What are the causes of eczema? Identify your eczema type and learn how to alleviate eczema.

According to data from the Hong Kong Allergy Association, nearly one in every five people in Hong Kong suffers from eczema at different times. If left untreated, it often leads to a decrease in the quality of life due to unbearable itching, and it can also cause depression and anxiety in patients.

In 2018, Hong Kong witnessed a tragic incident related to eczema when a recent university graduate used a knife to stab her parents before taking her own life. Her suicide note revealed that she had been tormented by eczema for a long time, leading her to despair. Today, we will take you through what eczema is, common treatment methods, and key points for daily care.

Types of Eczema

Atopic Dermatitis:

This is one of the most common types of eczema, often found in children but can occur at any age. The severity of symptoms and affected areas varies from person to person. In infants, eczema mainly appears on the cheeks, outer surface of the arms, and legs, and is less common on the back, abdomen, and chest. In children, adolescents, and adults with eczema, the most commonly affected areas are the back of the knees, inner elbows, and the back of the neck. The development of atopic dermatitis is complex and is often associated with genetics, immune system imbalances, and environmental factors.

Contact Dermatitis:

This refers to skin inflammation caused by direct contact with a substance. Rashes are only seen in the areas of skin that have come into contact with the substance, but in severe cases, they can spread to thicker or less exposed skin areas. Substances that cause contact dermatitis can be allergens or irritants. Allergens are related to the individual’s sensitivity to the substance and lead to skin inflammation upon contact. Irritants are caused by chronic or acute exposure to substances like cleaning agents or hair dyes.

Neurodermatitis:

Also known as lichen simplex chronicus, it is characterized by intermittent itching and thickening of the skin. Rashes can appear on the neck, wrists, forearms, legs, and around the anus. Stress, tight clothing (especially clothes made of wool or synthetic fibers), insect bites, nerve damage, and dry skin can trigger neurodermatitis.

Dyshidrotic Eczema:

Also known as pompholyx or vesicular palmoplantar dermatitis, this type is prone to occur on the palms, soles, fingers, or edges of the hands and feet, possibly causing a burning sensation, rashes, and blisters. It is often associated with skin contact with allergens or irritants like certain metals, especially cobalt and nickel, or some fragrances, laundry detergents, cleaning agents, and more. Excessive hand and foot sweating, prolonged use of latex gloves, or frequent wetting of hands during work can also trigger dyshidrotic eczema.

Nummular Eczema:

Also known as discoid eczema, patients develop circular or red patches on the skin, with papules, blisters, slight oozing, crusting, and scabbing. This is common on the limbs, such as the back of the hands, forearms, and lower legs. Triggers may be related to very dry or sensitive skin, as well as skin injuries caused by insect bites, scratches, or chemical burns.

Seborrheic Dermatitis:

This type typically occurs in areas rich in sebaceous glands, such as the upper back, nose, and scalp. Symptoms may include flaking, scaling, itching, and redness. The cause is often related to overproduction of sebum by the sebaceous glands, leading to an accumulation of Malassezia yeast on the skin. Additionally, immune system imbalances and hormonal changes can also trigger seborrheic dermatitis.

Stasis Dermatitis:

Also known as gravitational dermatitis, venous eczema, and venous stasis dermatitis, this is a skin inflammation that leads to chronic redness, scaling, itching, and swelling of the lower extremities. It often includes the deposition of dark brown skin pigments and is more common in patients with varicose veins and edema.

Common Treatment Methods for Eczema

Topical Creams:

When eczema flares up, doctors may prescribe non-steroidal or steroid creams depending on the severity of the condition. Steroid creams are the most commonly prescribed and are categorized into four classes based on their potency:

．low-potency

．medium-potency

．high-potency

．super high-potency.

The choice of topical steroids depends on the patient’s age, the severity of eczema, and the affected body parts. In most cases, low to medium potency steroids are sufficient to manage eczema.

How much steroid ointment should be used generally depends on how large an area of skin is affected. And we often use 1 “fingertip” as a unit to describe the required amount.

1 FTU is the amount of ointment or cream squeezed out of the tube along the last section of an adult’s finger, which is approximately 0.5 grams.

Non-steroidal topical treatments are increasingly used to reduce eczema flare-ups. Topical calcineurin inhibitors are a type of non-steroidal medication that works by blocking specific cells in the immune system from “activating,” preventing eczema symptoms. Another option is PDE4 inhibitors, which target phosphodiesterase 4 (PDE4), an enzyme responsible for producing various inflammatory cytokines within immune system cells.

Ways to soothe eczema

Wet Wrapping:

This method is mainly used for young children to wrap their entire body, or for adolescents on their limbs. Wet gauze bandages are applied to eczema-affected areas to prevent skin moisture loss, aid in the absorption of creams, and reduce itching. Wet wrapping is best done after bathing, moisturizing, and applying medication. Clean, preferably white, cotton clothing, cotton wrap dressings, or rolled gauze are used as the wet layer, while pajamas or sportswear serve as the dry layer. For eczema on the hands or feet, cotton gloves or socks can be used as the wet layer, with vinyl gloves or food-grade plastic wrap as the dry layer. This method requires patience and careful instruction to avoid the risk of bacterial infection or getting cold.

Phototherapy:

Phototherapy involves treatment with different wavelengths of ultraviolet (UV) light. It can be used for various forms of eczema in adults and children and helps reduce itching and inflammation. Phototherapy is typically used for widespread eczema or when local treatments alone have not shown significant progress, such as eczema on the hands and feet. The most common type of phototherapy for eczema is Narrowband Ultraviolet B (NB-UVB) light. Phototherapy is suitable for patients with moderate to severe eczema, aiming to locally control the skin’s immune response. However, this treatment often requires a considerable time commitment, as it involves multiple sessions per week, and may not be suitable for every patient. Moisturizing is crucial during phototherapy to prevent dry skin, which can lead to counterproductive results.

Oral Steroids:

In severe eczema cases, doctors may prescribe oral corticosteroids. However, these are usually a short-term solution and are not recommended for long-term use due to the risk of side effects, including high blood pressure, osteoporosis, weight gain, diabetes, and more.

Antihistamines:

Oral antihistamines can help reduce itching and improve sleep in patients with eczema, but they do not treat the underlying cause. They are often used at night to help manage itchiness.

Key Points for Daily Eczema Care

Moisturize:

Use a good-quality moisturizer regularly to keep your skin hydrated. Look for products that are fragrance-free and suitable for sensitive skin.

Avoid Triggers:

Identify and avoid triggers that exacerbate your eczema. These triggers can include allergens, irritants, stress, temperature changes, and certain fabrics.

Gentle Cleansing:

Use mild, fragrance-free cleansers and avoid hot showers, as hot water can dry out the skin. Pat your skin dry gently after washing.

Diet:

For some individuals, dietary factors may trigger or worsen eczema. Common culprits include dairy, eggs, nuts, and certain food additives. If you suspect certain foods are a trigger, consider keeping a food diary and consult with a healthcare provider.

Cotton Clothing:

Choose loose-fitting, breathable cotton clothing to minimize irritation and itching.

Stress Management:

Stress can worsen eczema symptoms. Practice stress-reduction techniques such as meditation, yoga, or deep breathing exercises.

Allergy Testing:

Consult an allergist if you suspect that allergies are contributing to your eczema. Allergy testing can help identify specific triggers.

Stay Hydrated:

Drink plenty of water to keep your skin hydrated from the inside.

Keep Nails Trimmed:

Keeping your nails short can help prevent skin damage from scratching.

It’s essential to work closely with a healthcare provider, such as a dermatologist or allergist, to develop a personalized eczema management plan. The treatment approach may vary depending on the type and severity of your eczema. Patience and consistency are key to managing eczema effectively.