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Eczema arises because of complex interaction of genetic and environment factors. While it is mostly inherited, it displays characters of an overactive immune response to environment factors. The same factors have no effect on the skin of non-eczema person.

There is no sure thing when it comes to Eczema and that is what makes it so complicated for doctors to understand. Despite children who comes from family with Eczema history, they never develop Eczema and children with no family history of Eczema can suffer from it.

Eczema does not always look the same across different age, ethnic origin, creams applied prior and other factors can alter the way Eczema looks and feels. However there are some general patterns to where the Eczema is found on the body according to the age of the person.

INFANTS

• Infants less than one year of age often have widely distributed eczema. The skin is often dry, scaly and red with small scratch marks made by sharp baby nails.
• The cheeks of infants are often the first place to be affected by eczema.
• The napkin area is frequently spared due to the moisture retention of nappies. Just like other babies, they can develop irritant napkin dermatitis, if wet or soiled nappies are left on too long.

TODDLERS AND PRE-SCHOOLERS

• As children begin to move around, eczema becomes more localised and thickened. Toddlers scratch vigorously and eczema may look very raw and uncomfortable.
• Eczema in this age group often affects the extensor (outer) aspects of joints, particularly the wrists, elbows, ankles and knees. It may also affect the genitals.
• As the child becomes older the pattern frequently changes to involve the flexor surfaces of the same joints (the creases) with less extensor involvement. The affected skin often becomes lichenified i.e. dry and thickened from constant scratching and rubbing,
• In some children, the extensor pattern of eczema persists into later childhood.

SCHOOL-AGE CHILDREN

• Older children tend to have the flexural pattern of eczema and it most often affects the elbow and knee creases. Other susceptible areas include the eyelids, earlobes, neck and scalp.
• They can develop recurrent acute itchy blisters on the palms, fingers and sometimes on the feet, known as pompholyx or vesicular hand/foot dermatitis.
• Many children develop a ‘nummular’ pattern of atopic dermatitis. This refers to small coin-like areas of eczema scattered over the body. These round patches of eczema are dry, red and itchy and may be mistaken for ringworm (a fungal infection). Most GPs will diagnose as fungal infection however do seek second opinion if the fungal cream has no effect and most likely to be Eczema.
• Mostly eczema improves during school years and it may completely clear up by the teens, although the barrier function of the skin is never entirely normal. This also means that teens with Eczema will have higher chance of catching illness especially with flu bug etc. 

ADULTS

• Adults who have Eczema may present in various different ways.
  They may continue to have a diffuse pattern of eczema but the skin is often more dry and lichenified than in children.
• Commonly adults have persistent localised eczema, possibly confined to the hands, eyelids, flexures, nipples or all of these areas.
• Recurrent staphylococcal infections may be prominent.
• Eczema is a major contributing factor to occupational irritant contact dermatitis. This most often affects hands that are frequently exposed to water, detergents and /or solvents.
• Having atopic dermatitis does not exclude contact allergic dermatitis (confirmed by patch tests) in children and adults)
• Hand dermatitis in adult atopics tends to be dry and thickened but may also be blistered.

Eczema is a complicated health problem that does not just begin from the skin. It is an indication from your body that something is not right, may it be an internal or external allergy. Some people get it since young while some developed it halfway into their mid life. While there are many possible reasons why you get it, there is no hard and fast solution to your skin condition as everyone’s skin and body condition vastly differs.

The short answer to the question is No, there is no cure to Eczema medically. There is no medication nor topical cream that can cure eczema. Whatever is available on the market, including biologic medication such as Duplixent are mainly relieving symptoms. It may appear to “cure” you in the short term however once you are off the medication, your symptoms will come back.

Henceforth the only sustainable solution is to understand your skin, learn about what stage you are in and use natural healing products that have been tested and proven by other eczema sufferers. This is a long term fight but if you manage well, you will be as functional as anyone with normal skin. 

It is important to note that more care has to be given to children who are experiencing eczema or TSW (due to improper use of steroid) as they have good chance of outgrowing eczema if you manage it well. 

There is emerging evidence that inflammation in Eczema is associated with immunue-mediated and inherited abnormal skin barrier. This barrier failure results in more “holes” in the skin and reduces skin function to kill germs, dirt and fungi. An Eczema attack or flare up results in dehydration of the skin with increased risk of infection and extreme dry skin. Children with severe Eczema will need more help in preventing infection of the skin and they are more prone to falling sick from common illness.

The immune system develops in the first six months of life. There is an imbalance of immune system structure and that results in:

• Reduction in skin Ceramide (fatty acid)
• Reduction in antimicrobial peptides
• Bacteria colonise and infect the skin
• Infections are harder to control.

Once you understand how immune system affects the skin, you will also understand that both genetic make-up of the individual and external environmental factors contribute to the likelihood of developing Eczema, its severity and its response to treatment.

When you unfortunately have Eczema, your skin barrier lost functions such as:

• Easier moisture lost
• Irritants such as soap, detergent, solvents, dirt, etc may penetrate the skin easier.
• Allergens such as pollens, dust-mites antigens and microbes may also penetrate the skin easily.

Dry skin is a sign of the loss of barrier function. Factors that make the skin even drier may make eczema harder to control:

• Winter weather
• Frequent washing particularly with very hot water
• Washing in hard water (which increases pH)
• Soap (which also increases pH) and antiseptics
• Low humidity
• High ambient temperatures
• Chlorine in swimming pools

A brief shower or bath once a day is enough if you have dry skin. However, your doctor may specifically recommend bathing for longer or more often during the acute blistered phase of eczema. Use a non-soap cleanser.

Regular use of an emollient helps skin retain moisture and combat dryness.

About 90% of systemic allergic reactions are due to the following food items:

• Egg
• Milk
• Peanut
• Soy
• Fish
• Seafood
• Wheat
• Tree nuts.

Everyone’s allergy is different however there is a grey area of food allergy vs food intolerance. The quickest way to determine what the food allergy is/are via:

• Prick tests
• Specific IgE blood tests (RAST)
• Patch tests, in some cases of dermatitis
• Skin biopsy
• Antigliadin/antiendomysial blood test for gluten sensitivity/coeliac disease and dermatitis herpetiformis.

However you may also find out by eliminating the common food allergies first and introducing them one at a time on 3 days interval. We would normally target eliminating milk, peanut and eggs first especially when the patient is an infant.

Treatment of Eczema may take many months and possibly even years. From our experience, the treatment duration will lengthen when you had experience with topical steroid, oral steroid or immunosuppressant. However the treatment nearly always requires:

• Reduction of exposure to trigger factors such as food and external environment factors whenever possible.
• Regular moisturising
• Regular healing balm application to speed up healing.

In order to ease itch and reduce inflicting damage to the healing skin while maintaining proper sleep cycle, antihistamines may be needed. 

Eczema affects 15–20% of children but is much less common in adults. It is impossible to predict whether eczema will improve by itself or not in an individual. Sensitive skin persists life-long. A meta-analysis including over 110,000 subjects found that 20% of children with Eczema still had persistent disease 8 years later. Fewer than 5% had persistent disease 20 years later. Children who developed Eczema before the age of 2 had a much lower risk of persistent disease than those who developed Eczema later in childhood or during adolescence.

It is unusual for an infant to be affected with Eczema before the age of four months but they may suffer from infantile seborrhoeic dermatitis or other rashes prior to this. The onset of Eczema is usually before two years of age although it can manifest itself in older people for the first time.

Eczema is often worst between the ages of two and four but it generally improves after this and may clear altogether by the teens.