By Professor Claudia Gray, Paediatrician and Allergist, Kidsallergy Centre, Pinelands, Cape Town
Eczema (otherwise known as atopic dermatitis) is a chronic itchy skin condition caused by many factors. The underlying cause is a disrupted barrier of the skin, usually due to genetic reasons. Several things can aggravate eczema, such as heat, sweating, illness, irritants, and in some cases, certain foods.
Eczema causes a very itchy rash, with red inflamed patches, often against a background of dry skin. Acute flare ups can be wet and weepy. Scratching is often unavoidable but in itself leads to the eczema flaring up more, leading to a vicious cycle (the “itch-scratch” cycle).
Eczema cannot be cured, but it can generally be managed very well. It may come and go over many years, but often is outgrown over time. In babies, eczema may affect the face as well as the body; in children, eczema often tends to affect the flexure creases such as the insides of the elbows and back of the knees and neck; in adults, hand eczema is more common.
Management of eczema by your allergist or dermatologist will include:
- Identifying and reducing triggers.
- Regular use of emollients, chosen carefully for each patient (special bland moisturisers).
- Avoiding soaps and scented products.
- Using anti-inflammatory agents such as topical steroid creams and ointments.
- Other creams with anti-inflammatory action, and occasionally oral drugs in the very resistant cases.
- Occasionally, hospital admissions for wet-wraps will be needed.
Is eczema caused by food allergies?
It is a common misconception that eczema is usually caused by food allergies. Indeed food allergies are far more common in eczema patients than in patients with a normal skin, but usually not the cause of eczema.
Up to 40% of patients with moderate to severe eczema have a food allergy of sorts, most commonly to eggs, peanuts and cow’s milk. This is more common in children with early onset eczema less than six months of age, and in those with severe, treatment-resistant eczema. However, in less than 20% of cases does ingestion of these foods actually lead to the eczema.
More commonly, these foods cause a typical immediate reaction in eczema patients, such as immediate hives and rashes, and even more severe reactions such as breathing difficulties. In the minority of eczema patients such foods actually cause eczema flares.
Blanket elimination diets are not to be used in eczema patients. Therefore, if the patient or clinician is concerned about a food allergy contributing to eczema, rather have a proper assessment by an allergist, who can determine exactly which foods may be involved.
Interestingly, although many people believe that food allergies cause eczema, which we have now learned occurs in the minority of patients, it is true that the opposite relationship is more common: eczema can cause other allergies such as food allergies and also respiratory allergies. This is because a broken skin barrier can let allergens through the skin and set up an immune response which can lead to allergies.
Therefore, effective treatment and prevention of eczema is an important step in trying to reduce the development of other allergies such as food allergies or asthma.
Why does eczema frequently flare up during summer?
Watch out for the S’s:
- Sun and heat
- Sunscreen (find one that suits your child’s skin; it may need to be a mineral sunscreen rather than a chemical one).
- Sand and sea: irritants such as the salt-water in the sea, sand and chlorine can really flare eczema.
- Sickness: any illnesses stress the immune system and often flare up eczema.
- Stress itself can be a cause of eczema flares, especially in adolescents and adults.
- Seasonal allergens: suffering from a grass pollen allergy can flare up the whole system during summer and thus contribute to eczema flares.
What can we do to protect our skins during the summer?
- Stay with your basic eczema care! This includes emollients and in some cases maintenance anti-inflammatory creams and ointments.
- Avoid, where possible, the obvious triggers such as heat and sweating, and avoid the sun during the midday hours when it is particularly harsh.
- Find an appropriate sunscreen that suits your skin (usually one for sensitive skins) and use it judiciously.
- Moisturise, moisturise, moisturise! Use a good quality emollient as often as possible, ideally twice daily or more.
- Ideally, shower after a swim in the sea of a swimming pool and then apply emollient to the skin. If the skin is particularly sensitive to salt or chlorine, apply a moisturiser before swimming too!
- You may have to step up the eczema treatment in times of sickness or when seasonal allergies are playing up. Also, remember to stay on top of your allergic rhinitis (and asthma) treatments.