Eczema
Eczema or else known as atopic dermatitis is a chronic inflammatory, skin condition that is characterised by skin rash and itching. Patients with moderate to severe form of eczema can present with extensive rashes, skin cracking and scaling. These symptoms can affect the quality of sleep and life of both patients and carers.
It usually starts in infancy more commonly on the cheeks and other parts of the body. One of the most commonly asked questions is if it triggered by food allergy. In vast majority of patients this is not food driven, but is has to do with the skin barrier in infancy. An allergist can guide you if a food exclusion is required to rule out non immediate food allergy. It is important to avoid unnecessary food exclusion.
Studies have shown that genetics often account for the eczema and particularly deficiency in filaggrin, which leads to a “leaky” skin barrier that allows higher than normal water loss.
Possible triggers that cause eczema flares are : airborne allergens such as house-dust mite, animal dander and pollen, perfume, chemicals, temperature change, sun and infections. More recently research has revealed the role of Sbi protein of staphylococcus aureus and that is exciting news as the research now focuses on identifying new non-steroid treatments.
Mainstay of treatment is the use of emollients either as a cream or ointment at least twice daily even if the skin looks healthy in order to maintain a healthy skin barrier. The use of local steroids is important to reduce the inflammation. Local steroids are safe when used with guidance regarding method of application, right choice and duration. In cases of difficult eczema particularly in sensitive areas like the face and neck we can use immunomodulating agents which are calcineurin inhibitors. These can also be used long term to prevent eczema flares.
Increasingly there is wide use of biologics for the treatment of severe eczema.
References:
- National eczema society
- Al Kindi, A., Williams, H., Matsuda, K., Alkahtani, A., Saville, C., Bennett, H., Alshammari, Y., Tan, S. Y., O’Neill, C., Tanaka, A., Matsuda, H., Arkwright, P., & Pennock, J. (2021). Staphylococcus aureus Second ImmunoglobulinBinding Protein drives atopic dermatitis via IL-33. Journal of Allergy and Clinical Immunology, 147(4), 1354- 1368.e3. https://doi.org/10.1016/j.jaci.2020.09.023