QUESTION: I am 54 years old, have not had any serious illnesses or operations, and am still reasonably fit and well.
At the end of 2011, however, little red spots started to show on my legs and I thought that they might be flea or tick bites, but pathology tests indicated that it was eczema.
The typical presentation is reddish, inflamed skin with the associated itch. First the itchy red pimples appear. Then, after the irresistible scratch, the whole area flames up. Both my lower legs, especially the shins, look like they have been 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 outside of the upper arm. 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? Please advise.
I cannot overstate how the onset of this problem has changed my life. This condition drives me up the wall.
I used to wear shorts and sandals, but now feel obliged to wear longs to cover up.
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.
Your advice would be greatly appreciated.
ANSWER: 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 occasionally wet – referred to as weeping eczema.
The clinical spectrum is diverse, with accurate grading of the condition guiding the treatment. Local versus systemic treatment applies.
I suggest you contact an allergy specialist. A detailed history of your environmental exposure will be requested, as well as a family history. A thorough systemic examination is recommended. Blood will be taken for proving allergy response, rather than infection.
What to bring along:
* A food diary.
* A calendar of acute attacks is also useful.
* A list of hygiene and cosmetic products.
* Family history profile and age of onset of the condition.
How to treat chronic inflammation caused by disease
There are multiple triggers for the condition. Unfortunately, a very strong genetic component exists too. Exaggerated inflammatory responses with high concentrations of histamine 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 the treatment is to suppress the dramatic immune response. For this reason, the mainstay drugs of choice are steroids. Both 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). Sun exposure and UV protection are often forgotten.
Immunosuppressive agents are used in various medical conditions.
Drugs like cyclosporine, methotrexate, cyclophosphamide and azathioprine are not without risk – so you must be be well informed before agreeing to this as chronic treatment. As you know, there are well-known 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 you clear instructions as to the long-term plan for dealing with eczema.
Certainly, some people outgrow the condition, but for many it is a persistent seasonal or nutritional struggle.
Many and varied eczema triggers
* Dairy products – cheese, ice cream, yoghurt, milks and milk formulas.
* Snacks/chips with colourants and preservatives.
* Perfumes and cosmetic preparations.
* Washing powders and softeners.
* Air conditioners and carpets.
* Tannins, sulphites and nectar.
* 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. - Cape Argus