HOW TO TREAT ECZEMA OR DERMATITIS

 Dr. K S Prasanna, Dermatologist, Institute of Applied Dermatology, Kasaragod, Kerala

It was a depressing sight to see Shakeel, a 25-year-old man coming into the clinic, accompanied by distressed parents; while one would normally appreciate a person's agitation, or their shivers, his skin seemed to attract the gaze to its problems. It was peeling all over, bits and pieces coming off, dangling around, revealing a still immature, red skin underneath.  Scars marred his body, marks of his battle with the itch. Blood would leak from some scratches too intense for the skin. Seeing this, the receptionist immediately asked them to meet the dermatology nurse. She took a detailed history and did a general review of his vitals. During the history, the parents burst out "He has been working in the middle east for the past five years. He was fine, but six months ago, he began to itch and ooze all over his body. He has consulted many doctors. Last week, he told us that he couldn't take it anymore, and we told him to come back home and get an opinion from our doctor. We wanted him to get married around now, but who will agree? He was so handsome, but now… we can't bear this!" Our nurse brought him over to the doctor, and he made a diagnosis of exfoliative dermatitis, the kind where the whole skin begins to get shed. He started him on medications and asked for a weekly review. About a month later, when the symptoms had reduced, and he was able to well tolerate it, he was asked to get a patch test done as well, and the family readily agreed. The test was performed over a few days, and the culprit for the disease was discovered, much to everyone's delight. It was fragrance mix, which he must've been exposed to while working in the perfume shop. Armed with the knowledge about the cause, he began to avoid the mix and was able to pick up his life once more. A year later, he came back in proudly holding a wedding invite. He was no longer the broken man with a skin that shed; he was now quite regal, with radiant skin! The diagnosis of perfume allergy was not possible in Shakeel`s case without a patch test.

Eczema  or Dermatitis- Common Skin Allergy

This is a very common condition called Eczema or dermatitis. Eczema is broadly classified into 1. Endogenous (within the body)-E.g., Atopic dermatitis. 2. Exogenous – caused by external allergens like perfume, cement, rubber, etc. Exogenous is further classified into Irritant and allergic contact dermatitis. Allergy which is seen on the hands of ladies because of the soap etc is an irritant contact dermatitis.

Irritant dermatitis could be due to, acid (e.g., acid fly bite, commonly seen in children studying in hostels), alkali (bleaches, dyes, soaps, and detergents), metal(pesticides), solvents (dry cleaning), alcohol/glycols(cosmetics), detergents, disinfectants, food (garlic, onion, pineapple, vinegar)

 Allergic contact dermatitis could be due to so many chemicals which can be determined only by doing a patch test.

Common Symptoms of Eczema

Patients come to us with 1. Sudden onset of red, itchy, oozy lesions with swelling and pain over a particular area- Acute eczema.2 Long-standing, itchy lesions with thickening of area-chronic eczema 3. Sudden development of pain and pus discharge over long-standing thick, dark area/cracks over the feet-Acute over chronic eczema. Sometimes it starts in one area, slowly it progresses to another area and involves the whole body. Pt might give a history of touching a particular plant or things like cement before the development of itching in a particular area. Patients always come and say that the itching reduces, whenever they apply for the medicine, but it comes back whenever they stop applying the ointment.

Diagnosis and Treatment

The diagnosis of eczema is made by history and patch test. This test helps to identify the cause of an allergy. Blood investigation is necessary if there is an infection, or if the doctor wants to give oral steroids in case of eczema of the full body.

Treatment is avoidance of causative irritants in the home or workplace. Strategies in the prevention of irritant contact dermatitis include the identification of irritants with appropriate substitution, utilization of personal protective equipment such as gloves, special cloths, and barriers such as ointment, creams, and emollients. A moisturizer that contains ceramide can improve the barrier function. . In case of allergic contact dermatitis, once the allergens are identified, the patient should be given written information on all these chemicals. The information sheet should contain data regarding the name of the chemical and avoidance of these substances which contains the chemical including the diet. The patient should also be instructed on how to read the labels of any new or old products to avoid further exposure. Each time the patient wishes to buy a product, he or she should utilize an updated information sheet, because ingredients in a given product can change over time and place. After identifying the substance to which the patient is allergic, the most important step is to educate the patient regarding the names of allergen.

The doctor will treat you with antihistamines, topical, and sometimes with systemic steroids. Steroids are medicine like fire. Whenever necessary only it should be used and under the guidance of a doctor. The patient should completely avoid the allergen causing eczema. It may take 6 weeks or more to see complete and prolonged clearing even when the allergens are being avoided.