Eczema: Your essential guide. Regina Malan
it feels like to experience this disruptive condition. Only you know how much it itches, how painful and unsightly it is. You know how difficult it is to adapt your daily routines to accommodate your eczema. You know how terrible you feel when other people shun you and sometimes even look at you in horror. Eczema involves your body and your health. You, therefore, have the right to try to obtain as much information as possible from your doctor in order to improve your quality of life. The more you know and the better you understand the condition, the more effectively you will be able to manage it and prevent new acute flare-ups.
The questions you ask your doctor may involve matters such as the diagnosis itself, medication, alternative remedies and resources, the cost of medical treatment, and emotional issues.
A few questions you might ask your doctor:
•What is eczema? Tell me more about the condition.
•What is the difference between eczema and psoriasis? Is it possible to suffer from both?
•What is the best medical treatment for eczema?
•How long can I use the medication and what are the side effects?
•How soon can I expect to see results?
•Are there alternative treatment options available?
•What should I do if my symptoms worsen?
•What can I do to prevent future flare-ups?
You have the right to ask your doctor a lot of questions. Knowledge and information are the keys to enabling you to manage your eczema successfully.
•Does the sun play a role in my eczema?
•Do I have to modify my diet?
•Should I alternate my skin care routine according to the seasons?
•Do I have to see a specialist?
Eczema is in your genes and is thus an inseparable part of who you are. For the most effective treatment the right diagnosis is essential. You should also have all the relevant information made available to you. The aim of treatment is to control the condition to such an extent that you hardly ever experience symptoms.
Most doctors are sympathetic and understand the adverse impact of eczema on you and your life. There may, however, be exceptions and if you are not satisfied with the care provided by a particular doctor, be sure to consult another one. Because eczema is a long-term condition and will require frequent return visits to ensure effective management of the condition, it is very important to have a good relationship with your medical specialist.
Part 2
THE CAUSES OF ECZEMA
It is easier to diagnose eczema than to determine the particular triggers that cause the flare-ups.
3
How does the skin work?
Your skin is your body’s largest organ. The skin of an average adult comprises one to two square metres and weighs between three and four kilograms.
Your skin’s main function is to act as a protective barrier between your body and the outside environment.
ECZEMA is a condition that specifically targets the skin. Your skin is a living and vital organ. It is not a simple external layer that you can keep in good condition by occasionally applying body wash or cream. It is very complex and is affected by various other systems operating in your body, including the immune, hormone and digestive system. Problems manifesting on the surface of the skin may therefore signal imbalances and malfunctioning of one or more of the body’s systems.
THE SKIN’S BARRIER FUNCTION
Our skin forms a waterproof cover for our bodies. Beneath it there are bones, muscles, ligaments, nerves and internal organs, all of which are highly susceptible to infection from foreign microbes. Your skin thus acts as a barrier between these internal building blocks of your body and the external environment.
The skin also has several other functions:
•It acts as a sensory organ. A network of nerve cells in the skin enables us to feel cold, heat, touch and pain. If these nerve cells are damaged, the result is neuropathy, which means that our sensory capability – to experience pain, for instance – is lost in the damaged section.
•The skin controls our body temperature.
•It plays an indispensable role in the absorption of vitamin D from sunlight. At the same time, it blocks the penetration of harmful ultraviolet rays of the sun.
What happens in an eczematous skin?
Author Sue Armstrong-Brown explains the appearance of an eczematous skin in a simple way:
‘The skin develops little fluid-filled vesicles, like bubbles, which weaken its structure. Blood vessels in the lower layers of the skin (the dermis) swell, and blood cells that fight infection migrate into the skin, causing redness and itch.
‘Normal cell growth in the epidermis (outer skin layer) speeds up, causing cells to pile up and thicken the skin. The cells are smaller and weaker than healthy skin cells and the lubricating liquid between the cells, which helps to make normal skin flexible and waterproof, is disrupted.
‘Older cells build up on the skin’s surface, because the biological “glue” that holds them together stops breaking down and allowing the cells to be gradually shed. This results in the thick layer of dead dry skin at the top of the epidermis.’
(The Eczema Solution, pp. 13–14)
The most important function of the skin, however, is to act as a barrier against onslaught from the environment. Day and night, your skin is at work to protect your body. How does it do that?
It retains moisture inside the body and prevents excessive moisture loss. Unrestrained loss of body fluids would mean that our bodies, from our water-rich internal organs to the tiniest cells, would shrivel up and we would die.
Our skin further protects us from assaults from the outside environment, such as knocks and blows, temperature changes, the rays of the sun, poisonous substances, and chemicals and pathogens that may penetrate the skin and cause disease and infection.
If the skin is damaged – through continuous scratching, for instance – all its functions are affected. It then loses its ability to retain moisture inside the body, dries out and becomes less supple and elastic. An overly dry skin is particularly vulnerable to eczema flare-ups.
Why do we focus so extensively on the skin’s barrier or protective function? Because eczema is caused by a defect in the barrier function. This defect can in turn be ascribed to problems with the immune system. Eczema itself can lead to overstimulation of the immune system, thus damaging the barrier function even further.
A pathogen is any micro-organism, such as a bacterium or a virus, that can cause a disease.
THE LAYERS OF THE SKIN
We are better able to appreciate the nature and causes of eczema if we understand the structure of the skin.
Human skin consists of three layers (see Figure 3.1):
•Hypodermis. The bottom layer is the hypodermis, or subcutaneous tissue.
•Dermis. The hypodermis is followed by a living middle layer known as the dermis.
•Epidermis. The thin, strong, protective outer layer is called the epidermis.
The hypodermis or subcutaneous tissue
The hypodermis is a fatty layer deep in the skin that insulates the body against heat and cold and acts as a protective padding or shock absorber. The thickest part of the shock absorber is found on the buttocks,