The Different Types of Eczema

Environmental eczema

Allergens or irritants in the environment can also cause eczema. Allergic contact dermatitis is due to skin contact with a substance that the sufferer is allergic to, such as perfume or nickel. In this case, a diagnosis can be made through a careful and detailed history and a patch test. Here, individual suspected allergens are applied to the skin in tiny concentrations and the point of contact is then observed for a reaction. Irritant contact dermatitis is due to repeated exposure of the skin to irritants. The most common irritant in our environment is water. Frequent exposure of the hands to water – as is the case with chefs and housewives – results in chapping of the skin. If the exposure continues, the skin of the hands becomes dry, inflamed and itchy and full-blown dermatitis develops. Apart from treating the inflammation of the skin, it is vital that the hands be protected from the excessive exposure to water by the judicious use of gloves for wet work.

These skin reactions can be managed with steroid creams, moisturisers, oral antihistamines and the avoidance of skin contact with the identified allergens or irritants.

Living well with eczema

Lifestyle changes are important in managing and preventing eczema. These good habits are helpful in preventing eczema from flaring up, or preventing the condition from worsening:

• Avoid excessive exposure to sunlight, particularly between 10am and 4pm. Use sunscreen and protect skin with hats, sunglasses and clothing
• Moisturise skin liberally at least twice a day after showers
• Maintain general health with adequate rest, exercise and a healthy, balanced diet
• Do not smoke as smoking is detrimental to skin health
• Manage stress well as eczema is often aggravated during stressful periods

Genetic eczema

Eczema due to genetic factors is known as endogenous eczema. This form of eczema is chronic and recurrent. Often, endogenous eczema sufferers may also have other hypersensitive conditions such as allergic rhinitis, allergic conjunctivitis or asthma.

Three of the most common sub-types of endogenous eczema are:

• Atopic eczema: This condition often starts in childhood and affects about 20% of school children in Singapore. The rashes are severely itchy, red, dry and scaly and can appear on the limbs, knees and elbows, as well as on the scalp, eyelids, ears, trunk, fingers and toes. In some cases, the affected skin becomes wet and weepy, or painful.
• Asteatotic eczema: This form of eczema causes cracking and mild peeling of the skin and typically affects older people. It is due to dryness of the skin which is a natural part of ageing.
• Discoid eczema: Discoid eczema causes circular red patches of little blisters or red spots that develop into pink-red, dry and scaly itchy patches. It tends to occur in young people and may be precipitated by insect bites.

The condition can be triggered by exposure to extremes of weather, excessive exposure to sunlight, dust, friction, harsh soaps and cleansers, and viral infections such as the flu and stress. Treatment involves a multi-pronged approach. Apart from avoiding aggravating factors and triggers, eczema sufferers should also take gentle and appropriate care of their skin. This includes avoiding long hot showers and opting for lukewarm quick showers instead, using gentle, soap-free shower cleansers and not scrubbing the skin. Regular application of moisturiser is essential. Mild eczema that is not extensive can be treated with steroid creams or antihistamine pills. In more severe cases, the use of light therapy (phototherapy) or oral medication that impacts the immune system, such as steroids, may be needed.