Eczema (Atopic Dermatitis)

Eczema, also known as atopic dermatitis, is a chronic, relapsing skin condition characterised by dry, itchy, inflamed skin. It is the most common inflammatory skin disease worldwide, affecting children more often than adults and tending to run in families alongside other allergic conditions such as asthma and hay fever (the "atopic triad"). In Nigeria, eczema is very commonly seen in paediatric outpatient clinics. While there is no cure, eczema can be well controlled with consistent skin care, moisturisation, and appropriate treatment during flares. Many children with eczema improve significantly or outgrow it by adulthood, though some continue to have the condition lifelong.

Symptoms vary with age and tend to fluctuate between flares and periods of improvement: Infants (under 2 years): • Dry, scaly, red rash on the cheeks, forehead, and scalp • Rash may also appear on the trunk and limbs • Intense itching: infants may rub their face against bedding Children and adolescents: • Itchy rash in the skin creases: inner elbows, behind knees, wrists, ankles, and neck • Thickening of skin in chronically scratched areas (lichenification) • Scratching worsens inflammation, creating an itch-scratch cycle Adults: • Rash commonly affects hands, face, and skin creases • Skin may be chronically dry, leathery, or darkened from years of scratching Acute flare features (all ages): • Intense itching: often worse at night, causing sleep disruption • Red or brownish-grey patches • Small, fluid-filled blisters that may weep and crust • Raw, swollen skin from scratching • Burning sensation

Eczema results from a combination of a defective skin barrier and immune system dysregulation, influenced by both genetic and environmental factors: Skin barrier dysfunction: • Mutations in the gene for filaggrin (a protein essential for a healthy skin barrier) are found in many eczema patients • A defective barrier allows moisture to escape, making the skin dry, and lets allergens, irritants, and bacteria penetrate Immune dysregulation: • The immune system overreacts to normally harmless substances, triggering inflammation in the skin Common triggers that cause flares: • Harsh soaps, detergents, and cleaning products • Synthetic fabrics (nylon, polyester) • Heat and sweating • Dry air and low humidity • Dust mites, pet dander, pollen • Stress • Certain foods (in young children: milk, eggs, nuts are common; less so in adults) • Bacterial skin colonisation by Staphylococcus aureus (worsens inflammation) • Dry skin from weather changes

• Family history of eczema, asthma, or hay fever: the strongest risk factor • Personal history of other allergic conditions • Living in urban environments (higher exposure to pollution and altered microbial environment) • Dry climate • Use of harsh soaps and skincare products • Early introduction of formula feeding (exclusive breastfeeding may be protective) • Stress and poor sleep (worsen existing eczema) • African and Black ethnicity: higher prevalence and often different pattern of eczema

• Asthma and hay fever: children with eczema often develop asthma and/or allergic rhinitis later ("atopic march") • Bacterial skin infection: Staphylococcus aureus colonises eczematous skin and causes impetigo, which requires antibiotic treatment • Eczema herpeticum: a rare but serious infection with herpes simplex virus on eczematous skin; causes rapidly spreading painful blisters and fever; requires antiviral treatment • Chronic sleep deprivation from nocturnal itching: leads to fatigue, poor school or work performance • Psychological impact: anxiety, depression, and low self-esteem are significantly more common in people with moderate-to-severe eczema • Skin thickening and permanent discolouration from chronic scratching

For those prone to eczema, regular skin care significantly reduces flares: Moisturise daily: • Apply a generous amount of fragrance-free, dye-free emollient (petroleum jelly, shea butter, or a prescribed moisturiser) to the entire body within 3 minutes of bathing: this is the single most effective preventive measure • Reapply throughout the day whenever skin feels dry Bathing habits: • Use lukewarm water (not hot) • Bathe or shower for 5–10 minutes, then immediately apply moisturiser • Use mild, fragrance-free, soap-free cleansers Avoid triggers: • Wear soft, breathable clothing (cotton, not nylon/polyester/wool) • Use fragrance-free laundry detergent • Keep fingernails short to reduce skin damage from scratching • Manage stress For infants at high risk: • Exclusive breastfeeding for at least 4–6 months may reduce risk • Regular emollient use from birth for high-risk infants