An allergy doctor’s take on eczema

If your skin has become inflamed, red, itchy, cracked, and rough, you are likely to have eczema. The word “eczema” is also used specifically to talk about atopic dermatitis, the most common type of eczema. What triggers these flare-ups? And what are your treatment options? 

1. Eczema is a chronic ongoing condition with ups and downs that requires hands-on management to keep it in check. While there is no cure for eczema, it is possible to outgrow it, just like small children often do.
2. Emollients are an essential part of treatment and are cortisone sparing. It’s important to remember eczema is a “barrier dysfunction”, which means inflammation in your skin leads to your skin losing excessive amounts of moisture leading to very dry and itchy skin. It also means that your skin is more prone to infections like Staphylococcus Aureus and Molloscum Contagiosum.
3. Emollients should be applied at least twice a day and in very generous amounts. Children with severe eczema require up to 250g per week, and adults up to 500g per week. To choose the best emollient for your skin can be a costly exercise and reason should prevail. The best way to approach this expense is to work out a budget for 250g or 500g per week. Familiarise yourself with the products in the price class you can afford and look for a product that best suits your skin. I am a big proponent of Petrolatum because of its efficacy and affordability. Reactions to Petrolatum is very rare, and the flavourless products do not contain any preservatives. (Read my blog post about  emollients  and how to choose a product that suits your skin and pocket.)
4. Wet wraps can help to control eczema and soothes the skin when it is very itchy. Wet wraps are suitable for moderate to severe eczema flares. It is when a wet fabric is applied to help with fluid loss. Patients need to apply these wraps over the topical cortisone and emollient. There are different ways to apply the wet wraps, from silk garments to area-specific occlusive bandages. Care must be taken in young children. Click here for more information about this form of treatment.
5. Fluctuations of your eczema can be caused by triggers in yourself or your environment. This is why it’s crucial to identify, anticipate and manage these triggers so you can keep your skin in check. Some of these triggers include:

• • Stress: A known trigger and it is a well-known fact that is facilitated by messengers in your body called neuropeptides;
  • Food: Tends to be a trigger in children under three years of age. Food avoidance in children must be done under the supervision of an allergy doctor;
  • House dust mites: These annoying little creatures spread an enzyme called Protease, which aggravates eczema. High humidity levels like we see at the coast tend to facilitate the growth of house dust mites;
  • Seasonal factors: Environmental allergens can contribute to your skin flaring up;
  • Physical triggers include rough clothing, wool and polar fleece;
  • Chemicals, including some of your eczema creams, can also be triggers;
  • Acute or chronic skin infections with Staphylococcus Aureus can be a trigger for a severe flare-up. Heat and sweating can also cause a flare-up. Regular bathing can control the Staphylococcus Aureus on your skin and improve control.

7. Hit your flare-ups early and hit them hard to reduce your treatment schedule and control the inflammation. The first-line treatment should include single or multiple topical treatments, including topical cortisones, which patients need to administer consistently. It’s also helpful to anticipate flare-ups and have a written plan at hand, which will help you gain control over flare-ups before they get out of hand.
8. Parents should remember eczema in children can lead to food allergies. It is especially infants with eczema and egg allergy that are at high risk for developing peanut allergy. If you’re going to introduce peanut to your child’s diet, and your child already suffers from eczema, it’s best to do it under the care of an allergy doctor. All foods, including allergenic foods, should be introduced to infants between four and 11 months of age help to prevent food allergies. Read more about introducing solids in your baby’s diet here.

The purpose of this article is to raise awareness of allergies and the treatment options that are available for it. This article should by no means be used, or viewed, as a primary source for medical or other professional advice – please arrange for a personal consultation with your medical practitioner before taking any decisions that could affect the wellbeing of you or your loved ones. Read our medical disclaimer for more information.