczema?
What is eczema? Medically speaking, Eczema (atopic dermatitis) refers to a chronic inflammatory condition of the skin characterized by a defective skin barrier. It is a very common skin condition, mostly appearing in childhood and may be associated with asthma or allergic rhinitis (sensitive nose) in two thirds of cases. As itching tends to be chronic, it can cause profound sleep disturbance and interfere with social, behavioural and educational development. Eczema is a complex disease, influenced by genetic and environmental factors. The defective skin barrier allows allergens to trigger an eczema flare. It is rather common for individuals with eczema to be sensitive to house dust mites, pollen and animal dander. Cow’s milk, eggs, wheat, soy and nuts can cause an eczema flare in young children.
How Common is Eczema?
Atopic eczema or dermatitis often starts from childhood. It is reported that about 70% of individuals first develop eczema during the first 5 years of life. Adult onset eczema is not uncommon either, representing about 30% of the cases. The prevalence of atopic eczema appears to have increased over the last few decades. Although it appears to be more common in affluent countries, there is an increasing trend worldwide. Although eczema does gets better in about two thirds of cases during the adolescent period, there may be occasional flares during adulthood.
What Conditions Are Associated With Atopic Eczema?
Atopic eczema is considered an atopic disease. Atopic diseases are those where there is a heightened response of the immune system to allergens. Asthma, Allergic rhinitis (sensitive nose) and allergic conjunctivitis (sensitive eyes) are examples of atopic conditions. There is a 60-70% chance of developing either asthma or allergic rhinitis if you have existing atopic eczema.
What Causes Eczema?
Although atopic eczema is a common condition, the underlying mechanism is complex and involves an interplay between genetics, immune system, skin barrier dysfunction and the environment. A mutation of the epidermal protein known as Filaggrin has been shown to be the strongest genetic factor in atopic eczema. However, not everyone with filaggrin gene mutation will develop eczema. Furthermore, studies have shown that individuals who migrate to a urban region from a rural one will increase their risk of atopic related diseases.
How Eczema Impact Your Health
In many individuals, atopic eczema that is not well controlled can cause sleep disturbances, poor school or work performance and low self-esteem. This may subsequently affect recreational activities, and cause significant psychological and financial stress for the individual and their families at large.
The management of eczema aims to reduce eczema flares, improve symptoms such as itching and sleep disturbance, and reduce complications like infection. Restoring the skin barrier and dry skin with an emollient is central to eczema management. An emollient helps to trap water within the skin, and protects the skin from external irritants and allergens. Common brands include Physiogel, Atopiclair, QV and Cetaphil. You may ask what is the best emollient. Well, there isn’t one really, but the best one is the one that you prefer and works well for you. We recommend regular use of an emollient both as a daily moisturizer and for bathing (best to avoid soaps and detergents if you have eczema).
Prescription topical medications help to reduce the inflammatory reaction of an eczema flare, and is safe to use under medical supervision. What is not safe is using creams of dubious source that may contain very potent anti-inflammatory ingredients. Recently, the development of a topical medication that alters the immune response to inflammation has been introduced in the market; the topical calcineurin inhibitors. Topical calcineurin inhibitors are approved for use in children more than 2 years of age who do not respond to standard therapy.
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- Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014 Feb. 70(2):338-51.
- Leung DY, Bieber T. Atopic dermatitis. Lancet. 2003 Jan 11. 361(9352):151-60.
- Sidbury R, Tom WL, Bergman JN, Cooper KD, Silverman RA, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches. J Am Acad Dermatol. 2014 Sep 25.