WHAT IS ATOPIC ECZEMA?

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Atopic eczema, also known as atopic dermatitis, is a common chronic inflammatory skin condition that leads to dry, itchy, and inflamed skin. It can start at any age but often begins in childhood, affecting up to 1 in 5 children at some point. Atopic eczema is more common in skin of colour populations who have migrated to urban settings, and is also more likely to be severe. It often appears as patches of skin that are red, brown, or grey, depending on the skin tone. It can affect anyone, but its appearance, severity, and triggers can differ significantly in people with skin of colour.

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UNIQUE CONSIDERATIONS FOR SKIN OF COLOUR

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Atopic eczema can present differently in people with skin of colour. Instead of the red appearance seen in lighter skin tones, eczema may appear as darker brown, or ashen-grey
patches in those with darker skin. It can look more like small bumps, especially around the hair follicles, in patients of African descent. Due to the increased melanin production,
individuals with skin of colour are more prone to postinflammatory hyperpigmentation (PIH), or postinflammatory hypopigmentation (PIHo) where affected areas darken or lighten respectively after the inflammation subsides. Often these pigmentary changes are of more
concern than the eczema itself. Additionally, atopic eczema in skin of colour is often misdiagnosed, leading to delayed or inappropriate treatment.

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CAUSES AND TRIGGERS

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Atopic eczema results from a combination of genetic, environmental, and immune system factors. It often runs in families. If one or both parents have atopic eczema, there is an increased likelihood that their children will develop it. It is linked to a compromised skin barrier that makes the skin more susceptible to irritants, allergens, and infections.

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Common triggers include:

• Environmental factors: Cold weather, harsh soaps, and

• washing powders.

• Allergens: Pollen, dust mites, pet dander, and mould.

• Irritants: Fragrances, certain fabrics, and stress.

• Genetic predisposition: A family history of atopic eczema, allergies, or asthma.

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WHAT DOES IT LOOK LIKE?

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The primary symptom of atopic eczema is intense itching, which can lead to scratching, further aggravating the skin. 

Symptoms can vary and may include: 

• Dry, scaly patches: These may appear thickened or leathery, especially if scratched frequently.

• Colour changes: Patches may appear dark brown, or grey in skin of colour.

• Bumps or oozing lesions: In severe cases, affected areas can develop small bumps that may ooze or become infected.

• Lichenification: Repeated scratching can lead to thickening of the skin, making it more prone to itching.

• In some cases, it may appear as small bumps (papular eczema) or as scale around the hair follicles (eczema with follicular prominence).

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TREATMENT

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Diagnosing atopic eczema in skin of colour requires careful examination by a healthcare provider familiar with its unique presentation. Treatments aim to reduce inflammation, control itching, and restore the skin barrier.

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• Moisturisers (emollients): Emollients are the cornerstone of atopic eczema treatment. Regular application helps restore the skin barrier and retain moisture. Soap substitutes should be used to avoid irritation from conventional soaps.

• Corticosteroids and calcineurin inhibitors: These reduce inflammation and itching but must be used cautiously to avoid side effects, especially on sensitive areas.

• Antibiotics and antiseptics: For cases where atopic eczema becomes infected, a short course of antibiotics or antiseptics may be needed. Continuous use of antiseptics is discouraged due to potential skin drying.

• Bandaging and Wet Wraps: Cotton bandages can be applied over emollients to help retain moisture and reduce scratching.

• Phototherapy and systemic treatments: For severe cases, phototherapy or systemic treatments like oral (taken by mouth) or injected immunosuppressants may be considered.

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SELF-CARE TIPS

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Managing atopic eczema involves a combination of medical treatments and lifestyle changes. Self-care tips for individuals with skin of colour include:

• Use Gentle Products: Opt for fragrance-free, gentle cleansers and moisturisers to avoid irritation.

• Moisturise Frequently: Apply a thick, non-perfumed moisturiser multiple times daily, especially after bathing, to lock in moisture.

• Avoid Triggers: Stay away from harsh soaps, synthetic fabrics, allergens, and stress that can cause flare-ups.

• Practice Gentle Skin Care: Use lukewarm water, soap substitutes, and pat skin dry; immediately apply moisturisers.

• Resist Scratching: Scratching can worsen atopic eczema; use cool compresses and keep nails trimmed to avoid skin damage.

• Protect Your Skin from the Sun: Use sunscreen to prevent darkening of inflamed or hyperpigmented areas.

• Be Cautious with Herbal Remedies and Imported Creams: Avoid unregulated products that may contain unregulated amounts of prescription only steroids and sometimes even harmful ingredients like mercury. Examples of these unregulated creams include Abido cream, Wau Wa cream, Yiganerjing cream and Muijiza cream.

• Manage Stress: Practice stress-reduction techniques like meditation or yoga to prevent flare-ups.

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CONCLUSION

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Atopic eczema is a chronic skin condition that requires a multifaceted approach to manage effectively, particularly for individuals with skin of colour. Understanding its unique presentation, triggers, and appropriate treatment options can help achieve better outcomes and improve quality of life.

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