A brief overview

ECZEMA

Eczema (otherwise known as atopic dermatitis) is a chronic itchy skin condition of “multifactorial” origin, which means that many factors contribute towards it. The underlying problem is a disrupted barrier of the skin, usually due to genetic causes. Many factors 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 tends to affect the flexural 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 will be individualized by your allergist and/or dermatologist. Management 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/ointments
  • Other creams with anti-inflammatory action, and occasionally oral drugs in the very resistant cases
  • Sometimes admissions for wet-wraps will be needed.

IS ECZEMA CAUSED BY FOOD ALLERGIES?


It is a common misconception that eczema is caused by food allergies. Indeed, food allergies are far more common in eczema patients than in patients with a normal skin, but are 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 egg, peanut and cow’s milk. This is more common in children with early onset eczema less than 6 months of age, and in those with severe, treatment-resistant eczema. In less than 20% of cases does the ingestion of these foods lead to the eczema. More commonly, these foods cause a typical immediate reaction in eczema patients, such as hives and rashes, and maybe even more severe reactions such as breathing difficulties. In the minority of eczema patients such foods actually cause eczema flares.

Certainly, blanket elimination diets are not to be used in eczema patients. Therefore, if the patient or clinician is concerned about food allergy in 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.

Copyright © Claudia Gray 2018

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