Eczema

What is eczema?

Eczema is a common inflammatory itchy condition of the skin. It is due to a combination of genetic and environmental factors. Many people with eczema have a family history or a history of asthma or rhinitis. Certain environmental factors can trigger or worsen eczema such as heat, sweating, dry weather, stress and sometimes certain foods.

There are different types of eczema. Atopic eczema is the commonest and typically affects the folds of the body, the face and neck. Seborrhoeic dermatitis typically affects the scalp, eyebrows, sides of the nose and ears. Discoid eczema looks like oozy coin shaped patches and are often on the arms and legs. Hand and feet eczema may appear as scaly patches or small blisters on the fingers and toes (pompholyx). Asteatotic eczema is caused by dry skin and leads to scaling and cracking on arms and legs. Stasis eczema is caused by poor venous circulation in the legs, resulting in pigmentation and dryness on the ankles, sometimes associated with skin ulcers.

What is the treatment for eczema?

Eczema may be difficult to cure but it can be effectively controlled in many people. The treatment involves avoiding any environmental triggers, relief of itch and inflammation, treating any infection and moisturising the skin.

Topical medication include topical steroids, immunomudulators e.g. Elidel® (pimecrolimus), Protopic® (tacrolimus), and phosphodiesterase inhibitors e.g. Staquis® (crisaborole).

Systemic medication include antibiotics for infected eczema, antihistamines for itch relief, and short term oral steroids for severe acute eczema.

Phototherapy with special ultraviolet light (UVB or UVA)  is an option for extensive eczema. Patients will require multiple regular sessions with specialised equipment usually in a tertiary centre.

Immunosuppressants are sometimes prescribed for severe recurrent eczema. These include methotrexate, azathioprine and cyclosporin. Blood test monitoring will be required.

Biologics such as Dupixent® (dupilumab) is indicated for moderate to severe atopic eczema in children (6 months and above) and adults. Blood test monitoring is not required.

Janus kinase (JAK) inhibitors are a new group of oral medication for severe recalcitrant cases of eczema. These include Cibinqo® (abrocitinib) and Rinvoq® (upadacitinib). Blood test monitoring will be required.

Your dermatologist will need to assess the severity of your eczema and discuss all options with you before recommending the most appropriate treatment for you. If an allergic component is suspected, allergy testing or patch testing may be recommended.