Eczema is a chronic, itchy skin condition that affects people of all age groups. The skin becomes dry because it is unable to retain moisture, making it itchy and more vulnerable to infections. Dry skin is also more exposed to allergy-producing substances, or allergens, which can further worsen the condition. Genetics is one of the major contributing factors in eczema. A family history of asthma or allergies increases the risk of developing the condition. Many individuals with asthma have a genetic deficiency of the protein responsible for maintaining a healthy skin barrier. This allows moisture to escape, leading to dry skin. Microbes and allergens can then enter the skin, causing inflammation and infection. An overactive immune system may also trigger inflammation when exposed to substances that cause flare-ups. Common triggers include soaps, detergents, shampoos, chemicals, and perfumes. Dust, mites, pet dander, pollen, and moulds are also known triggers. Woollen fabrics, polyester clothing, smoke, dust, and low humidity may aggravate eczema. Stress, anxiety, depression, and certain foods such as peanuts, eggs, and dairy products may trigger flare-ups in some individuals. Eczema may appear in different clinical forms, but the symptoms are usually similar. These include itchy rashes, small bumps, and dry, thickened, leathery skin. In weeping eczema, fluid may ooze from the rashes. Repeated scratching can lead to secondary bacterial infections, causing boils and fever. Eczema is not contagious. Although it can occur anywhere on the body, common sites include the hands, neck, elbows, knees, ankles, feet, and face—especially the cheeks—as well as around the ears and lips. In some cases, it may also affect the nipples and genital areas. The condition may go through periods of remission and relapse, or remain chronic. Childhood eczema may improve with age, while eczema beginning in adulthood is often persistent. Diagnosis is usually based on symptoms, family history of allergies, and examination of the skin. If needed, a patch test may be performed, especially when allergic contact dermatitis is suspected. In this test, small amounts of potential allergens are applied to the skin and the reaction is checked after 48 hours. A skin biopsy may also help identify the type of eczema. The main aim of treatment is to keep the skin moisturised and avoid triggers. Regular use of a good moisturising lotion or cream, applied two to three times daily, helps prevent dryness. Very hot water should be avoided during bathing, as it can worsen dry skin. Applying moisturiser immediately after bathing while the skin is still damp helps retain moisture for longer. Elderly individuals should be particularly careful, as ageing naturally makes the skin drier. People with diabetes should keep their blood sugar levels under control, since high blood glucose can lead to dry, itchy skin and increase the risk of infections. Similarly, individuals with hypothyroidism often have dry skin, which may aggravate eczema. If itching is severe, anti-allergy medications may provide relief. Steroid creams can also help reduce inflammation. In cases where boils or abscesses develop, antibiotics may be required. Some vitamin supplements may support skin health in selected individuals. Preventive care and avoidance of known triggers can go a long way in reducing eczema flare-ups and improving quality of life. The writer is a specialist in internal medicine.
