Medical Chronicle November/December 2013 | Page 56

DERMATOLOGY

DR RAKESH NEWAJ
Specialist Dermatologist, Intercare Irene, Centurion and Arwyp Medical Centre, Kempton Park

ECZEMA - Education is key
The prevalence of eczema has more
than doubled in the past 40 years.
Though it is one of the commonest
diseases in a medical practice, very
little emphasis is laid on it at medical
schools. The term ‘eczema’ is usually
interchanged with the term ‘dermatitis’,
which basically denotes an inflammation of the skin, however, one should be
careful, as dermatitis may be used with
other diseases of the skin. Eczema is
not a homogenous disorder and there
are many different subtypes (see Table
1). Although in most cases clinical
diagnosis is straightforward, in a few,
the diagnosis needs to be confirmed
on histology. Typically, a rash with
erythema; dryness and scaling; and
pruritus, is in most likelihood eczema
(apart from seborrhoeic eczema that is
less pruritic).
Table 1: Eczema subtypes

Atopic eczema
Seborrhoeic eczema
Discoid (nummular) eczema
Pompholyx (hand and foot) eczema
Juvenile plantar dermatosis
Lichen simplex
Varicose eczema
Contact dermatitis

function of the stratum corneum. It is
inherited as autosomal dominant with
incomplete penetration and in some
cases is associated with asthma, allergic rhinitis and urticaria.

Presentation
The typical presentation is that of a
child of about three months of age,
with a dry, erythematous and pruritic
rash on the face, trunk and flexures.
With time, the scalp and whole body
surface may be affected, which can
make it difficult to differentiate from
seborrhoeic eczema. Atopic eczema
less commonly, can also start in
adulthood or during pregnancy and
can be very persistent. As the person
scratches, there is thickening of
the skin (called lichenification) and
oozing of clear fluid may be noted.
There may also be post-inflammatory
hyperpigmentation as well hair loss in
severe involvement of the scalp. Later,
the excoriations can lead to bacterial,
viral or fungal infections. The disease
typically varies with time and tends
to worsen during stressful times,

teething, change in weather pattern or
during an unrelated illness.

Treatment
The treatment should be tailored
according to the presentation
of the patient. It is not always
straightforward, as there are various
degrees of the diseases as well as a
few complications that may need to
be addressed first. The dryness, the
eczema itself, the degree of scratching,
the presence or absence of infection
and the extraneous psychological and
social facto