Explaining Eczema

The world of a child with eczema is an itchy one.

- Lim Teck Choon

An often-misunderstood problem, eczema brands a child as “different”. Some may avoid the child out of fear that the disease is contagious (it isn’t), while others may find the child’s appearance a good enough reason to bully the child (and it really isn’t). Hence, parents of children with eczema are almost always concerned not only about the child’s flare-ups but also about the child’s psychological well-being.

If you are one such parent, take heart. This month, paediatrician Dr Erwin Khoo Jiayuan explains why eczema occurs, and how parents can help their children manage the symptoms as best as possible.

WHAT GIVES RISE TO ATOPIC DERMATITIS?

According to Dr Erwin, there are actually a few types of eczema. Usually, though, when we mention “eczema”, we usually refer to a specific type of eczema called atopic dermatitis. Therefore, to avoid any potential confusion, from this point on, “atopic dermatitis” will be used instead of “eczema”.

Doctors call atopic dermatitis a chronic pruritic inflammatory skin disease (see Figure A). To understand atopic dermatitis (AD), we first need to look at the healthy human skin.

Our skin has many layers, and the outermost layer, stratum corneum serves as the natural skin barrier. This barrier helps to keep out foreign matter such as germs, allergens, dust, pollutants and more.

In someone with AD, the natural skin barrier function is disrupted. If we think of the barrier as a wall, the disrupted barrier is like a wall that has loose or missing bricks. As a result, foreign matter can slip through these ‘cracks’ in the barrier. When this occurs, our immune cells detect the unwanted guests and surge to the affected area to eliminate these guests. This triggers the inflammation in the skin of someone with AD.