As a doctor with an interest in primary care dermatology, I attend to eczema patients daily in my clinic. Although eczema is common, many still find it hard to differentiate atopic eczema from other skin ailments. Hence, I wish to write about atopic eczema, addressing all you need to know about atopic eczema, and answering some frequently asked questions.
What is atopic eczema?
Eczema refers to inflammation of the skin. Some doctors may describe it as dermatitis, sensitive skin, skin allergy, and inflamed skin. On the other hand, atopic or atopy describes the genetic tendency to develop a group of hypersensitivity conditions, namely eczema, asthma, or rhinitis. When both words are side by side, atopic eczema refers to skin inflammation in people with a genetic tendency to hypersensitivity.
How does it present?
This condition causes a dry, itchy, inflamed skin rash. It often presents in infancy and childhood but can also occur for the first time in adults. Infants often have a rash on the face and limbs. Older children often have rashes over their skin over the elbow bends, back of the knees, and neck. Skin inflammation may also occur around the lips, eyes, hands, and feet.
Mild cases presents as a dry, red, and itchy rash. In severe cases, there may be oozing, crusting, and bleeding. Itchiness is the main symptom, which can disturb sleep, causing tiredness, irritability, and poor growth in children.
What are the causes?
While the cause is not fully known, we do know that genes play a role. An imbalance in the body’s immune response may play a role in the development of eczema. The immune system in such patient over-reacts to harmless substances or conditions. Dust mites, animal danders, soaps, fragrances, and detergents are common triggering factors. In addition, impaired skin barrier function in a patient with eczema also predispose them to external allergens and increases the risk of skin infections.
What makes eczema flare up?
1) Environmental allergens (heat, dust, or pets)
2) Irritants (soaps, detergents, sanitizing liquids)
3) Dryness of skin
4) Being unwell (having a cold or flu)
5) Skin infections
6) Food allergens
Can I spread eczema to my spouse or people close to me?
No, this condition is not infectious. You cannot spread it to other people. Eating, staying, and working together or sharing the toilet doesn’t cause the spread it.
Can atopic eczema be cured?
At present, there is no absolute cure. Childhood eczema tends to improve or clear as the child gets older. However, the the skin rashes may still occur on and off, even in adulthood.
What is allergic testing? How can it benefit me?
Knowing what you may be allergic to can help you avoid them and reduce the chance of an flare up. There are a couple of methods you can choose to get tested. Among the test done in Malaysia include skin patch tests or skin prick tests and allergen-specific IgE testing.
Treatments commonly prescribed for the condition include moisturizers and topical creams. Steroid creams can reduce skin inflammation. They are safe if used appropriately. Steroid-free creams, such as tacrolimus and pimecrolimus, are also available to treat atopic eczemas.
More severe or widespread condition may require systemic treatments such as antibiotics, short-course steroids, or antihistamines.
Severe chronic cases of atopic eczema may require phototherapy or biologics.
Newer breakthrough treatments such as immunotherapy  (Sublingual Immunotherapy, SLIT) may be the only solution that treats the origin of the disease. Immunotherapy helps to desensitize our body’s immune system to a particular allergen. I have seen remarkable result and receive many patient’s positive feedbacks for this treatment. Good compliance is crucial to ensure the effectiveness of immunotherapy.
: Mastrandrea F, Serio G, Minelli M, Minardi A, Scarcia G, Coradduzza G, Parmiani S. Specific sublingual immunotherapy in atopic dermatitis. Results of a 6-year follow-up of 35 consecutive patients. Allergol Immunopathol (Madr). 2000 Mar-Apr;28(2):54-62. PMID: 10804094.