Eczema is a common skin disorder seen worldwide and in Uganda. It usually presents as dry, itchy, red or darker areas of skin. Sometimes referred to as “the itch that rashes”, the term eczema is used interchangeably with dermatitis, which literally means inflammation of the skin.
In people with skin of color (Africans), eczema often appears “ashen”, brown, or grayish in color. Eczema is the second most frequent skin disease in Africans and is one of the most common skin disorders seen in infants and children overall.
There are several types of eczema or dermatitis, some of which are discussed below:
(a.k.a. atopic eczema), often used synonymously with eczema, is a disease of unknown cause. It usually starts in infancy (before the first birthday) and is characterized by itchy, scaly lesions, xerosis (dry skin), and lichenification (accentuation of skin markings).
Atopic dermatitis is commonly associated with other atopic diseases such as asthma or allergic rhinitis. The frequency of atopic dermatitis appears to be increasing and appears to be more common among Blacks and Asians than before. In infants, eczema is usually seen on the forehead and cheeks. In children, eczema is seen on the hands, wrists, ankles, feet, and elbow and knee creases. In adults, eczema is usually seen on the face, neck, upper arms and back, elbow and knee creases, and back of the hands, feet, fingers, and toes.
Although it remains unclear as to what the cause of the condition is, dermatologists believe environmental factors such as mold, pollen, and pollutants play a role in triggering an episode of Atopic Dermatitis. Soaps, detergents, and perfumes are also believed to trigger the condition.
(a.k.a. nummular eczema) appears as itchy “coin-shaped” areas of inflammation and can be crusty or scaly.
Nummular Dermatitis is a common form of dermatitis that develops after the skin experiences trauma (skin injury such as a burn, abrasion, or insect bite). That being the case, the most common areas that develop nummular dermatitis are arms, knees, legs, and buttocks. The hallmark of this condition are unique coin-shaped (nummular) or oval lesions and patches of irritated and itchy skin.
Xerotic (asteatotic) Eczema:
(a.k.a asteatotic eczema), in this type of eczema, extremely dry skin becomes inflamed and may require treatment beyond moisturizers.
in this form of eczema, skin irritation can form from excessive contact with irritants (e.g., soap, detergents, harsh chemicals) and allergens (e.g., poison ivy, nickel, fragrances, etc.). Contact dermatitis brings along redness, itching, and burning in areas where the skin has come into contact with the allergen.
Due to the vast number of substances with which individuals come in contact with on a daily basis, it can be difficult to determine the exact trigger for contact dermatitis. When the contact leads to irritated skin, the eczema is called irritant contact dermatitis. As with atopic dermatitis mentioned above, it is very common to find that those with contact dermatitis have a family history of the condition.
This form of eczema occurs on the palms of the hands, sides of the fingers, and soles of the feet. Dyshidrotic dermatitis typically causes a burning or itching sensation along with a blistering rash. In our office one may hear a doctor refer to this condition by a different synonym such as hand eczema, pompholyx, vesicular eczema, and vesicular palmoplantar eczema.
As mentioned above, there are several different and unique types of eczema. Hand eczema or hand dermatitis does not refer to one specific type of eczema, but rather is a broad and general name given to conditions of eczema that develop on the hands. The reason hand eczema is given specific attention by medical professionals is because hand eczema is often the result of one’s occupation. The cause of allergy may be directly related to their specific occupation.
Neurodermatitis, as its name implies, stems from a condition in the body’s nervous system. This form of dermatitis arises when nerve endings in the skin become irritated, triggering a severe itch-scratch-itch cycle.
Patients with this condition report that endless scratching does little to relieve the itching sensation of the condition. Common causes of nerve irritation include an insect bite and emotional stress. Women are more likely to develop Neurodermatitis than men. The condition generally will present itself between the ages of 25 and 50 and can result in thickened and leathery skin.
Seborrheic dermatitis generally presents on the scalp as oily and waxy patches. It is not uncommon for this form of dermatitis to spread to the face, cheeks, and shoulders. Seborrheic dermatitis does not necessarily have the “itching sensation” that come along with other forms of eczema. As mentioned previously, seborrheic dermatitis has a tendency to flare up when exposed to triggers such as cold temperatures and dry weather.
Stasis dermatitis occurs almost exclusively in middle aged people. As one ages, circulation in the lower extremities such as the legs begins to slow. Diminished blood flow to the lower extremities can lead to a fluid build-up. This ultimately leads to swelling that affects the skin by causing an itchy rash with painful sores and skin discoloration. To effectively treat this form of dermatitis, our doctors will not only take into account the trauma to the skin, but will focus on correcting the circulation problem thereby diminishing the swelling which will ultimately terminate the skin condition.
Eczema can also look different in darker skinned patients. Some of the unique forms of eczema seen more commonly in darker skin include papular eczema (bumps) and eczema with follicular prominence.
A major concern for people with dark skin is the skin discoloration associated with eczema. Eczema or scratching secondary to the itch of eczema can lead to darkening (hyperpigmentation) or lightening (hypopigmentation) of the skin. This discoloration can last for months to years, even after the eczema is treated. Darkening of the skin is especially visible in children with skin of color. If the patient’s underlying eczema and inflammation is treated, however, the changes in skin color can be improved.
The cause of atopic dermatitis and many forms of eczema is unknown but is potentially due to a dysfunction in filaggrin, a protein that maintains the membrane of skin cells.
It is also thought that genetics (inheritance) and an improperly functioning of the local immune system contribute to the development of atopic dermatitis.
Environmental factors also likely play a role. Atopic dermatitis tends to be more common in industrialized nations and urban areas, and the incidence appears to be increasing in developing nations as they become more Westernized.
In contact dermatitis, an irritant or allergen directly causes the rash. However, in many cases of allergic or irritant contact dermatitis, a clear trigger cannot be found.
How do I know if I have Eczema?
Eczema is usually diagnosed clinically. Direct physical examination and taking of a medical history allow dermatologists to accurately recognize the different forms of eczema. They may also ask about family history of eczema and associated diseases.
There are many helpful, easy ways to treat or soothe eczema. The first step is to avoid irritants or allergens, to which your body may react. Vigilant moisturization is the mainstay of treatment of atopic dermatitis and is also quite helpful in other forms of eczema. Gentle skin care is also recommended:
- Avoid extremely hot or extremely cold showers/baths
- Avoid fragrances (perfumes, colognes, cleansers, detergent, etc.)
- Avoid other irritants such as tight-fitting clothing. If a patient with eczema also has food allergies, avoiding those foods may help resolve eczema symptoms.6
- Bathe for 5-10 minutes with a gentle cleanser no more than once daily followed by patting skin dry and immediately moisturizing the skin
- Use bland, fragrance free emollients (moisturizers) at least daily. Ointments and creams are best. For active flares of eczema, placing a lukewarm, clean cloth on the affected area or soaking in lukewarm water can help to soothe the itch. An emollient MUST be applied immediately after removing the cloth or exiting the bath.
- Take baths with rice starch added to the bath water or bleach baths using one quarter cup of bleach for a half-full bath or one half cup of bleach for a full bath. Immediately apply moisturizers after these baths.6
- Avoid using alternative medicines such as herbal therapy, vitamins, naturopathy, traditional healing, homeopathy, and Ayurveda. These treatments may have allergens and irritants that can trigger an eczema reaction.7
A dermatologist may also prescribe a topical corticosteroid. These steroids help with both acute and chronic eczema and help to reduce inflammation.
Eczema, especially atopic dermatitis, is often secondarily infected, so your dermatologist may also prescribe antibiotics or anti-bacterial cleansers to treat any associated infections. Rarely, in severe cases, eczema is treated with systemic medications that alter the immune system.
Instead of scratching and irritating the skin, one should use a cold compress to control the uncomfortable sensation and should visit a dermatologist to start an appropriate treatment plan.
To learn more about Eczema, contact us today to schedule an appointment with our dermatologists.
ADVANCED SKIN CLINIC
Ground Floor, Susie House, Plot 1001 Ggaba Road, Nsambya Central, Kampala. P.O Box 612, Kampala.
Tel: 0755-562430 (Office Line) or 0778-389002