Eczema is one of the commonest dermatological conditions which affects 1 in 5 people at some point of their lives. It is also called dermatitis and these 2 terms are interchangeable. Eczema can present in many different forms with “atopic” or endogenous eczema being the commonest. It presents often in childhood and in many cases continues lifelong. It is therefore classified as a chronic skin disease with no definitive cure but treatments are available to bring the condition under control.
The hallmark of eczema is a defective skin barrier in the upper layer of the skin called the epidermis. This together with inflammation in the skin gives rise to the clinical appearance of eczema. The skin has many functions one of which is providing a barrier against the environment. A compromise in the integrity of this barrier will lead to irritants and allergens entering the skin as well as loss of water and moisture. These 2 factors lead to dryness of the skin and an increased inflammatory response to the irritants and allergens as seen clinically with redness and symptoms of itching. In the acute or early phase of eczema the skin tends to be red, intensely itchy and in some cases associated with small blisters. As the condition becomes chronic (longstanding) the skin becomes more dry and in some cases slightly thickened and darker in colour compared to the surrounding uninvolved skin.
Eczema that appears as a result of an allergy (not related to concentration or frequency) to a material such as rubber in people who are allergic to plasters or gloves is called allergic contact dermatitis. When eczema develops as a result of irritants (relates to concentration and frequency) it is then called irritant dermatitis or irritant contact dermatitis. A common example of this is hand dermatitis (or hand eczema) as a result of excessive and frequent hand washing.
The treatment of eczema is composed of avoidance of irritants and allergens, restoration of the defective skin barrier through the use of moisturizers and soap substitutes, and in some cases a short course of steroid creams or steroid-sparing topical therapy that aims to control the inflammation. In severe and widespread disease some immunosuppression tablets are used. Long-term maintenance treatment is through the avoidance of irritants and the continuous use of moisturizers.