What is Eczema?
My tablemate used to scratch his arm frequently, and he once shared with me that he had eczema. So, what exactly is eczema?
Eczema is an inflammatory skin condition that causes dry, itchy skin. It cannot spread between people and affects anyone at any age. In fact, one in ten people will develop it in their lifetime. Infants are especially prone to eczema and 10-20% of them will have it. Generally, it is a chronic (long-term) low-lying condition that only flares up upon exposure to environmental triggers.
Symptoms - What does eczema look like?
People with eczema have dry, itchy skin and may have a rash and bumps on their skin. They may also have flaky or leathery skin, which is most commonly found on their elbows, back of their knees, on their face or their hands. This is less commonly observed on their nipples and breasts.
Causes - What leads to eczema?
The most up-to-date literature leads us to believe eczema is caused by a combination of genetic and environmental factors:
1. Genetic – Eczema runs in families. People from families with a history of dermatitis, allergies or asthma have a higher risk of developing eczema.
2. Environmental – Irritants like soap detergent, allergens like pollen and certain foods like dairy, nuts, seeds all can cause eczema. Rough and coarse fabric, sweat on the skin, low humidity, which dries skin and causes itchiness, could also trigger eczema.
Pathophysiology – How do things go wrong?
What happens in eczema is your immune system overreacts to these triggers. This results in the body’s innate defense being activated, which involves mast cells. These cells degranulate and release powerful chemicals that result in inflammation of the skin.
Diagnosis – How do we tell if somebody has eczema?
Until now, there is no specific test to diagnose eczema, so it is often diagnosed after a medical history is taken and a patch test is done, or in rare cases a skin biopsy too. Your GP will ask a series of questions pertaining to a family history of allergies, symptoms and when they appeared to build a picture of how their disease developed.
They may then refer you to a dermatologist, who may perform a patch test. This is the best diagnostic tool currently and it is left on the skin for days. Afterwards, analysis of the skin below tells them if you have eczema, and which allergy it is linked to if you do.
In rare cases, a skin biopsy is still needed to rule out other conditions and the doctors were unable to diagnose using a standard physical exam or patch test.
Treatment – How to cure somebody with eczema?
Unfortunately, there is no cure for eczema yet, but its symptoms can definitely be reduced. Gentle skin moisturizers applied throughout the day can soothe the dry, itchy skin. Topical corticosteroids and antihistamines will also reduce the inflammation and immune response, meaning less skin itchiness. The disease varies because for some people, their eczema naturally subsides and goes away with time while for others, it stays throughout their lifetime.
Life with Eczema
Eczema takes a big toll on one’s mental health too. It can make you feel embarrassed and lacking confidence in your appearance. Evidence shows that those with eczema are more likely to be bullied. To make matters worse, your sleep is disturbed due to itchy skin so you may also fail to keep up regular hygiene practices. Despite it being impossible to catch and spread eczema, those with it are treated as if their eczema is contagious. This stigma causes social isolation, which can be depressing.
Recent Advancements in the Field of Eczema
Living with eczema is very tough, but the future seems bright. There are now more support groups and home tips from many blogs about eczema and living a normal life with the condition. Through sharing stories and what worked for them, they empower those with the disease and help them feel less judged.
JAK inhibitors are a novel treatment for eczema. JAKs are molecules that transmit signals for the immune system to cause inflammation and red, itchy skin, so blocking these would reduce dry skin, curbing eczema’s symptoms.
Another advance is phototherapy, where narrow-band UVB light is shone onto skin regularly and this helps reduce some symptoms. This is continued for a few months, and then exposure is progressively reduced. This may get rid of eczema for some people permanently.
With more ongoing research, there are high hopes in the future for an affordable, targeted and effective cure for eczema, and till then, we can all be a bit more supportive to our affected friends and help them feel a little more comfortable in their own skin.
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