We often here the expression “to feel comfortable in one’s own skin”. This is usually meant metaphorically, but for a growing number of people in western society, they literally are not comfortable in their skin. This can be due to a number of skin conditions. Eczema is probably one of the more common skin conditions affecting people in this part of the world. Eczema is an inflammation of the epidermis of the skin. Indeed, the word “eczema” comes from Greek, meaning to “boil over”. Atopic Eczema is probably the most common type. It is an allergic disease and is thought to be hereditary in nature. It is quite common for a person who suffers from eczema to also suffer from another allergic complaint such as hayfever or asthma. The outer layer of the skin becomes very swollen, inflamed and itchy. It is usually noticeable on the head, neck and limbs, and it is quite common in infants. As the person scratches the skin, it becomes more inflamed, increasing the itch and so the condition continues to deteriorate. The folds of the skin tend to be very troublesome areas, such as the backs of the knees and the flexures of the elbows. Recent studies have suggested that dietary allergies may trigger the condition. If the patient can identify the particular offending food and isolate it from the diet, they can go a long way to managing the disorder.
Contact Dermatitis is another common form of eczema. This is where contact of the skin with an irritant or allergen causes a reaction and the skin epidermis inflames and swells.
The trigger can be anything from nickel on the back of a watch, liquid detergent on the hands to even sunlight, which can trigger phototoxic dermatitis. Fortunately, the complaint is easily curable. Once the trigger factor is identified and removed from contact with the skin, the condition should clear up rapidly. Contact dermatitis is on the rise in the developed world. The conclusive reason for this is still open for discussion, but the current thinking is that the environment we grow up in doesn’t expose us to enough allergens or “dirt”, which causes an over-reaction in our immune system when we do come across them.
First –line treatment for eczema is usually with an emollient cream, which is essentially a medicated moisturizer. These are specially formulated to hydrate the skin and correct the moisture balance in the skin. Combating the dryness of the skin in these conditions is half the battle and indeed some eczemas can develop from chronic dry skin which is left untreated and allowed to get out of hand. Some common examples of these creams are Aqueous cream and Silcocks Base. They should be applied frequently and liberally especially over the first few days of use. As the hydration returns to the skin, they need not be applied so frequently. Application of a couple of times daily should be enough to maintain the moisture in the skin. Some of these creams will lather up with water. This allows them to be used as soap substitutes. Rather that drying out the skin like a regular soap, they help moisturize the skin as they clean which is ideal when suffering from dry skin. Some brand such as Oilatum or Elave provide complete ranges from soaps, creams, shampoos, body washes , all specially formulated for people with dry skin. it should also be noted that over-bathing dries out the skin and the water used should be at a tepid temperature rather than “piping-hot”.
During periods when the skin flares up, emollients on their own might not be enough to control the condition. Use of a mild corticosteroid cream such as Hydrocortisone 1% can help bring it back under control. It should be applied very sparingly , no more than twice daily for no more than 4-5 days. It should only be used on a small area that’s particularly inflamed, such as back of the knees or folds of the skin. Once the condition has calmed down a bit, discontinue the steroid cream, and maintain the condition with the emollient creams.
Skin conditions such as Eczema tend to be chronic in nature, in that they tend to affect the individual for long periods of their life. As with any such condition, they should be managed under the supervision of a medical doctor, particularly where over-the-counter treatments are failing to control the complaint.
Cormac Harte M.P.S.I.
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