Written by Dr Nomphelo Gantsho
If your skin is feeling tight, itchy or inflamed, dryness may very well be to blame. In fact, dry skin is a very common problem – one which is easily exacerbated by various factors such as cold weather, extreme heat, medication and harsh cleansers or soaps (amongst others).
Now, while most people suffer from periods of dry skin at some stage, there are those with persistent dry skin that can be predisposed to developing eczema. Eczema is a chronic inflammatory condition characterised by recurrent or persistent episodes of red, itchy, and dry skin.
It is believed that 10% of the population at any one time suffer from some form of eczema. Eczema and dermatitis refer to the same disease pathology – and while the terminologies are used interchangeably – for simplicity reasons, I will refer to the former to indicate either condition.
Eczema affects patients of all ages and ethnicities. The condition is most prevalent in children, however, it can persist into adulthood or make its first presentation in adulthood.
Eczema most often develops as a result of an allergic reaction, dysfunctional skin barrier, or an immune-system malfunction. And while the precise cause of eczema remains unknown, scientists have pin-pointed a very strong link between physical, environmental, or lifestyle triggers in eczema sufferers.
Eczema at work
This skin condition usually appears as a red rash on the skin, and can include the following symptoms:
- Raised crusty patches
- Dry or scaly skin
- Skin discolouration
Moreover, the itch-scratch cycle of eczema has been shown to lead to significantly lower quality of life (QOL) scores in individuals, as it disrupts their sleep and functioning.
Eczema is diagnosed by physical examination and patient consultation. Because many people with eczema often have other allergies, allergy tests may be prescribed or performed so that possible triggers can be avoided.
Different faces of eczema
Eczema takes on different forms, depending on the nature of the trigger and the location of the rash. While they all share some common symptoms – like itchiness – there are differences.
The following are some of the most common types of eczema in aesthetics:
The most frequent form of eczema, atopic dermatitis is thought to be caused by abnormal functioning of the body’s immune system, the lack of filaggrin (filament aggregating protein) and abnormal skin barrier. This protein helps shape individual skin cells, and plays an important role in our skin’s barrier function. If a person has a genetic mutation that prevents proper filaggrin supply, they can develop skin conditions such as eczema.
Atopic dermatitis tends to run in families, with atopy defining those with an inherited tendency to develop asthma, eczema and other allergic conditions.
Contact dermatitis is caused when the skin comes into contact with an allergy-producing agent or an irritant, such as chemicals.
Coming into contact with a trigger, such as wind or an allergy-producing fabric, launches the rash and inflammation.
Patients with eczema may have adverse skin reactions to many common products, such as soaps, cosmetics, perfumes, lotions, jewellery or detergents. These can cause irritation and inflammation anywhere on the body, but irritation is especially prevalent on the face.
In the case of allergic contact dermatitis, the key to successful management is identification and avoidance of the offending agent, which may be found in the patient’s make-up, moisturizer, or other topically applied make-ups.
This type of eczema strikes the palms of the hands and soles of the feet. It produces clear, deep blisters that itch and burn.
Dyshidrotic dermatitis occurs most frequently during the summer months and in warm climates, and can be as a result of contact allergy dermatitis. It can also be common in therapists due to the chemicals they use in practice.
Seborrheic dermatitis is a common condition that causes yellowish, oily, and scaly patches on the scalp, face, or other body parts. Dandruff in adults, and cradle cap in infants, are both forms of seborrheic dermatitis. Unlike other types of eczema, seborrheic dermatitis does not necessarily itch and tends to run in families. Known triggers include weather, oily skin, emotional stress, and infrequent shampooing.
Every patient is different, so specific treatments will vary. The best treatment for eczema may be prevention. By avoiding triggers such as certain soaps or detergents, patients may be able to keep outbreaks at bay.
One should also use mild cleansers and keep skin well moisturized at all times. Furthermore, one must avoid scratching the rash (which can lead to infection) and situations that make you sweat, such as strenuous exercise.
For mild cases, over-the-counter topical creams and antihistamines can relieve the itching. In persistent cases, a dermatologist will likely prescribe stronger medicine. The standard of care is topical corticosteroids to calm the skin, along with emollients and excellent skincare. Non-steroidal creams such as Elidel and Protopic are used to control the flares, but not to treat active disease. Sometimes phototherapy is also helpful, but in cases where the eczema is very severe, referral to someone who will prescribe stronger systemic immunosuppresants may be needed.
Issues relating to the aesthetic
The presence of eczema on the face may alter the use of certain treatments and cosmetics. It is additionally not unheard of for a reactive eczema to occur following an aesthetic treatment.
When dealing with eczema patients, one should also consider that chemical peels and other topical treatments that are designed to be irritant could likely worsen an eczema condition. This may then be classified as an allergy. These patients should, therefore, avoid alkaline soaps and products that cause frothing or ‘bubbling’ on the skin.
Where possible (and especially if abrasive treatments are to be used), administration on a non-cosmetic area of the skin (eg. the arm), can be useful in determining the skin sensitivity to such products.
Take home message
We must be ever more vigilant in our usage of cosmetic treatments in patients suffering from eczema and the challenges they present to our practice. The practitioner should be mindful of the fact that eczema is primarily a pathology stemming from loss of skin barrier function, and that any cosmetic treatment that compromises that barrier may well negatively impact the quality of the skin.
Most importantly, one must ensure that the patient is made fully aware, via verbal or, ideally, written consent, that skin which is prone to eczema has a higher likelihood of flare-up. If the patient wishes to proceed with an aesthetic treatment, they should be told to avail themselves of preventative measures such as emollient, antihistamine treatment and protection for the face.
Written by Dr Nomphelo Gantsho
BSc, BSc (Hons), MSc (Pret), MBCHB
- Fellowship: College of Medicine of South Africa (Dermatology)
- Dermatologist in private practice, with rooms in Century City, Cape Town www.capeskindoctor.com
- Executive Committee Member of SASDS, Secretary
- Member of DSSA
- Member of AWDS
- Member of DASIL
A2 Disclaimer: This article is published for information purposes only, nor should it be regarded as a replacement for sound medical advice.
This article was written by Dr Nomphelo Gantsho and edited by the A2 team EXCLUSIVELY for the A2 Aesthetic & Anti-Ageing Magazine Dec 2019 Edition (Issue 32).
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