- Eczema is an unbrella term for non-contagious inflammatory skin conditions.
- Different types of eczema affect different parts of the body and can be caused by contact or other factors
- Environmental factors, fabrics, allergies and sweat can all affect eczema reactions.
Our skin is what we show to the world and what connects us to people. It’s easy to take the importance of your skin for granted when you don’t have to worry about it. But people with eczema don’t enjoy that privilege.
Take Senzi Ndlovhu*, for instance.
“I have very bad eczema on my face,” she says.
“It sometimes bleeds and leaves my skin looking disgusting. When it gets this bad, my self-esteem plummets, and I don’t want to live. I walk among pretty girls with perfect skin, some with make-up on, and I find myself hating them for not realizing how lucky they are to have rash-free skin.”
Another patient, Gugu Mvimbi*, explains, “Even when it’s not there, when I’m not having a flare-up – when the skin becomes inflamed, very itchy and red – I am thinking about the next time it will happen. It leaves me feeling anxious.”
What is eczema?
The word ‘eczema’ is an umbrella term for a number of skin conditions, but it mostly refers to a common, chronic skin disease called atopic dermatitis, also known as atopic eczema. It is a non-contagious inflammatory condition characterised by intense itchiness, dry and inflamed skin, and scaling.
Atopic dermatitis is complex because its underlying causes aren’t always known. Dr Fatema Thawer-Esmail is a consultant at University of Cape Town’s division of Dermatology and the recipient of the UNESCO-L’Oréal award in sub-Saharan Africa. She says the disease has multiple causes, including genetics, the environment, allergens, irritants, infections and the immune system.
“All these factors play a part in generating the disease in a patient,” she says.
Dr Mohinie Moodley, a specialist dermatologist based at Kingsway Hospital in KwaZulu-Natal, says eczema has been on the rise worldwide over the past 15 years.
“Research done on atopic dermatitis has found that it’s usually an inherited disorder that’s associated with a family history of asthma, hay fever and eczema.
“It’s been found that 50 percent of atopic dermatitis occurs in the first year of life of a child and the rest within the first five years of age, while adults can have it by the age of 30. There is a 25 percent chance that eczema will persist from childhood into adulthood and a 50 percent chance that a child will have eczema if one parent has a history of it. The percentage rises to 79 percent if both parents are affected. So genes play an important role.”
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The disease affects men and women, dark and Caucasian skin alike, although Dr Mohinie has found it to be more common in Indians and Africans.
“Studies show that eczema may be due to a problem with the skin barrier,” she says.
“The problem arises from a defective lipid in the epidermis that renders the skin unable to retain moisture. We need an intact skin to prevent water loss from our epidermis. A major feature of eczema is dryness of the skin.”
Dr Fatema adds, “The latest discovery is that of the Filaggrin gene, which maintains a normal skin barrier function. A genetic defect of Filaggrin dries out and weakens the skin, making it vulnerable to germs, foreign bodies and allergens.
“In babies and young children, eczema can appear on the face, elbows and knees. In older children, it often affects the flexures (body creases). In adults, it tends to be more localised, affecting the hands, nipples and eyelids. It affects different people in different ways.”
Eczema can be acute (wet, weepy, red and crusted) or chronic (thickened, dry, scaly skin with increased skin markings and varied colour changes).
- Contact eczema is caused by being exposed to something in the environment, like chemicals in the production and manufacture of products such as rubber, leather, cosmetics or perfumes.
- Seborrhoeic dermatitis mainly affects the seborrhoeic or greasy areas of the body such as the scalp, central face, body folds, arm pits and groin.
- Nummular eczema presents well defined and very stubborn plaques of eczema, often on the limbs. The cause is unknown.
- Napkin eczema occurs in the nappy area and is due to a combination of seborrhoeic eczema and irritant eczema.
- Xerotic eczema occurs when people get older and the oil secretion by oil glands is less. The quality of the epidermal barrier decreases after 55 years.
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Triggers and tips
Different factors aggravate eczema. The triggers are varied, depending on the individual, and include:
- Allergens: Pollen, house dust mites or pet fur.
Tip: Keep pets outside and keep your house well ventilated. Avoid giving children stuffed toys as they collect dust and harbour dust mites. It’s best to have no carpets or rugs. Change your bed linen regularly.
- Irritants: Cleaning detergents, soaps, shampoos, bath oils, fragranced lotions, perfume, cigarette smoke and solvents.
Tip: Switch to fragrance-free, gentle glycerine soap. Avoid fabric softeners, perfume, bubble baths and oils.
- Food allergies: “The role of food in atopic eczema is complex and controversial,” says Dr Mohinie. “Food isn’t a common cause of eczema in adults, but food allergies in children may be associated with cow’s milk, eggs, wheat, peanuts and soya.”
Tip: Johannesburg-based dietitian Faye Harrison says, “Probiotics, which are essentially ‘good gut bugs’, have shown promise in managing eczema in children. Our gut is a barrier to the outside environment.
“When foreign particles enter our body, the immune response is elicited and bodily tissues like the skin may be damaged in the attack, giving rise to eczema. It’s thought that probiotics help to reduce eczema by lining the gut and enhancing the immune system, thereby preventing foreign particles from entering the body.
“Foods that are good for the skin include water, as it prevents dehydration, and fruit and vegetables high in antioxidants, which prevent skin from being damaged, and high in omega-3 fats.”
- Fabrics: Synthetic fabrics and rough clothing.
Tip: Wear 100 percent cotton clothing and other natural-fibre clothing. Avoid tight clothes, polyester and scratchy fibres like wool, which irritate the skin.
- Sweat: Too much heat and sweat can make your skin itchy and irritated.
Tip: Exercise in a cool environment like the gym.
- Environmental factors: Extremely cold and dry conditions in winter dry out the skin, while hot and humid conditions in summer also affect your eczema.
Tip: With heaters in winter, put water in front of the heater so the air is humidified. Use air conditioning in summer. The ideal temperature is 19 to 20 degrees.
*Not their real names
