Published:  01:09 AM, 08 April 2020

Eczema: Let's start from scratch

Eczema: Let's start from scratch
Dr Leong Kin Fon

Eczema can lead to itchy and inflamed skin. Read on to find out the basics of this condition. Most children get rashes at one time or another. They can be itchy and irritating, but they usually go away on their own. Unfortunately, in some cases, a rash does not go away or the skin may become so inflamed that medical attention is required.

Eczema is a common problem that causes the skin to become inflamed. The itching can get intense, which can be a nuisance, especially for infants and young children. Scratching will make the problem worse. In fact, damage to the skin during eczema often occurs due to scratching.

Severely affected skin may develop deep, painful cracks, also called fissures. Defects in the skin barrier could allow moisture out and germs in, causing skin to become inflamed. Occasionally, small and fluid-filled blisters may also form.

What causes atopic eczema?

Atopic eczema is caused by the dynamic interaction between genetic and environmental factors.

It is not a condition with a single causative agent or factor, but is thought to be linked to skin barrier defect (porous outer skin layer) and an overactive response by the body's immune system to an irritant or allergen in the environment (such as dust, molds, pollens and animal dander).

It is this response that causes the symptoms of eczema, also known as atopic eczema.

Atopic eczema is the most common type of eczema. Research shows that atopic eczema can affect two in every 10 people in Malaysia and about 10%-14% of children below the age of 14. This is especially true among urbanised communities.

Another way that symptoms of eczema can flare up is if the person comes into contact with rough or coarse materials that may irritate the skin.

Exposure to heat (sweating), cold (dry air) or upper respiratory infections may also lead to an outbreak. Stress could aggravate the condition. Some experts think that children are genetically predisposed to atopic eczema, which means that they inherit characteristics that make them more vulnerable to the condition.

Children who have a family history of eczema, asthma or hay fever are more prone to developing atopic eczema.

The incidence of eczema is on the rise, with as many as one in four children affected by it. In Malaysia, prevalence of atopic eczema among primary school children was estimated to be around 12-13% in 2001. One explanation for the rise is the increased frequency of bathing and use of soap and detergents.

Air pollution from rapid urbanisation can also cause your child's skin to become itchy and inflamed, or aggravate his eczema.

Watch out for the signs

Signs and symptoms of atopic eczema typically appear within the first few months of life, and almost always before a child turns five. These include:

Scaly or cracked skin

·Small bumps may appear on the cheeks, forehead, or scalp (may also spread to the arms and legs, in the front of the bend of the elbow, behind the knees, and on the ankles, wrists, face, neck and upper chest)

Itchiness that can be severe (almost always)

Scratching the skin can lead to thickening of the skin or bleeding and crusting, thus creating wounds that may become infected.

However, most find the itch to be intolerable, which results in a vicious cycle of itch-and-scratch, and ends up with bleeding and pain.

Coping with eczema

As eczema is a life-long condition, the main goals of treatment are to tackle the itching and reduce flare-ups. Indeed, the Eczema Patient Impact Survey suggests that 62% of caregivers are constantly worried about their child's next flare-up.

It is important to act proactively to ensure that the skin remains moisturised, even when the child's eczema is under control. The application of moisturisers will provide a barrier to protect the child's skin from water loss and further damage, whilst keeping the skin supple.

It is crucial that parents choose a moisturiser with the right formulation, and most importantly, is effective in helping treat the child's condition, and prevent the child from suffering the scratch-itch cycle.

Apart from treatment, there are a few other self-help remedies that children with eczema can adopt to keep the itchiness away.

They should avoid wearing scratchy materials that could irritate the skin, such as pure wool, polyester or acrylic materials. Instead, go for soft, smooth materials like cotton.

Try to avoid taking long, hot baths as this can dry up a child's skin. Frequent short baths using only lukewarm water to rinse the body after exercise is fine, as sweat acts as a skin irritant.

After a bath, immediately apply some lotion on your child's skin while it's still moist, to help keep the moisture in the skin.

If your child has eczema, it is a good idea to keep his or her fingernails short, as longer nails are more likely to injure your child's skin when he or she scratches.

Managing these lifestyle factors may help control the symptoms of eczema and reduce the frequency of flare-ups.The good news is, most children will outgrow eczema before school-going age.

More than half the children who experience eczema symptoms in childhood grow out of it by the time they are teenagers.However, some kids will have eczema into adulthood. Remissions can happen and can persist for years. Dry and irritable skin from the condition also tends to linger.

The writer is a doctor

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