Eczema: Your essential guide. Regina Malan
tion>
Eczema
Your essential guide
Regina Malan
Human & Rousseau
The layout in this digital edition of Eczema: Your essential guide may differ from that of the printed version, depending on the settings on your reader. The layout displays optimally if you use the default setting on your reader. Readers can experiment with the settings to have the text displayed differently.
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