Eczema: A huge skin pain to families

By Dr. Ronald Katureebe

Mothers and fathers as well plus other caretakers often endure long sleepless and scary nights when the children under their care develop Eczema.

Lindah a mother of two young school going children has endured a number of sleepless nights that started as itchy irritated skin for one of her children.

“The itchiness got out of hand as my 7 year old son  Jerome lost all the peace he had as a result of scratching himself continuously through the night making it a very uncomfortable and sleepless night for us all” she says.

I had some pain killers in the house that I tried to give him to relieve the itchiness till morning when we could go and see a doctor but there was little difference.

What is Eczema?

Eczema scientifically known as Atopic dermatitis is an inflammatory skin disease that is very common in children over 6 months through to their teenage years.

Dermatologist Dr. Ronald Katurebe the Lead Consultant at Kampala Dermatology clinic Bugolobi says that this condition usually manifests with dry skin, very itchy patches and it occurs in about one of every 5 children. 

Generally those with extremely dry skin which stays looking pale even when Vaseline or lotion is applied are likely to get this condition at one point.

However Dr. Katureebe notes that 60% of children outgrow this condition by the time they are the teenagers. 

What causes Eczema?

This Inflammatory condition emanates from the natural barrier of the skin itself being defective. It does run in families which implies that one has the genetic predisposition to get it if a relative or family member has it. 

Dr. Katureebe says that ideally the skin barrier is supposed to prevent harmful external materials from getting in while also keeping water inside from escaping. 

Normal skin as a result has tightly packed skin cells that help keep water in and prevent dryness while preventing allergens and irritants from getting through.

However in the case of some one suffering from Eczema Dr. Katureebe notes that their skin is open which leads to water escape, dryness and the barrier is compromised allowing allergens, irritants and micro organisms to get in and inflammation occurs as a result of the body trying to fight off these foreign bodies.

The inflammation is the reason the itchy red patches and rash occur as symptoms.

Conditions that facilitate Eczema

First is the genetic factors which predispose one to catch Eczema based on family history of the condition being present in the family lineage.

Secondly Dr. Katureebe notes that environment does play a big part too in one getting Eczema. “ In urban areas with pollutants that irritate the skin, you find this condition occurring more commonly there.”

 Other factors include diet, and weaker immune systems that become hyper sensitive to every attack.

How does Eczema manifest?

In young babies the patches often times occur on the cheeks and for those over 2 years it shows up around the elbow joints, behind the knees, neck and armpits.

However when it is widespread it can affect all other parts too.

What may trigger Eczema?

Skin irritants like soaps, detergents, aero allergens ( from the air), grass, pollen, animal fur and dust mites will cause sensitive skin to react according to Dr. Katureebe. Synthetic clothes also trigger Eczema especially on the back for those with sensitive skin he notes. 

Fabric softeners, stress, weather changes, food allergens especially skin reactions to animal proteins from milk, meat eggs and ground nuts can all be triggers.

Complications associated with Eczema

Dr. Katureebe emphasizes that Eczema is not a fatal condition but can cause significant morbidity (sickness). The condition is not curable but can be managed and controlled.

In some cases he notes that the patches can get secondary infections usually bacterial or viral and this occurs in about 50% of Eczema cases.

It is not infectious and with treatment one can live a symptom free near normal life with the condition.

However it is often a big challenge and distressing as the scratching and irritation means sleepless nights for both parents and children.

It also means isolation at school because the patches can look really terrible in some cases resulting in missed school days for the children and missed work days for the parents too leaving families strained and stressed as a whole.

Treatment of the Disease

One should avoid the triggers for the irritation and reaction for a start. 

Maintaining the skin barrier using the right moisturizer to help maintain the barrier, the moisturizers have to contain the right emollients. 

Eczema is also linked to other conditions like Allergic Rhinitis and Asthma, it is sometimes referred to as ‘Asthma of the skin.’

Dr. Katureebe says the rash when it flares is treated using medicated creams called steroids, these clear the inflammation. This treatment should take not more than 2 weeks.

 Prolonged use of these has side effects and should only be prescribed by a medical professional in special circumstances he adds.

In severe cases systemic treatment is used and this according to Dr.Katureebe includes Immuno suppressants and other regimens.

Eczema can also affect adults and there are a number of variants including Nummular Eczema, Dishydrotic Eczema, Asteatotic and Statis Eczema which are seen in adults and the elderly as well.

The Author is a Dermatologist at Kampala Dermatology clinic Bugolobi

Email: rmkatureebe@gmail.com