Eczema is a skin condition that causes inflammation and irritation of the skin. The most common type of eczema is atopic dermatitis, which is a chronic condition that causes red, itchy, and inflamed patches of skin. Eczema often is early onset, developing during infancy and includes chronically relapsing course. It is not contagious. Yet, there is no cure for eczema, there are many treatments available to help manage the symptoms.
A common type of eczema – atopic dermatitis (AD) is a complex genetic disease and is often accompanied by other atopic disorders such as asthma and food allergies. These conditions may appear simultaneously or develop in succession. The cause of AD can be modulated into genetic and environmental factors.
Epidermal barrier dysfunction is a key feature of atopic dermatitis. The skin barrier is made up of several layers of skin cells and lipids that help to keep moisture in and irritants out. For individuals with AD, they are observed with deficiency in filaggrin, a protein that helps to form a protective surface of the skin layer. Mutations in the filaggrin gene have been identified as a major genetic risk factor for AD. As the skin barrier is weakened, irritants and allergens could easily penetrate into the skin. The increased colonisation of bacteria may weaken and disable regulation of immune responses and inflammation, leading to inflammation and itching.
In infants, atopic dermatitis often appears as a rash on the scalp and face, and may cause oozing and crusting. In children and adults, the rash is more commonly found on the hands, feet, and in skin creases. AD is often associated with intense itching, which can lead to nodules, and thickened (lichenified) skin due to scratching and rubbing. In addition to these features, eczema can also have a significant impact on a patient’s quality of life, causing sleep disturbance, anxiety, and depression.
Types of eczema include:
- Atopic eczema
- Allergic contact dermatitis
- Irritant contact dermatitis
- Seborrheic dermatitis
- Discoid eczema
- Varicose eczema
Management
Atopic dermatitis is a chronic, relapsing disease, a proactive approach that includes long-term maintenance therapy is recommended to alleviate symptoms caused by AD.
Your doctor will try to identify and tackle the contributing factors that may be causing you eczema. Patch testing may be performed to identify a causative agent if your dermatologist suspects a contact allergy (allergic contact dermatitis).
Maintaining a good general skin care routine is important, especially as dermatitis can be a long-term affliction:
- Keep your skin well moisturized by applying an emollient liberally and often, especially after bathing and when feeling itchy; avoid perfumed products where possible
- Take brief baths and showers, bathing between five and ten minutes to reduce evaporation
- Avoid hot water, use warm water instead
- Use a non soap-based cleanser as soaps tend to dry the skin out
- Always moisturize immediately after bathing
Drug Treatment
- Topical therapy
Topical corticosteroids work by suppressing the immune response and reducing inflammation in the skin. They are suitable to use for long-term maintenance therapy to prevent relapse.
Topical calcineurin inhibitors (TCIs) work by inhibiting the activity of calcineurin, an enzyme that plays a role in the immune response and inflammation, in order to reduce inflammation and itching.
Wet wrap therapy is typically used for severe or widespread eczema to improve skin barrier function. It involves applying a topical corticosteroid to the affected area, as to hydrate the skin and enhance absorption of medication.
Crisaborole is an inhibitor of an enzyme which causes inflammation. By blocking certain enzyme release, crisaborole can ease the inflammation and therefore relieve symptoms of individuals with mild to moderate AD.
2. Systemic therapy
Oral corticosteroids can be taken as they are synthetic versions of the hormones produced by the adrenal gland, which could regulate the body’s response to stress and inflammation.
Cyclosporine is an immunosuppressant medication that works by suppressing the immune system and reducing inflammation. It is typically used for short-term treatment of severe eczema that is not responsive to other treatments.
Dupilumab is a biologic agent that targets molecules involved in the immune response. It is administered via subcutaneous injection and is effective in reducing eczema symptoms in adults with moderate to severe disease that is not adequately controlled with topical therapy.
3. Adjunctive therapy
Adjunctive therapy refers to additional treatments that are used in combination with the primary treatment (usually topical corticosteroids) to improve outcomes. The use of antibiotics may lower the risk of bacterial infection, while antihistamine could ease allergies, such as itching, sneezing, and runny nose.