Fight The Flare Up: Everything You Need To Know About Eczema

Eczema is a genetic condition that causes dryness, flaking, and itching and it does not discriminate based on age. It affects children, adults, and the elderly. In India, the prevalence of eczema in children up to 16 years ranges from 3.1% to 7.21%, while in adults, it ranges from 2.1% to 4.9%. While there is no permanent cure yet, eczema is manageable and treatable. 

Eczema is a chronic, common, non-contagious skin condition related to inflamed skin. It is an umbrella term for seven different types of skin inflammations. People of all ages can develop eczema.

AD is the most common type of eczema and usually affects children but can also occur or flare up in adults. Symptoms typically affect the arms, elbows, knees, scalp, and cheeks. Sometimes, AD can cause vulval/groin itching.

As the name suggests, this starts when the immune system reacts to an irritant in contact with the skin. Similar to allergy, it takes about 48 hours for symptoms to show. 

Dyshidrotic eczema, or pompholyx, causes tiny, itchy, fluid-filled blisters on the fingers, toes, palms, and soles. Symptoms last two to three weeks. Triggers include allergies, humidity, metal exposure, stress, and smoking.

Neurodermatitis or lichen simplex chronicus causes thick, itchy patches all over the body. The cause of this eczema is unknown. Scratching aggravates the issue and may lead to infection.

Also called nummular eczema, this produces circular, itchy patches that can linger for years. It begins as tiny lumps and progresses into coin-shaped, flaky lesions. Dry skin and other eczema types may increase the likelihood of developing this.

Stasis dermatitis, frequently seen in people with impaired circulation, such as those with varicose veins, develops when fluid seeps from weak veins into the skin. This causes swelling, colour changes, itching, and pain, particularly in the legs and ankles.

Seborrheic dermatitis or seborrheic eczema produces scaly, oily patches in locations with a high concentration of sebaceous glands. It appears in infants as a ‘cradle cap’ but continues in teenage and adulthood. Stress, illness, hormonal changes, and harsh weather are all potential triggers.

Eczema develops as the by-product of an interaction between genetic predisposition and environmental factors. To elaborate further:

• Those with a family history of allergies, eczema, or asthma are highly predisposed to eczema.
• AD is commonly associated with a dysfunction of the filaggrin gene (FLG), which produces the protein filaggrin, which helps maintain the skin's barrier function.
• Eczema is linked to several immune response genes, including those that regulate T-cells, cytokines, and immunoglobulins.
• The compromised skin barrier in eczema makes the skin susceptible to allergens and environmental triggers, like heat, wind, cold, pets, sun, etc.  Even toothpaste and face wash can cause a flare-up.
• Studies suggest that people with eczema exhibit an overactive immune response to environmental stimuli, which results in inflammation and skin damage.

While the seven different types of eczema have differentiating symptoms, this inflammatory condition of the skin has certain telltale signs and symptoms:

• Opposing the usual process of an itchy rash, eczema is called the ‘itch that rashes’. It starts with an itch that develops a reddish patch due to compulsive scratching or rubbing.
• The itchy, dry, rough, flaky and irritated skin can flare up and subside unexpectedly.
• Symptoms may intensify at night, causing sleep difficulties. 
• Severe itching and red or grey patches can develop small ooze-producing lumps, crusty patches, thickened skin, and tender spots. 

The distribution of eczematous skin differs with age. Eczema in infants is widely scattered. There will be dry, scaly, and reddish skin patches with tiny peel-offs, particularly on the face, like on the cheeks. 

With age, the rash becomes more localised, affecting extremity surfaces such as the wrists, elbows, ankles and knees. School-going children often follow the pattern seen in adults, with flexural surface involvement as in the joints — inner knees, elbows, etc. 

Yes. Given the distorted skin barrier, eczematous skin is prone to bacterial, viral, and fungal infections. Additionally, it causes sleep troubles and aesthetic concerns and may precipitate asthma and hay fever later on in life.

There is no definitive curative therapy for eczema; however, certain preventions and management techniques may help tackle stubborn skin flare-ups. 

The first line of prevention of frequent flare-ups includes excluding all products used on the skin — overwashing, soaps, regular creams, salon procedures, makeup, and ornaments, if any. Dermatologists often prescribe steroids and immunosuppressant-based creams with tailored methods of use. They also advise ointments for the itch. 

Moisturising the unprotected, inflamed skin is key. Typically, no-fragrance, medically prescribed moisturising techniques work. Healthy eating, physical activities and good mental health with stress reduction protocols have been known to reduce episodes of eczema. 

Here are some tips from Dr Snehankita Chawdhry, MBBS, MD, DVL, and dermatologist. 

“Eczema is an interplay between genetic and environmental factors, and allergens. People with bronchial asthma, allergic rhinitis, and allergic conjunctivitis are more eczema-prone.”

Quick tips to prevent eczema flare-ups:

1. Take short showers (ideally less than 5 minutes) with lukewarm water and a fragrant-free mild cleanser, followed by dabbing the skin dry.
2. Apply a hypoallergenic moisturiser in downward strokes on damp skin immediately after bath and as and when skin feels dry or itchy.
3. Clothes and soft toys should be washed in liquid, fragrant- and dye-free detergents.
4. Wear loose cotton clothes and a layer of cotton clothes beneath the woollens to prevent woollens from directly touching the skin.
5. Keep the air conditioner settings at an ambient room temperature and humidity.
6. Use dust mite-proof upholstery wherever possible.
7. If eczema is recurrent and/or severe, consult a dermatologist for a prescription of oral and/or topical medications that help treat and reduce it.

While the internet is flooded with hacks on eczema care, understanding what causes the disease, minutely excluding the probable causative factors and managing it with a certified eczema specialist can make the ‘eczema journey’ easier. 

Eczema affects infants, schoolchildren and adults. Its presentations and management vary depending on the age.

Eczema is a non-contagious skin condition.

Even though eczema and autoimmune disorders have similarities, according to science, eczema is not an autoimmune condition.

Eczema rash develops due to itching. It is itchy, dry, rough, flaky, irritated skin that can flare up and subside unexpectedly.

In India, the prevalence of eczema in children up to 16 years ranges from 3.1% to 7.21%, while in adults, it ranges from 2.1% to 4.9%.