Understanding Eczema: Atopic Dermatitis

Eczema or atopic dermatitis is a common chronic skin disease which can occur at any age, but is more common in children. And while around 7.5 to 22.5 percent of people in the Arabian Peninsula suffer from this non-contagious skin condition, many don’t understand what it entails. Dr. Jaya Mehta explains more.

WHAT IT MEANS The term atopic, defines Dr. Mehta, means a group of conditions that are linked by their underlying cause – which is a special type of allergic hypersensitivity reaction or exaggerated IgE-mediated immune response that occurs upon exposure to certain allergens and triggers. She elaborates, “These atopic conditions include atopic dermatitis (eczema), asthma, and hay fever. There is a strong association among these as it has been observed approximately that about half of the patients with severe eczema/atopic dermatitis eventually develop asthma and about two-thirds develop allergic rhinitis.”

WHAT HAPPENS According to Dr.Mehta, in healthy individuals, the outermost layer of the skin, also known as epidermis, acts as a primary barrier between the body and the outside environment. “It not only prevents entry of harmful pathogens and toxins inside the body, but also helps in retention of water in the skin that is essential for maintaining skin hydration.” Essentially, in eczema/atopic dermatitis, the skin barrier becomes dysfunctional, resulting in dehydrated, dry, cracked skin. In these patients’, their weaker skin barrier is easily penetrable by the triggers that induce exaggerated immune response, causing skin inflammation. The dysfunctional skin barrier also increases susceptibility to infection.

POSSIBLE CAUSES Although the exact cause of atopic dermatitis still continues to elude us, Dr. Mehta adds that undoubtedly, genetics plays an important role in its development. “This is based on the fact that people with personal or family history of eczema or other atopic conditions are more likely to develop it,” she says. “In these genetically predisposed people, certain environmental factors can act as triggers to cause flare of the eczema symptoms.”

SYMPTOMS The common symptoms, she points out, include: intense itching that tends to be worse at nighttime, skin dryness and scaly patches, patches of inflamed skin, small, raised bumps, cracking, weeping or crusting lesions, skin darkening and thickening, and skin infection. Not surprisingly, the majority of individuals with eczema/atopic dermatitis develop symptoms before age five years. Dr. Mehta explains, “The disease course is marked by periodic flares and remissions of symptoms. While a great majority of these children cease to be symptomatic by adolescence, a few may show symptoms throughout the adulthood.”

DIAGNOSIS Diagnosis can be arrived at based on detailed medical history and appearance of the rashes, she says. “Typically, history of recurrent itchy lesions that initially began during childhood, worsening of symptoms upon exposure to certain triggers, and a family history of similar symptoms or other allergic diseases (asthma and seasonal allergies) are suggestive of the diagnosis.” If still unsure, allergy testing and patch testing may be advised.

MANAGEMENT While there is no cure available for eczema/atopic dermatitis, the good news, Reduce inflammation, irritation and itching by application of topical steroids once or twice daily as prescribed to help reduce inflammation and moisturize skin.

Oral antihistamines to reduce itching.

Wet dressings may be advised to help hydrate the skin, reduce itching and loosen the crusting.

reveals Dr. Mehta, is this can be successfully treated and managed with regular moisturizing and medications. The symptoms can be treated and flare-ups can be prevented as follows:

HYDRATE THE SKIN Use fragrance-free emollients, such as coconut oil, petroleum jelly, thick moisturizers and creams, to hydrate the skin and prevent dryness. They can be applied once or twice daily and they work best when applied after bath.

Lukewarm baths to hydrate and cool the skin; avoid hot water baths. In case of infection, depending on the type of infection, antibacterial, antifungal or antiviral medications may be used.

Severe eczema can be treated with oral steroids, UV light therapy, and injectable biologic medications may be advised. H REFERENCES

1. Waleed Al-Herz. A Systematic Review of the

Prevalence of Atopic Diseases in Children on the Arabian Peninsula. Med PrincPract. 2018;27(5):436–442. 2. Ntaemeth V, Evans J. Eczema. [Updated 2020

Nov 20]. In: StatPearls [Internet]. Treasure

Island (FL): StatPearls Publishing; 2021 Jan-.

Available from: https://www.ncbi.nlm.nih.gov/ books/NBK538209/.