I have realised over the years while dealing with my daughter’s eczema that there are a lot of misconceptions and also lack of awareness about this condition in our society. Unlike in Western countries where it is very common, here in India, it is not. This leads to a lot of questions, doubts, stares and occasionally not so kind comments which we have faced as a family and my daughter has had to face on her own as well. I would like to highlight some basic facts about Atopic Dermatitis (which is one of the different types of eczema).
- Eczema is essentially a very dry skin condition where the skin lacks the protective barrier which is critical for retaining moisture and keeping out irritants, germs and other foreign substances. Atopic Dermatitis is a type of eczema which is quite common. It usually begins in infancy or childhood but can strike people at any age. It is also a highly individual condition and varies from person to person. The skin condition is usually very dry and can be scaly, itchy, inflamed in mild cases and crusting, bleeding and oozing in severe cases.
- Non contagious– Atopic Dermatitis is not contagious and affects only the person with this skin condition. This cannot be spread to another person through touch or in any other manner. This is one of the key areas of ignorance as far as eczema is concerned in our country.
NFM- natural moisturizing factor
Stratum corneum- portion of the outer layer of dead skin
Barrier lipid- natural skin oil and fat
- Moisturize! Moisturize! Moisturize! For people with healthy skin the skin serves as a strong protective barrier against infection or irritation and the fats and oils (lipid barrier) in healthy skin help retain moisture. Effectively the skin cells act as bricks and the fats and oils act as cement that keeps everything together just like a seal. Thus, a critical part of the treatment of eczema is fortifying the protective barrier of the skin by first getting water absorbed by the outer layer of the skin and second to seal the water before it evaporates. Sealing and retaining the water is done by using emollients ( moisturizers). I will be discussing this in further details in my subsquent articles.
- Symptoms– Some (but not all) of the common symptoms of eczema are as mentioned below–
- Broken/dry/cracked skin
- Many areas of the skin will be itchy and sometimes raw if scratched a lot
- Some areas may become red, inflamed, develop blisters and ooze liquid
- Scratching may result in thickened skin which usually returns to normal once scratching stops
- Although these patches of dry skin may occur anywhere, in Atopic Dermatitis they are usually located on the neck, behind the knees, elbow joints, ankles, wrists, face, hands, feet, arms and upper chest.
- Controlling eczema– People often ask me how I manage Aiyana’s eczema. She has had eczema since she was 1 year old, so we have been dealing with it for about 6 years now. There are some things that have worked for her and some that have not. The first line of treatment consists of emollients (moisturizers) which are used all the time and topical (applied directly onto the skin) cortisteroids or steroid creams as they are ususally known which are used on areas of the skin as required. When these measures fail to work the second line of treatment is prescribed which consists of antihistamines to control the itching; ultraviolet light therapy for children with severe eczema; immunosuppressants like closporine, azathioprine when other medications have failed; immunomodulators like Protopic and Elidel which are medicated creams to control inflamation and reduce immune system reactions and oral cortisteroids like prednisolone in extreme cases. We have had to apply both the first and second line of treatment for my daughter both of which I will discuss separately.
- Others– Since we have been dealing with Aiyana’s eczema for some time now, I have been able to incorporate a few other steps that have helped other children by interacting with their parents both online and personally.
- We have made some lifestyle changes