What you need to know about eczema

Did you know that in 2022, according to the International Eczema Council, 223 million people were living with eczema?

Eczema is a type of inflammatory skin disease that disrupts the skin barrier and its ability to hold moisture. It is the most common chronic skin disease and is genetically transmitted.

Eczema affects individuals of all ages, but most commonly begins in infancy and early childhood. It can last into adulthood and also begin developing in adulthood, according to the World Allergy Organization's (WAO) 2003 revised nomenclature.

"The percentage of adults with eczema is higher among women (8.9 per cent) compared to men (5.7 per cent)," according to the Centres for Disease Control and Prevention (CDC)

"Children 6-11 years are most likely to have eczema (12.1%), followed by children 0-5 years (10.4 per cent), and children 12-17 years (9.8 per cent)," the report further details.

Dermatologist Dr Venkatesh Narasimhan, a consultant at Aga Khan University Hospital, clarifies eczema by highlighting its various manifestations and the interaction between hereditary and environmental factors.

According to him, eczema is not a singular term, but rather a comprehensive category encompassing diverse skin conditions.

"When it's quite extensive, we can call it atopic dermatitis (a condition that causes dry, itchy, and inflamed skin). When there are fewer lesions, we can call it just focal eczema. There are different types of other eczemas also, like follicular eczema and nummular eczema, which are certain things that fall under the broad category of eczema with different presentations," he explains.

Is there a specific age group targeted?

"Primarily, eczema starts at a young age and we generally see an improvement with age. But of course, there is also adult onset eczema or adult flares of eczema," Dr Narasimhan elaborates. "In terms of children, it can start as early as infancy and present through the paediatric age; it varies widely."

He adds that usually, there's a genetic factor involved.

"If there is a family history of either eczema, asthma, or something called allergic rhinitis in either the parents or some close family members, the child can then have some symptoms of eczema," he adds.

But that's not in all cases.

"In some cases where there's no family history of those, the child can still develop eczema because it's an interplay between genetic factors as well as environmental factors," Dr Narasimhan says.

He further explains how eczema can clinically manifest across age groups.

"Speaking of how it can present in a child, we can see atopic dermatitis in infancy, which can involve rashes around the cheeks extending onto the body; involving the whole abdomen and chest over the back and even extremities," Dr Narasimhan elaborates.

"In terms of how we go through the age groups through paediatric age, it almost has a similar sort of presentation in adulthood. It mostly involves symmetric folds of skin, like your elbow creases, your neck, your axillary folds and other folds," he says.

Environmental and lifestyle factors

"I usually counsel all my patients on all the lifestyle factors or environmental factors that they can try to improve to help reduce the flares of eczema. So primarily, I would start with the kind of showers they take. I advise short showers, which means going in and out within 8 minutes and using lukewarm water. Avoid both cold and hot water, which is detrimental to skin with eczema," Dr Narasimhan explains.

He also advises patients to use milder soaps. "There are certain kinds that you can speak about and discuss with a dermatologist. The most important factor is moisturising with plain, heavy moisturising cream within 3-5 minutes of showering. Not on dry skin, but as soon as they come out of the shower, pat dry and apply the moisturiser regularly," he says.

"In children, especially, I counsel to primarily use cotton clothing for children with eczema because wool and polyester-based clothing can flare up eczema. Also, in terms of not only clothing but bedding and other things we normally use," Dr Narasimhan says. "Apart from that, the detergent that is used to wash the cloth has to be a fragrance-free and mild detergent."

Is it a heat rash or is it eczema?

Because of their similar appearances, heat rash and eczema can be difficult for laypeople to distinguish.

"It's quite difficult for the layman to be able to pick it up. It's a very clinical presentation. So sometimes distribution can help, but it's a clinical diagnosis. Most rashes look quite similar; it just depends on age, symptoms, distribution, duration and other factors that help us determine what exactly it is," he says.

Dr Narasimhan also notes that even in the absence of a prior history of asthma or eczema, allergic contact and reactions to materials like jewellery may contribute to focal eczema.

"Let's say you don't have a history of asthma or eczema. Can you still develop focal eczema? Yes. Or it can be an allergic reaction to something that you had worn like jewellery," he says.

How do you know when to seek help?

Eczema can present in a variety of ways, making self-diagnosis difficult.

"Nummular eczema is quite different from atopic dermatitis in terms of how it presents itself," Dr Narasimhan says. "In terms of climate, in warmer weather, eczema tends to improve. In colder weather, because of the dry nature, this takes away moisture from the skin in an already compromised skin barrier in eczema. So in winter, you expect to see eczema flares. So people should be more diligent with their moisturiser and the kind of showers they use," he adds.

Using a fragrance-free moisturiser emerges as a crucial component in managing eczema. "So I would just say moisturising is one of the biggest components of managing eczema. And in terms of organic products, well, there are too many brands to make a generalised statement. Of course, there are a few good ones, but it's hard to tell," Dr Narasimhan says.

"Basically, by trying to follow all the lifestyle factors that we talked about and getting themselves a plain heavy moisturiser. Usually, acute flares do need anti-inflammatory therapy in terms of topical creams, but that is not something we recommend over the counter. So if they can find some medical help in that regard while following all these other factors, it can help," he adds.

Clearing up misconceptions, Dr Narasimhan compares eczema to diseases like diabetes that call for lifestyle modifications and explains that eczema requires continuous care.

"It's almost like something that can be managed with time and usually, compared to a common illness like diabetes, you have to make some changes in terms of diet and lifestyle to be able to manage."