The words eczema and dermatitis are synonymous i.e. they can be used interchangeably.
Eczema or dermatitis can be classified into two big groups, namely exogenous or endogenous. Exogenous causes include irritant contact dermatitis, allergic contact dermatitis or photodermatitis. Endogenous causes include atopic eczema, seborrhoeic dermatitis, nummular eczema etc.
However, the most common type of eczema is atopic eczema. This type of eczema often comes on in childhood and there is an associated family history of asthma and hay fever. It may be a debilitating and lifelong condition. Atopic eczema is a condition that affects up to 20% of children in the Western world and there has been a marked increase in this skin condition over the last few years.
Atopic Eczema today
In the past, atopic eczema was primarily thought to be an allergic condition of the skin but we now know that it is primarily due to a disturbed epidermal barrier function. We also now know that approximately 10% – 15% of people with atopic eczema also suffer from Ichthyosis Vulgaris where you have genetically dry skin from birth due to filaggrin deficiency. Because of this disturbed epidermal barrier, the body’s immune system becomes exposed to various allergens e.g. house dust mites and grasses. It then builds up an abnormal allergic response to these antigens i.e. the allergies are secondary to the abnormal barrier function.
“In the past, atopic eczema was primarily thought to be an allergic condition of the skin but we now know that it is primarily due to a disturbed epidermal barrier function”
To maintain healthy, normal skin, you need to maintain the skin’s microbiome. In other words, we must not disturb the normal good bacteria, yeasts, viruses, mites etc that live on our skin’s surface. Normal healthy skin has a pH of 5.5 i.e. slightly acidic and this lower pH contributes to what is called the protective acid mantle on the skin.
Therefore, if we are to recommend various topical skin care products for treating eczema they need to contain ingredients that improve the barrier function of the skin, do not disturb the skin’s microbiome and preserve the protective acid mantle. People with a history of asthma, hayfever and eczema need to use the correct skin care products literally from birth. A study has shown that the daily use of the correct cleanser and moisturiser during the first 32 weeks of life reduces the risk of developing atopic eczema.
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Whether you use a cleansing bar or a liquid cleanser is a personal preference. Liquid cleansers generally come in a plastic container (which can be recycled) but for this reason, I often recommend a cleansing bar. However, whatever cleanser you use, it should have a pH as close to 5.5. as possible, should not strip the skin of the normal lipids and should preserve the skin’s microbiome. The Avène XeraCalm cleansing products, be it the cleansing bar or cleansing oil contain Avène Thermal Spring Water which has anti-irritation and softening properties, it contains I-MODULIA, a postbiotic which is beneficial for preserving the skin’s microbiome and it also contains CER-OMEGA which contains Omega 6, ceramides and plant-based cholesterol. Unfortunately, many soaps bought in supermarkets are alkaline with a pH of between 8-10 which just strips the skin of its natural lipids. Avoid anti-bacterial soaps that will disturb the skin’s normal microbiome.
Choosing the correct moisturiser is a critical part of treating people with eczema. These moisturisers should contain ingredients similar to natural skin lipids. Avène XeraCalm A.D Lipid-Replenishing Balm containing aquaphilus dolomiae extract from the Avène Thermal Spring Water which is effective in the management of eczema and pruritis. This product is moisturising without leaving a sticky residue. It is fragrance and preservative-free.
The correct cleanser and moisturiser are essential in treating eczema but sometimes this alone is not sufficient. To effectively break the scratch/itch/scratch cycle you often need a prescription topical corticosteroid cream or a topical calcineuron inhibitor from a medical practitioner.
For more information: Atopic Eczema Support Group – South Africa