Eczema is the name for a group of conditions that cause the skin to become red, itchy and inflamed. The terms dermatitis and eczema refer to the same condition. It is due to inflammation of the skin and has many causes, and it occurs in different forms. It causes red, itchy skin which may also blister. There are five types of eczema: Atopic Eczema, Asteatotic Eczema, Discoid Eczema, Seborrhoeic Eczema and Venous Eczema.
Eczema is probably the commonest cause of dry, sensitive skin. In the acute stages, the skin may look red, oozy and swollen; on the end, the chronic stage may look thickened, dry and cracked. Itch is a universal symptom.
Atopic eczema is the commonest type of eczema. It affects up to 20% of children in Singapore, and adult-onset is also possible. The word “atopic” depicts the presence of certain allergic tendencies. People with atopic eczema have a higher chance of developing allergic conditions like asthma and allergic rhinitis. There is no single cause of atopic eczema – it is believed to arise from genetic factors, a deficiency in the skin barrier function, and a “hyperactive” immune system. Apart from these, many other factors may cause a flare of eczema, such as climatic changes, pollution, exposure to house dust mite, stress. Any part of the skin may be affected, though the common sites are the skin next to the creases such as back of the knees and inner folds of elbows. In babies, the face is commonly affected.
Asteatotic eczema is another common eczema but it typically occurs in older people. The skin is extremely dry, feels rough and scaly, and looks like cracked tiles on the floor.
An itchy scaly red network on the legs of an elderly man
Discoid eczema typically occurs on the limbs of young adults. It appears as coin-shaped red itchy and scaly islands which tend to blister and discharge.
Oval red scaly island of discoid eczema on the leg.
Seborrhoeic eczema appears as a scaly yellowish rash that has a preference for the scalp (especially the hairlines), the face, armpits and groins, upper chest and back. In infants, it usually clears within two months. In adults, it can look exactly like dandruff when the inflammation is not apparent.
Venous eczema occurs around ankles and legs. This happens in some older people who developed varicose veins which pool blood (due to gravity).
All the above can also be considered under an umbrella term “endogenous eczema”, which means the underlying cause of the eczema is not related to direct contact with an inciting agent. Contact dermatitis has two types: irritant and allergic. Irritant contact dermatitis is due to exposure to an irritating substance such as detergent, soap, bleach – anyone is vulnerable to developing this type of reaction if given sufficient exposure time and frequency. Allergic contact dermatitis is due to an immune mechanism which has arisen to target an allergic substance that has come into contact with the skin, such as nickel, fragrance, rubber.
A scaly rash appeared where it had been in contact with the nickel-containing buckle of jeans.
Severe eczema is challenging to treat, but the good news is that with proper care and education, most patients can control their condition.
The key parts of management are: