Fifteen-year-old Aaliyah A from England recently developed dark, patchy and itchy areas on her neck, chest and the inside of her arms. Assuming that dry skin was causing the problem, she tried using dermatological moisturising creams and even tried rosehip oil and coconut oil. None of these helped. This is when Aaliyah decided to consult a doctor who diagnosed her with a fungal infection and eczema.
Eczema is a group of non-contagious, skin conditions that manifest in the form of itchy, red rashes and inflamed skin. Dr Vyakaranam Nageshwar, allergist and immunologist, Ashwini Allergy Centre, Hyderabad, says that when there is genetic susceptibility to atopic dermatitis (a type of eczema characterised by red, itchy skin) and people are exposed to environmental triggers, allergens or even stress, their immune system gets activated and pro-inflammatory mediators are released. “This is when the signs and symptoms of eczema, inflammation, redness, itchiness, all come into the picture,” says Dr Vyakaranam.
Although she was recently diagnosed with eczema, Aaliyah says she has had symptoms of the skin condition since she was a child. “Surprisingly, I wasn’t officially diagnosed till a few months ago since it hadn’t been that severe.”
“It’s honestly so hard not to scratch, because i know skin will get irritated and red. It’ll also start hurting at some point. Sometimes I resort to rubbing it (and by default making it worse to deal with). Aaliyah was then prescribed miconazole nitrate and hydrocortisone for around four weeks. “And I finally got it (irritation) reduced. It still itches sometimes, but for the most part, it’s much better,” she says.
According to the US National Eczema Association, “one in ten individuals develop eczema during their lifetime with prevalence peaking in early childhood.”
The association lists seven different types of eczema:
- Atopic dermatitis (this is the most common and long-lasting eczema. It may even be carried into adulthood; symptoms include itchy, dry skin and red rashes)
- Contact dermatitis (in this type of eczema, the skin becomes inflamed after it comes into contact with environmental or other types of triggers; it is not hereditary unlike atopic dermatitis)
- Neurodermatitis (In this type of eczema, dry, itchy patches appear on the skin. Unlike atopic dermatitis, which can be spread across several parts of the body, in neurodermatitis, only one or two patches form)
- Dyshidrotic eczema (this condition causes small, itchy blisters to appear on the skin, usually between the fingers and toes and the palms and soles of the feet. This type of eczema is more commonly seen among young adults and the blisters are limited to the arms and feet)
- Nummular eczema (this type of eczema manifests in the form of coin-shaped lesions, that often ooze liquids, on the arms, legs or torso)
- Seborrheic dermatitis (in this type of eczema, it is mostly the oil-rich areas such as the scalp, nose and the face that get affected. Symptoms include scaly, greasy patches on the scalp)
- Stasis dermatitis (this type of eczema usually affects the feet or lower legs and symptoms include itching, scaly and dry skin; lesions may appear red in lighter skin toned-people and grey or ashen in those with a darker skin tone.)
Among the seven different types of eczema, the most common one is atopic dermatitis. Very commonly diagnosed among children, atopic dermatitis is often mistaken for other forms of eczema and childhood psoriasis as well, says Dr Vijaya Gowri Bandaru, visiting consultant, dermatology, Sakra World Hospital, Bengaluru.
“Atopic dermatitis is a condition among children aged six months and above. It is basically a dry skin condition which is hereditary in nature. Major symptoms of atopic dermatitis include itching, red rashes on the skin and dryness,” says Dr Bandaru. He adds that it commonly occurs in the folds of the limbs which include arm folds, elbow folds and knee folds.
“Some of the triggers are sudden changes in the weather, usage of woollen or rough clothes, usage of dry soaps and vigorous rubbing of soap on sensitive skin, making the skin drier. Atopic means allergy. Therefore, dust, pollen and various other allergens can be a contributing trigger for atopic dermatitis,” says Dr Bandaru.
He adds that atopic dermatitis will reduce as the child grows. “But due to the triggering factors, the condition might return, and the condition mostly returns during the winter season,” he says.
About living with the skin condition, Aaliyah says, “Well, on some days it’s calm and nothing really happens. But some other days, it’s honestly such a pain. It’s incredibly itchy and sometimes I bleed if I scratch it too much. Even putting a little bit of moisturiser leaves my skin burning.”
The itchiness that comes with eczema is the hardest part of living with the condition, says Aaliyah.
How is eczema treated?
The goal, says Dr Bhumesh K, a paediatric dermatologist and associate professor of dermatology, venereology and leprosy at Gandhi Medical College, Hyderabad, is not to cure but rather to manage the condition. “The goal is to clear the symptoms and take care of the skin and ensure that flare-ups are mild. When the severity increases, more complications arise. Atopic dermatitis can also progress into the development of asthma and allergic rhinitis later on in childhood,” says Dr Bhumesh.
“I tell my patients to follow the rule of three – taking a three-minute bath and applying moisturiser three times a day. Moisturising is the backbone of the management of atopic dermatitis. Educating and involving the parents and adolescents is very important in tackling atopic dermatitis,” he says.
“We recommend patients to massage the body well with vegetable oils like olive oil or coconut oil before bath and use very mild body wash or soaps to reduce the rashes and itchiness. We also recommend keeping the skin hydrated by using moisturising creams. Some of the medications used for treating this condition are steroids and anti-allergic medicines like fexofenadine and hydroxyzine to reduce the itching. If the rashes are not reduced, we use strong oral medications to reduce them,” says Dr Bandaru.
Dr Nageshwar however points out that it is important to first identify the triggers. “It doesn’t just stop at dry skin. The skin becomes scaly once you scratch it and secondary infections start accumulating. The more we neglect to take care of the skin, the worse the problem gets. Many people think the rashes and itchiness can be managed with an antihistamine. It is not so simple,” says Dr Nageshwar.
Dr Nageshwar points out the first step is identifying the trigger of the eczema flare-up. Although due to family history, the person could be genetically prone to dry skin, the root cause should still be identified to prevent a flare-up,” he says.
Dr Nageshwar recommends taking a simple skin prick test to identify the triggers of a flare-up. “Based on allergic testing, we try to classify it into a food or environmental allergen. The testing is done from the age of two years. The skin prick test is painless and a range of allergens are used to determine what allergen is causing the reaction. Within 20 minutes, the test will tell you what is acting as the trigger for the patient,” says Dr Nageshwar.
Based on the skin prick test, Dr Nageshwar says that the affected persons will have to start avoiding this trigger. “We also look at adopting allergen-specific sublingual immunotherapy, a process of zeroing in on the major allergens the patient is allergic to, altering the body’s antibody responses and building up an immunity to the allergen over time,” he adds.
A study titled ‘Allergen-specific immunotherapy,’ published in the journal Allergy, Asthma and Clinical Immunology however points out that the treatment method should be prescribed only by physicians who are trained in treating allergies since there are chances of the patient having anaphylactic reactions.
Stigma hurts
Those affected with eczema also deal with battling the insecurities and stigma associated with it, as the red rashes as visible. Aaliyah says she was insecure about the red rashes on her skin, to a point where she would wear only long-sleeved shirts to school to hide the marks. “I was so insecure and covered it; I was embarrassed,” she says. Things have, however, changed post the eczema diagnosis and treatment. “Thankfully I’m a lot more confident and I wear short-sleeved shirts now,” says Aaliyah.
