Eczema - your essential guide

Part 1

UNDERSTANDING ECZEMA

It is much easier to treat and manage your eczema if you understand the condition.

1

What is eczema?

ECZEMA makes you itch. And scratch. It can drive you to distraction. It is unsightly. It may even repulse people. It makes you feel dejected and depressed. If you suffer from eczema, you know all this from personal experience. But there is good news – and, therefore, hope: eczema can be successfully treated and managed even though it cannot be cured.

The word ‘eczema’ is derived from a Greek word that means to ‘effervesce’ or ‘boil over’. The red, oozing eczema skin probably seemed to ancient health specialists to be boiling.

The first step towards improving the condition is to understand it. Eczema has given rise to many myths. It’s contagious, some say. It’s an allergy. You get eczema because your house is dirty. These are old wives’ tales that are simply not true. The most recent medical research shows that your unique genetic composition holds the key. In his book Eczema-free for Life, Dr Adnan Nasir points out that eczema is caused by the abnormal development of about 20 genes that determine how your skin will react to the environment.¹ Eczema is not an illness or an allergy, Nasir says, it is a vulnerability of your body.

Understand these terms

Eczema: Different kinds of dermatitis, such as atopic dermatitis (covered here), contact dermatitis (a skin irritation under your watch strap or behind an earring, for example) and seborrheic dermatitis (often appearing as cradle cap in babies).

Dermatitis: Inflammation of the skin accompanied by a rash, redness and itchiness. The skin sometimes forms small vesicles that may rupture and ooze.

Atopic dermatitis: The most common type of eczema. The term ‘atopic’ (literally ‘strange disease’) refers to an inherited tendency to develop allergic reactions such as dermatitis, rhinitis and asthma. This type of dermatitis is so common that the term ‘eczema’ serves as a synonym for atopic dermatitis. This book also deals only with atopic dermatitis.

DEFINING ECZEMA

Eczema is a chronic condition characterised by an overly dry, itchy and irritated skin. The word ‘chronic’ refers to its long duration rather than the intensity of the condition. Although some children outgrow eczema by the age of six to ten years, it often expresses as a lifelong condition that can be treated and managed but not healed.

This chronic condition has a cyclical component. Sudden, acute flares may arise, characterised by numerous small fluid-filled structures called vesicles that appear on red, swollen skin. When the vesicles rupture, or break – for instance, when the skin is scratched excessively – the fluid leaks out, causing typical weeping and oozing. When the fluid dries, a crust forms and the skin becomes scaly.²

An acute flare-up is followed by a period in which the condition appears to be under control. It may even seem as if the skin has healed. This may last a few days, weeks, months and even years. We then say that the eczema is ‘in remission’. But then, all of a sudden, the condition may deteriorate again and new flare-ups may follow. You can sometimes identify a trigger for the new flare, but it often seems to appear spontaneously. This is simply the typical eczema cycle.

THE ITCH-SCRATCH CYCLE

Another cycle associated with eczema is the so-called itch-scratch cycle (see Figure 1.1). The itching that accompanies eczema is much more than an irritation. It is constant, even painful and sometimes almost unbearable.

If you react to the itch by scratching, your skin releases chemicals that aggravate the itching. The more you itch, the more you scratch, but the more you scratch, the worse the itch and the more you want to scratch again. This is a vicious circle that tends to exacerbate the condition.

Scratching can damage an already weakened skin and infections caused by bacteria, viruses and fungi may occur. A common infection is caused by the bacterium Staphylococcus aureus (also known as a staph infection). It produces small erosions, cracks in the skin, yellow or red crusting and scabs.³

If an insect walks across your skin, it will also cause itching. The itch is a message to your brain that something potentially dangerous has appeared on your skin. The natural reaction is to scratch or wipe the insect from your skin. This protects you against insect bites, parasites threatening to invade your skin, or plant material that releases dangerous chemical substances.⁴ In the case of eczema, the itch warns not so much of a potential danger, but of a microscopic irritant that has penetrated the outer barrier of the skin.

Stopping the itch, and thus the scratching, will reduce the possibility of infection and make it easier to contain the dryness and the rash.

Although a lot of children outgrow their eczema by the age of nine or ten, this does not mean that they have been cured. Your body will always have the tendency towards eczema. Age is thus not directly linked to eczema. If the condition disappears with age, it simply means that your body’s natural healing mechanisms have become more efficient.

The problem with scratching is that it often becomes a habit. The eczema sufferer is not even aware of the habitual scratching. To be constantly mindful of the scratch action is a very important component of managing and clearing the condition. This is covered in more detail under ‘Scratch habit reversal’ in Chapter 10.

It is not easy to stop the scratching. The relief – even pleasure – it provides is even picked up by your brain. A study, using imaging technology to determine what goes on in our brains when we scratch, was done at Wake Forest Baptist Medical Center in North Carolina, USA, under dermatologist Dr Gil Yosipovitch. The results were published in The Journal of Investigative Dermatology. The researchers found that when we scratch, parts of the brain that are usually active when aversive emotions and memories are experienced became significantly less active. This paves the way for new medication that can target the relevant part of the brain in order to produce the same measure of relief.⁵

HOW COMMON IS ECZEMA?

Atopic dermatitis affects people worldwide, but a worrying feature is that it has gradually been increasing in prevalence in recent years. Almost the same number of men and women experience the condition. For reasons not yet known, children of mothers who are older when giving birth tend to develop eczema more often than children of younger mothers.

Between 10% and 20% of all people develop eczema at some stage of their lives. Statistics vary between countries and also depend on the level of industrialisation of populations. According to the French Foundation for Atopic Dermatitis, eczema occurs less in agriculture-based societies, while its prevalence has tripled over the last three decades in industrialised countries.⁶ The reasons are not clear but the increase in eczema cases may be connected to lifestyle factors as well as diet.

The cause of eczema lies in your own body. You have inherited a trait that determines how your skin will react to triggers and irritants. Since it is an internal rather than an external cause, eczema is known as an endogenic condition.

Figures for research on eczema in South Africa are not readily available. Limited research by ISAAC (The International Study of Asthma and Allergies in Childhood) found that between 5% and 10% of all school children in the Western Cape have eczema. It is, however, reported that pre-school children are the most affected by eczema.⁷

Scientists report that around 65% of eczema patients already show symptoms in their first year of life and 90% of patients exhibit symptoms before the age of five.⁸ It is rare for eczema to make its first appearance after the age of 30, but if it does occur, it is most often a result of your body being exposed to extreme conditions or to certain medications. But occasionally doctors do come across patients of 60 or even 80 years old who develop eczema for the first time. It is generally more difficult to treat adult onset eczema.

IS ECZEMA CONTAGIOUS?

More than one member of a family can suffer from eczema, but it is important to note that each eczema sufferer develops the condition separately. You cannot catch eczema from another person and, if you suffer from it, your children cannot catch it from you. Secondary infections, such as cold sores and fungal infections, may, however, occur and these are indeed contagious through skin contact.

Eczema is not contagious and cannot be transferred from one person to another. Neither an adult nor a child will develop the condition when coming into contact with an eczema sufferer.

If eczema isn’t contagious, why does it appear in families? Because the sufferer inherits the tendency. Scientists have found that the abnormal development of some 20 genes, responsible for controlling how the skin interacts with the environment, is one of the causes of eczema.⁹ The abnormal genes mainly affect two important elements: (a) the skin’s barrier function against environmental attacks, and (b) the reaction of the immune system when irritants and bacteria penetrate the skin.

Hereditary genes cannot, however, be the only reason for the rise in the occurrence of eczema. Various factors pertaining to the environment in which a sufferer finds himself also play a role.

In Part 2, The Causes of Eczema, we give a detailed discussion of possible causes such as the abnormal development of certain genes, problems with the skin’s barrier function, the malfunctioning immune system, as well as environmental factors.

CASE STUDY

Abby relates: I was born with eczema, and have lived with it for over 10 years. When I was 15, my eczema suddenly became so severe that my body was covered with it and I used to wake up with blood and dead skin flakes all over my bed. My legs looked like they were burned, and the flakes were so big and so numerous that I could sweep it and it would become like a large pile of sand on my floor. It was a scary experience.

I would walk down the streets with people looking at me and I was constantly seeing doctors on a weekly basis for steroid medications or check-ups – that did not help. The doctors said I would never heal.

It was very painful to walk (because of the eczema on my knees and joints), painful to wash my face, and my whole body would sting when I showered. I was afraid to see people – and afraid of what others thought of me … I kept praying and praying for God to cure me.

Finally, I saw a naturopath and nutritionist, and was told that it was nutrient deficiencies, food sensitivities, a damaged gut, and product sensitivities that were causing it …

For the next few months, I used cleaning products (that were natural without chemicals), supplements, did a detox, and I completely changed my diet. I switched to hypoallergenic products for eczema, which helped lessen the toxic load on my body; I also ate an extremely pure diet for two months, as my body had become so sensitive that whenever I ate the wrong foods (mainly sugar, wheat and sauces), my body would break out in eczema and tingle.

As I eliminated the allergens – wheat, sugar, MSG, processed foods, etc. – and filled my body with the nutrients that it was missing (i.e. through lots of vegetables, fruits, whole grains, and superfoods), within two months my body experienced dramatic healing. This was miraculous! It had never happened before.

Of course, it took about another year to see 90% of my skin heal – because so much damage had already been done. It took another while to see the last 10% heal (and trust me, that was the hardest part to heal!). I witnessed the power of food, as the greatest medicine that could cure my body.

Today, I am able to eat normal foods once again. I am also able to process toxins much better because I use great natural products for eczema – and I also feed my body the nutrients it needs on a daily basis.

(Source: http://www.primephysiquenutrition.com/how-i-overcame-severe-eczema-when-doctors-said-there-was-no-cure)

2

Diagnosing eczema

WHEN you have an irritating skin rash, the correct thing to do is visit a doctor to have your condition accurately diagnosed. The rash could be eczema, but it could also be another skin condition. Without the right diagnosis, it is difficult to get effective treatment to thoroughly clear up the condition. Many skin conditions that seem to resemble one another require completely different treatment procedures. If your general practitioner cannot give an accurate diagnosis, then visit a dermatologist.

WHEN SHOULD YOU SEE A DOCTOR?

Eczema is generally not a medical emergency and you may at times find relief in over-the-counter medication, skin creams and lifestyle adjustments. In any of the following instances, however, you should consult a doctor for more effective treatment:

•If the eczema has an adverse effect on your daily life, for instance your work is compromised, you cannot attend important events, your sleep is disrupted, etc.

•If over-the-counter medications, such as hydrocortisone cream, does not relieve the rash.

•If the rash is red, swollen and painful; if vesicles are formed, fluid is leaked and a crust develops; if you have a fever. These are all indications of an infection and require medical attention. It may even be necessary to check into the hospital’s casualty ward.

•If you have an impaired immune system, are suffering from medical conditions such as diabetes or HIV/Aids, if you have undergone chemotherapy or are over the age of 70, you should receive medical care at the slightest sign of infection.

If your doctor uses the term ‘pruritus’ during an examination, he is simply referring to the itch that accompanies eczema and other skin conditions.

Eczema cannot be diagnosed by means of a single blood test. The doctor will examine the rash and ask you a number of questions before making a diagnosis. Remember, there are numerous types of skin rash, and eczema – or atopic dermatitis – is only one of them.

But what does eczema look like and what