Eczema / Dermatitis

Do you have red, itchy, inflamed skin or what looks like an itchy rash that won’t go away? We know how irritating it can be! Come and see us at Wellington Dermatology if you suspect you have eczema / dermatitis of any kind – we can help! So what are typical triggers, and how can eczema be treated…

What is Eczema?

Also known as dermatitis, eczema is not contagious, and is essentially skin inflammation. There are several types of eczema, each having different causes and appearance – some eczema itches or burns, while others are barely noticeable. If the skin is itchy, red, flaky or weeps it is usually a clear sign of eczema. In New Zealand, the following types of eczema/dermatitis are common:

seborrhoeic eczema / seborrhoeic dermatitis
atopic eczema / atopic dermatitis
contact dermatitis

In principle, eczema can arise anywhere on the body, but seborrheic dermatitis often occurs on the face and scalp, and if it is hand eczema, it is often a contact dermatitis.

(See also Psoriasis)

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Eczema Causes

Eczema is inflammation of the skin. Inflammation is a sign that the body is fighting against something. These can be pathogens such as viruses, bacteria or fungi. But certain substances, allergens and even psychological influences can stress the skin so much that it sets its defence mechanisms in motion.

How it comes to this inflammatory reaction is different from eczema to eczema, and in part, not yet clear. In most cases, several influences are involved in the development of eczema.

Among the possible triggers of seborrheic dermatitis are

an infection with yeasts or staphylococci,
oily skin and
a weakened immune system.

An atopic eczema is also caused by an interaction of several factors. Some important triggers are:

Genetic predisposition: a family history of eczema is common amongst patients,
a somehow altered immune system, as well as,
psychological stress.

Physicians used to mistake the rash for a nerve inflammation, which is why the disease is also called “neurodermitis” (Greek neuron = nerve, derma = skin, inflammation= -itis).

Contact dermatitis can occur when the skin comes into contact with harmful effects such as UV radiation, high or low temperatures, and/or certain substances. Even harmless substances can cause contact dermatitis if the skin reacts with a hypersensitivity reaction. In this case, it is a so-called allergic contact dermatitis.

What does Eczema look like?

The exact nature of the eczema, the location on the body, and whether it is accompanied by other symptoms, depends on the type of eczema that is present.

Seborrheic eczema is greasy, sharply demarcated, scaly patches of skin that usually do not itch. They usually appear on skin with many greasy glands. Many of these so-called sebaceous glands are located in the head and facial skin, which is why eczema on the face and eczema on the scalp are usually seborrheic dermatitis.

Atopic eczema can look like dry, reddened patches of skin that cause intense itching. The area of skin on which it is located depends on the age of the person affected.

When infants have atopic dermatitis, it mostly shows on the outsides of the arms and legs as well as on the face. In children, adolescents and adults, the atopic dermatitis causes so-called flexural eczema, which mainly forms behind the knees and in arm-bends, and on the hands, neck and other parts of the body, and might be partially crusted.

Contact eczema can look very different. The appearance depends strongly on which substance caused the eczema. Characteristic of contact dermatitis is that they occur only at skin sites that have come into contact with the triggering stimulus.

Allergic contact dermatitis, on the other hand, can trigger disseminated secondary eczema, which means it spreads out from the point of contact. In addition, allergic contact eczema is usually itchy.

Eczema Treatment

The dermatitis treatment needed depends on the type of eczema.

Eczema cream

Eczema cream or lotions with anti-inflammatory drugs (glucocorticoids) can help against toxic and allergic contact eczema in the short term. In the long term, however, these eczema disappear only when the patient avoids the trigger – i.e. the allergen or the pollutant. Certain topical glucocorticoids can be used successfully in the long term for atopic eczema, too. Using the right moisturizer continuously is very important in the treatment of atopic eczema.

Phototherapy

Both UVA-1 and UVB therapy is good for eczema due to its anti-inflammatory effect. Phototherapy is normally delivered using light machines that provide a safer more predictable exposure to either UVA-1 or UVB. UVA-1 therapy is not available in New Zealand and most forms of phototherapy are narrow band UVB. This is indicated for second-line treatment for more widespread forms of dermatitis and can be easily arranged at Wellington Dermatology.

Eczema Medication

Systemic treatment (oral therapy/pills) is warranted for more severe forms of eczema covering large areas of the body or for acute flares of dermatitis. They are not an eczema cure, but provide good control for more severe forms. The most common systemic treatments used are:

Glucocorticoids (only short term!)
Methotrexate
Cyclosporin
Azathioprine
Mycophenolate mofetil

While these are effective in more severe forms of eczema, they can cause some side effects and issues associated with their use. It is best to talk about these with your dermatologist to find out which is the most appropriate for your eczema.

Injectable treatments (biologics)

Biological agents are relatively new in the treatment of severe forms of eczema. They are more targeted therapies at modulating the immune system causing eczema and are normally used in patients who are resistant to the above therapies. There is currently only one biologic for the treatment of eczema: the drug dupilumab. However, this drug is not approved or funded in New Zealand at this stage.

Seborrheic dermatitis

Seborrheic dermatitis can be treated with creams or shampoos, which counteract the fungal attack. Frequently, this eczema improves on its own in the summer, but often occur again and again – especially in winter.

Eczema Summary

Eczema remains a common condition, which is sometimes hard to control. Treatment for severe eczema can include certain systemic drugs and anyone with severe eczema should consider seeing a specialist dermatologist like ourselves regarding suitability for this type of therapy.

Wellington Dermatology specialists offer expertise in the different range of eczema treatments and can advise you on what treatment is best for your type of eczema. Contact us today to make an appointment, and get some relief!