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Medical Dermatology Conditions


What is Eczema

Eczema comes from the Greek term meaning “to boil over”. Thus Eczema is the term for a group of chronic skin conditions causing the skin to become inflamed or irritated. Eczema is also sometimes referred to as “atopic dermatitis” as the word “atopic” is Greek for hereditary allergy and “dermatitis” comes from the Greek work for “skin”. People with atopic eczema have an increased chance of developing other atopic conditions, such as asthma and hay fever.
Eczema often affects infants and children although some adults do develop eczema as well. At times, children who grow out of the disease often face it again in adulthood. Eczema ranges from mild (skin is dry, scaly, red and itchy) to more severe cases (weeping, crusting and bleeding). Eczema affects both genders although some people are predisposed to inheriting the disease if their parents have it as well.

Causes of Eczema

The exact cause of Eczema is not yet known. However, people with atopic eczema tend to have a reduced layer of the lipid barrier of the skin. This caused an increase in water loss and a tendency towards dry skin. Furthermore, an overactive immune system can cause the release of chemicals under the skin surface to respond aggressively to the presence of irritants on the skin, causing skin inflammation. Scratching of the skin inflammation leads to a worsening of the condition as it could cause an infection on the skin. Eczema is also commonly found in families with a history of other allergies or asthma.

An eczema flare-up (occurrence of one or more symptoms of eczema) can occur when triggered by these common factors –

  • Changes in the climate
  • Pollution
  • Allergies to dust mite or pollen
  • Skin contact with coarse or synthetic material
  • Skin contact with harsh soaps or detergent
  • Allergy to animal dander (material shed from animal’s body such as fur and skin cells)
  • Sweating
  • Stress
  • Food allergies

It is important to note that eczema is not contagious. It is not spread by any form of contact.

Types and Symptoms of Eczema

The different types of eczema are classified as follows:

Type of EczemaSymptoms
Asteatotic eczemaFissures or grooves on skin which look pink and red. Tend to only affect the superficial layers of the skin. Occurs mostly in patients above 60 years of age although it can affect young adults as well.
Atopic DermatitisDry skin condition that can flare-up and become red, sore and itchy. Usually found in faces and often affects creases in the body such as the neck, back of knees, the inside of elbows and wrists.
Contact DermatitisContact with skin irritants causes mild dryness and skin redness and the appearance of skin burns. It can be painful, red, fluid-filled and ulcerated.
Dyshidrotic eczema (Pompholyx)Blisters develop on the soles of feet and/or the palms of hands. The blisters are usually itchy and may be filled with fluid. Often comes with subsequent peeling as the skin dries out – the skin can become red and dry with painful cracks (skin fissures). Usually a seasonal allergy and flare-ups often appear during spring.
Nummular eczema (Discoid eczema)The appearance is distinct with ‘coin shaped’ slightly bumpy “discs”, usually on the lower legs, trunk or forearms. Within a few days the patches begin to ooze, and can become very itchy, crusted and infected. Eventually, the surface becomes scaly, and the skin dry and flaky. Usually affects adults.
Seborrheic EczemaThe skin rash appears on areas with a lot of sebaceous glands, hence the name. It usually starts on the scalp as dandruff that can progress to redness, irritation and increased scaling. As the disease progresses, the scalp becomes inflamed, which may then spread onto the face and neck. This usually affects adults and infants.
Stasis EczemaThe appearance is of scaling, open sores or itchy, reddish skin. Other symptoms include calf pain and swollen legs. This skin condition is normally develops in people with poor blood circulation, most commonly in the lower limbs. Pregnant women and overweight adults have a higher chance of developing this skin disease.

Treatments for Eczema

As most forms of eczema are caused by skin inflammation, steroid creams are usually prescribed for their treatment as they are anti-inflammatory. Besides steroid creams, non-steroid creams are also available; these are called topical calcineurin inhibitor (TCI) creams and are usually used in children above the age of 2. These creams are applied topically on the skin area where the rash forms and reduce inflammation while soothing the skin.

To cleanse the affected area and to remove whatever irritant is currently causing the irritation through contact, it is recommended that you use mild nourishing soaps, or synthetic soap substitutes. Do not use harsh soaps as these may cause further inflammation on sensitive skin.

Moisturizers must be used daily to build the protective skin barrier and reduce the chance of developing eczema. Moisturisers hydrate the skin and reduce itch, so you wouldn’t be tempted to scratch the affected area. Anti-itch medication in the form of anti-histamines can also be given to reduce the itch. Occasionally, a course of antibiotics is required if there is any evidence of skin infection. These antibiotics are usually taken orally and you must complete the course for them to be effective and long-lasting.

In very severe or extensive cases of eczema, oral steroids may be given. Phototherapy (UV light) is another treatment option for extensive eczema – should the eczema cover a large surface of the skin such as the torso or limbs. In some cases, oral immunosuppressive therapy with drugs such as ciclosporin, azathioprine or methotrexate may have to be considered by the dermatologist. These are usually prescribed only in severe cases.

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