eczema

Ditch the itch

https://www.telegraphindia.com/1170717/jsp/knowhow/story_162231.jsp

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Your Health - Dr. Gita Mathai

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Itchy red rashes are irritating. If they appear frequently, they interfere with the quality of life. Around 10 per cent of children and three per cent of adults have periodic flare ups of rashes. This phenomenon is loosely termed eczema and it is assumed that the cause is allergies. Quite often, the symptom runs in families. Some members itch, others sneeze (rhinitis), or wheeze (bronchial asthma). Fortunately, if the symptoms start in infancy, there is hope. The child may outgrow the allergies by the time he or she is 10.

Any part of the body can be affected by eczema but it always starts with uncontrollable itching. A rash may follow. Scratching does not relieve the itch, it only perpetuates it and makes it worse. It may result in secondary infection and crusting. Once the eczema disappears, the area may remain hypo or hyper pigmented for some time.

The exact cause of eczema is not known. One theory is that because the skin is unduly sensitive, it cannot perform its barrier function efficiently. Rough clothing, detergents, soap, sweating, exposure to cold temperatures, pollen, animal dander, nickel in fashion jewellery, colouring in food, face powder, perfume, makeup, exposure to sunlight and even mental stress can cause a flare up. Sometimes eczema is not due to an allergy but is an itchy infestation of the skin like scabies. This causes symptoms that persist till the scabies is treated and cured. Varicose veins cause stagnation of blood in the lower limbs. This can also cause eczema till the veins are treated.

Traditionally, we give babies an oil massage before their bath. Usually we use coconut oil. It penetrates the skin and efficiently moisturises it. A mixture of 250ml coconut oil, 250ml sesame oil and 100ml paraffin, castor or olive oil is an even better moisturiser. Oiling the whole body for 15 minutes everyday (also in adults) and then bathing with a mild soap will help prevent eczema. Adding a teaspoon of salt and soda bicarbonate (baking soda) to the bathwater also helps. Applying coconut oil after a bath is counter productive as it attracts ants which bite, causing itching and scratching.

Most detergents contain chemicals such as sodium lauryl sulphate, which remain behind in small quantities in the clothes despite rinsing well. They penetrate the skin when sweating occurs, aggravating eczema. Commercially available "hypoallergic" or "doctor tested and recommended" detergents have not been ratified or proven to be safer. It is preferable to use non-allergic soaps made from neem oil. They are marketed in India by the government-run chain of Khadi stores.

Treatment of eczema is an ongoing process that involves enjoying remissions and tackling sudden exacerbations. Known allergens should be consciously avoided. The skin should be moisturised regularly before a bath and after, when it is still damp. Non-staining preparations like paraffin oil and ointments with paraffin wax are efficient and inexpensive. Low dose one per cent steroid creams can be applied for short durations if moisturisation is not enough.

The itch, scratch, itch cycle has to be broken. Application of cold compresses to the itchy area reduces the desire to scratch. Antihistamines will reduce the itch. The newer non-sedating anti-histamines can be taken during the day too.

Adults (except pregnant women) and children over the age of two who do not respond to the above measures can be treated with prescription creams containing immunomodulators like pimecrolimus or tacrolimeus. These potentially increase your cancer risk with long-term use. So be careful of that.

Dr Gita Mathai is a paediatrician with a family practice at Vellore.
Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

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