More education on eczema would reduce its symptoms among sufferers. Lawrence Scerri, chairman of the Department of Dermatology, tells Stephanie Fsadni about the triggers to avoid and misconceptions to dispel.

In early childhood, eczema initially attacks the face. Later it becomes common on the neck, wrists and ankles, and in areas that bend, like the inner elbow and knees.

Eczema or dermatitis may be a common skin condition, but more education may lead to less flare-ups among sufferers, says Lawrence Scerri, chairman of the Department of Dermatology. Also discarding some misconceptions may lead to better lives.

Eczema is characterised by an itchy, red rash (representing inflammation) accompanied by dryness of the skin and in acute stages, it can produce an oozing and crusting condition. It may affect any part of the body, depending on the type of eczema.

One of the first things one should know is that the most common type of eczema, called atopic eczema, is associated with the atopic disorders asthma and hay fever, so one has to avoid almost all the same triggers of these other two disorders.

The second thing is that eczema is not infectious – that is, it does not transmit to other people or organisms – even though it might be secondarily infected (with bacteria), needing specific treatment. This misconception often leads to parents not sending their children to school.

“There’s no reason for children to miss out on classes,” assures Scerri. “Educators need to be educated about this.”

Scerri points out that stress is the “one of the most aggravating factors” of eczema.

The season may also affect the condition: spring is a common peak time for eczema due to pollen in the air (just like for asthma or hay fever), but in winter, an overheated environment may also lead to flare-ups.

In the same way that a child might grow out of asthma in the teenage years, one might grow out of eczema. However, just like asthma, the intolerance remains

“It is quite common for eczema sufferers to return from winter holidays with flare-ups. This is because planes and hotels, taxis and shops abroad have low humidity conditions as they are often heated up.”

He also laments that some parents may be doing their babies more harm than good when they overdress them in winter.

“Babies are often wrapped up in layers and layers of clothes, and covered with piles of ­blankets. This is not good at all for them if they have eczema. It’s better if they’re kept cooler.”

House dust mites also pose a problem.

“The immediate environment is very important. For example, babies crawl all over the floor, including carpets which may harbour many house dust mites. Keep rooms as simple as possible and avoid carpeting.”

It might also not be a good idea to let children with eczema history run freely in fields, as besides plants, soil is as irritating as dust or other powders.

“Parents may find it difficult to restrict their children’s movements, but one either lets them do as they will and suffer the consequences, or take precautions and prevent nasty repercussions,” says Scerri.

Contact with materials that can irritate you, also called contact dermatitis, such as detergents and toiletries that dry up the skin, may also trigger eczema.

Most women are likely to suffer from contact dermatitis due to earrings. One in 10 women is allergic to nickel, a common compound found in metal.

“Only gold and platinum jewellery are suitable for them, because even silver contains some nickel.”

A patch test may help find the cause of allergic contact dermatitis.

Fragrance is another hazard to avoid, such as for asthma and hay fever sufferers.

“Fragrance is their greatest enemy,” claims Scerri. “Even entering a department store is dangerous; just run away.”

He adds that sometimes people underestimate how harmful certain things may be, such as a man wearing aftershave hugging a baby or the use of air fresheners in homes.

As regards clothing material, cotton ranks as the best, while the worst one is wool, whom Scerri describes as “a very potent irritant “Even if you’re wearing a shirt and another garment underneath a woollen coat, the fabric may still irritate you.”

Scerri emphasises that occupational career advice at an early age is very important.

“In the same way that a child might grow out of asthma in the teenage years, one might grow out of eczema. However, just like asthma, the intolerance remains and one has to avoid certain occupations.”

He refers to jobs that can bring one into constant contact with irritants, such as catering, hairdressing and manual work.

“Make sure you get an office job; that’s the safest,” suggests Scerri.

Treatment

Eczema may cause of lot of misery in patients and their immediate families, unless it’s not kept under control.

Scerri emphasises that the most distressing part of the condition is the itch.

“It drives you up the wall. It’s a vicious cycle because you stress out more due to the itching and this causes the flare-up to worsen.”

There are a number of treatments for niggling eczema. Moisturiser is very important as it soothes the dry skin. Scerri recommends to be generous with moisturiser and apply it once or twice a day. Washing agents like bath oils and cleansers must be fragrance free and one must use these not only during flare-ups but also during ‘quiet’ times, to maintain the eczema under control.

During a flare-up, a steroid or corticosteroid in the form of creams and ointments is prescribed for the short term to treat the affected skin by reducing swelling and redness.

Steroid cream may have mild, medium or strong potency. Abuse (that is regular, frequent, long-term use) of the latter two types may lead to the thinning of skin, making it fragile, red and full of broken veins.

Another therapeutic treatment is anti-histamine pills or syrup for children, which help to treat the symptoms, that is controlling the itch. These are to be taken at night because the itch is worst at that time of the day and the treatment is sedative.

When acute rashes become secondarily infected by bacteria, forming a yellowish and oozing crust, antibiotics, either in the form of topical creams or oral pills, may be prescribed.

For more severe cases, when the eczema is spread out, a dermatologist may prescribe steroid pills together with steroid cream for a period of between two to three weeks, and as part of a treatment regime.

If eczema appears in adulthood for the first time, it mostly affects the hands, which are frequently exposed to water, detergents and/or solvents.

What is eczema?

• Eczema is characterised by an itchy redness (representing inflammation) accompanied by dryness of the skin and in acute stages, it can produce an oozing, crusting condition. It may affect any part of the body, depending on the type of eczema.

• There are two major clinical classifications: endogenous, meaning eczema is caused by internal causes, and exogenous, meaning it has an external cause, like coming into contact with external agents.

• Some people may be genetically prone to suffer from eczema, but external factors may trigger the condition.

• The most common type of eczema is atopic eczema, meaning it is associated with the atopic disorders asthma and hay fever. It is genetically determined, so if one or all three of these disorders run in one’s family, one is at high risk of developing this form of eczema.

• In early childhood, eczema initially attacks the face, then it becomes common in the extensor (outer) aspects of joints, particularly the wrists, elbows, ankles and knees, and around the neck.

• If eczema appears in adulthood for the first time, it mostly affects the hands, which are frequently exposed to water, detergents and/or solvents.

• Even though eczema is a chronic condition, it is also a dynamic one – it is characterised by fluctuations as one may have flare-ups every so often when one comes into contact with triggers.