QUESTION I am 54 years old, have not had any serious illness or operations, am reasonably fit and generally feel well. At the end of 2011, however, little red spots started to show on my legs and I thought they might be fleas or ticks but pathology tests indicated it is eczema.
The typical presentation is reddish, inflamed skin with the associated itch. First red pimples, then itching, then after the compulsory scratch the whole area flares up. My lower legs, especially the shins, look like they were severely burned. The skin dries out, peels and the itching goes on.
My lower and upper arms have this to a lesser extent. They are not as red as my lower legs, but still itch, especially the upper arm. Sometimes the lesions are wet, but in most cases they dry out and the skin peels off.
I am frustrated because I cannot find the trigger and cause. How much of a role does my diet play? Do I need to stop using sugar, dairy products, meat, eggs, or anything else.
I cannot overstate how the onset of this problem has changed my life. This condition drives me up the wall. I used to wear short pants and sandals, but now feel obliged to wear long pants to cover up the red skin disease.
I have two semi-permanent spots on my hands as well, one on the upper part of my hand, just below the wrist and the other between fingers two and three of my right hand.
Basically I feel despondent because I am not getting anywhere.
The specialist prescribed Dovate, but it does not help much. Other ointments keep the skin moist for a short while, but the itch and peeling continues.
ANSWER:
There are many issues surrounding your condition that are often overlooked – including the massive impact on your self-esteem.
Eczema is a relatively common condition that often starts in childhood.
It is usually the result of an atopic profile (that is allergy mediated). The skin becomes red and patches of abnormal dry, peeling areas can itch and cause irritation.
The skin can form crusty patches which are grossly sensitive and occasionally wet. This is referred to as weeping eczema. The clinical spectrum is diverse, with accurate grading of the condition guiding the treatment. Local versus systemic treatment applies.
Why excema is so difficult to manage
There are multiple triggers for the condition. Unfortunately a strong genetic component exists, too. Exaggerated inflammatory responses with high concentration of histamine and pro-inflammatory mediator release cause itchiness, redness and irritation.
It is really difficult to control the response as the mediators of chronic inflammation need to be controlled.
Therefore the mainstay of the approach to treatment is to suppress the dramatic immune response. For this reason, the drugs of choice are steroids – topical and, in severe cases, systemic steroids are prescribed to moderate and suppress the excessive response. Antihistamines are also popular in reducing the itchiness (pruritis).
Immunosuppressive agents are used in various medical conditions. Drugs like cyclosporine, methotrexate, cyclophosphamide and azathioprine are not without risk – be well informed before agreeing to this as chronic treatment.
There are side effects to this group of drugs, including weight gain and gastritis.Topical steroid creams are available in different concentration formulations. Your dermatologist should give clear instructions as to the long-term plan of dealing with eczema.
Some people outgrow the condition but for many it is a persistent seasonal or nutritional struggle.
Where to start
Contact the Allergy Institute at UCT, which specialises in difficult cases and know which blood tests are required. A detailed history of your environmental exposure will be requested, as well as a family history. A thorough systemic examination is recommended, looking for associated medical conditions like asthma, allergic rhinitis and coeliac disease.
Prep work for the doctor
* Food diary (young and old).
* Calendar of acute attacks.
* Hygiene and cosmetic products.
* Family history and age of onset.
There are hundreds of skin conditions that cause rashes similar to eczema, so always consult your physician or dermatologist for assistance with persistent symptoms.
* Dr Darren Green, a trusted figure in the field of media medicine, is a University of Stellenbosch graduate who adds innovative spark to health and wellness issues.
He features on 567CapeTalk, and is a regular guest on SABC3 and the Expresso show. Dr Green works as an emergency medical practitioner at a leading Cape Town hospital and completed four years of training as a registrar in the specialisation of neurology.
If you’ve got medical problems, contact the doctor at [email protected], 021 930 0655 or Twitter @drdarrengreen. Catch him in Cape Town on 567 CapeTalk, most Fridays at 1.30pm.
The advice in this column does not replace a consultation and clinical evaluation with a doctor.
Cape Argus