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Eczema Explained: What You Should Know About Atopic Dermatitis

Got a rash that turns into dry, itchy skin? You might have eczema.
PHOTO: istockphoto

Eczema flare-ups can be anything from mildly irritating and unattractive to something that can affect your quality of living because it causes you to lose sleep or increases your risk for infections. A friend of mine who suffers from eczema has joked that a bad flare-up leaves her feeling like she’s contracted grayscale from Game of Thrones.

But eczema, or atopic dermatitis, is a condition that is manageable—and one where quick and easy preventive measures can save you from the stress and discomfort of a flare. Keep reading to learn more about this condition and what you can do about it.

What is eczema?

You can have one or more types of eczema at a time. “Eczema and dermatitis are often used interchangeably. The term eczema refers to a group of conditions involving skin inflammation or irritation. There are several types of eczema,” says Dr. Kyla Talens, an aesthetic dermatologist at Skin Philosophie in BGC.

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There are multiple types of eczema, but most people are thinking of atopic dermatitis when they use the term.

“Atopic dermatitis usually starts in childhood, but it can occur at any age,” says Dr. Talens, explaining that it is usually related to asthma and allergic rhinitis. “There are some adults who still get atopic dermatitis.”

The condition has genetic as well as environmental risk factors; this means that it tends to run in families, but can be triggered or exacerbated by certain things as well as prevented through various measures.

What are common symptoms of eczema?

“It usually starts out as a red rash followed by dryness and scalyness, and its oftentimes accompanied by itching,” Dr. Talens says. “Especially with the itch-scratch cycle, blisters may form, and there can be a superimposed infection. The rashes commonly appear on the back of the elbows or knees, and they can also appear on the neck, the wrists, the ankles, and the crease between the butt and legs. Atopic dermatitis can also affect the face. When the rashes subside, they tend to leave behind dark spots, and sometimes the skin becomes thickened so it sometimes appears leathery.”

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Here’s a run-down of common symptoms of eczema, although the way these appear or feel and how extensive they can be may vary:

  • Dry skin
  • Itching (especially at night) and raw or inflamed skin from scratching
  • Thick, flaking or scaly skin
  • Small, raised, and often reddish bumps; these can be itchy but should not be scratched as they can leak fluid and crust over as a result
  • Reddish, brownish or even grayish patches of skin (these are particularly common on the extensor surfaces—the outside area of a joint—in infants and toddlers and the flexor surfaces—the inside areas of that touch when joints bend—in older children and adults)
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What causes eczema or increases a person’s risk of having it?

“Healthy skin helps retain moisture and protects you from bacteria, irritants and allergens. Eczema is related to a gene variation that affects the skin's ability to provide this protection. This allows your skin to be affected by environmental factors, irritants and allergens,” according to the Mayo Clinic, which also identifies the primary risk factor as a family history of eczema, allergies, allergic rhinitis or asthma.

Environmental factors include heat, dust, pets, and exposure to irritants and allergens. Viral or bacterial infections, especially staph infections, may also cause eczema flare-ups. And stress may be a contributing factor, making symptoms more likely to occur.

Other types of eczema, particularly seborrheic dermatitis or contact dermatitis, are often mistaken for atopic dermatitis, especially as contact dermatitis is often a complication of atopic dermatitis. The symptoms are similar, but these have different causes and therefore require different treatments.

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It should be mentioned, however, that contact dermatitis is marked by having physical or chemical triggers. These can include allergens such as components of hair dye or jewelry (especially nickel), cosmetics, fragrances, and so on. Other triggers can be irritants like water, soaps, detergents, solvents, acids, alkalis and friction.

“Irritant contact dermatitis may affect anyone, provided they have had enough exposure to the irritant [in] high concentrations [or through] prolonged exposure,” says Dr. Talens. “Allergic contact dermatitis affects only those who are allergic to specific substances. Seborrheic dermatitis may also be mistaken for atopic dermatitis, but seborrheic dermatitis usually involves areas that have more oil glands, such as the T zone of the face, for example, the eyebrows, the scalp and the back of the ears.”

What can I do to treat or prevent eczema flare-ups?

Here are some top tips if you have a history or eczema or may be prone to it due to genetics:

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  • For bath time: Bathe in warm (not hot) water, limiting bath time to five to ten minutes. Use cleanser only when necessary. Your cleanser should be mild and fragrance-free; you may also want to shift to nonsoap-based cleansers. After bathing, gently pat the skin partially dry instead of rubbing it.
  • Medication: If medicine was prescribed for your eczema, apply it when the skin is almost dry and use the medicine as directed. Your moisturizer should be applied on top of the medicine. Do not self-medicate with antihistamines, oral or topical steroids, or antibiotics without consulting a doctor. Steroid dependence may potentially lead to skin thinning, among other complications. Imprudent use of antibiotics may build up resistance, meaning you’ll start needing stronger meds meds to control infection.
  • Emollient (moisturizer) therapy: Applying moisturizer is absolutely essential even when you aren’t experiencing an eczema flare. Moisturizer should be applied two to three times daily, particularly on eczema-prone areas. Dr. Talens suggests using thicker creams or ointments and states that trial and error is inevitable when you’re trying to find the best moisturizer for you, but make sure any medication you take or apply is supervised by doctors, as these may damage your skin further.
  • Trigger avoidance: You’ll be more prone to irritant contact dermatitis when there’s pre-existing atopic dermatitis. This means using gloves when handling harsh chemicals such as cleaning products, for example. You should take care to avoid known allergens, especially in hair products, cosmetics, and so forth, and keep your clothes and household and work surfaces clean using products that are gentle on the skin and fragrance-free whenever possible. You may also want to avoid itchy clothing such as wool in favor of cotton and use appropriate workout wear when exercising as these help to keep you from sweating too much.
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The British Association of Dermatologists also advises, “Treat eczema early—the more severe it becomes, the more difficult it is to control.”

Lifestyle changes can also have a great effect on your risk factor for eczema flareups. Some changes you can implement are:

  • Improve your diet. Try to increase the amount of anti-inflammatory foods in your diet. These include fish that are high in omega-3 fatty acids, colorful fruits and green veggies (such as broccoli, spinach and kale), and foods high in probiotic bacteria like yogurt, miso, kimchi, sauerkraut, apple cider vinegar, unpasteurized cheeses like kesong puti, and more. Also pay attention to what you were eating six to 24 hours before a flare-up; it’s possible you may have a reaction to certain foods. Some foods/ingredients that often cause reactions include dairy, eggs, gluten, shellfish, certain types of nuts, soybeans and soy products, beans, and canned meats.
  • Lower your stress levels. Improving your emotional health can go a long way to curbing eczema flare-ups. Practice mindfulness and don’t forget to take frequent breaks. Every once in a while, escape your daily routine and take some “me time” to recharge your batteries. Manage your temper—as they say, don’t sweat the small stuff!
  • Get more sleep. Itching from eczema can worsen at night, which increases your sleep debt and your stress levels, further worsening the problem. If you can, minimize the other factors that can affect your sleep schedule and find ways to fall asleep faster.
  • Ramp up your personal hygiene. Use fragrance-free, hypoallergenic products when you can. Keep your fingernails short so they are less likely to collect dirt and also able to do less damage if you end up scratching any rashes or dry skin.
  • Manage your environment. Remove eczema triggers from your home and work spaces whenever possible; if not, try to minimize these. For example, if you have a pet such as a cat or dog in the house, make sure the animal is properly groomed and that your home is thoroughly cleaned and vacuumed on a regular basis. Change your sheets frequently and wash all new clothes before wearing them. Avoid leaving windows open, especially if these face dusty areas like streets or construction sites. You can also try and manage the temperature and humidity in your home and work areas; as dry air may worsen eczema, a humidifier can sometimes help, especially if you keep your air conditioner on for long stretches of time.
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When should I see a doctor about my eczema, and what can I expect out of a clinic visit?

While there is no hard-and-fast rule as to what you might consider severe, the Mayo Clinic suggests these conditions:

  • It disrupts your lifestyle
  • You have a skin infection
  • Home remedies are ineffective

When you do see a doctor, chances are the diagnosis can be made on sight without additional tests. Make sure you tell your doctor about the following:

  • Symptoms you’re experiencing and how long they’ve been present for
  • Medication you’re taking and remedies you’ve tried
  • Behaviors, food, and environmental factors that might be triggering the symptoms

“See a doctor when flares are frequent and severe!” Dr. Talens says. She also stresses the importance of not using medication unless approved by your doctor.

Dr. Kyla Talens keeps clinic hours at Skin Philosophie, 3/F B3 Bonifacio High Street 9th Ave corner Lane P, Bonifacio Global City, Taguig, Metro Manila.

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