Eczema – Ask the expert

What is Eczema and how is it different to Atopic Dermatitis?
Eczema is a general term used to describe skin inflammation (redness) and itching of the skin. There are many different types of eczema. A few examples include atopic dermatitis, hand eczema, irritant eczema and allergic eczema.

Atopic dermatitis is a sub-type of eczema that typically starts early in life. It tends to develop in those with a genetic tendency (family history) but environmental triggers play a role too. Often eczema, asthma and hay fever run together in families.

Are food allergies a trigger people with atopic dermatitis?
Food allergies can trigger a flare of atopic dermatitis in young babies who are just starting solid food. There are 5 main groups of highly allergenic foods. These include eggs, peanut, tree nuts, crustaceans, prawn, soy and fish. To decrease the risk of allergy to these foods, they should be introduced in children between 4 to 6 months of age. It is much less common for adults with atopic dermatitis to develop new food allergies.

People often say topical steroids are bad for the skin. What are your thoughts on this?
There are many misconceptions surrouding topical steroids. Topical steroid is a traditional, highly effective and safe treatment option for all types of eczema when used under supervision and direction by a medical doctor. It specifically treats the inflammatory (red and itchy) part of eczema.

However, side effects can occur when prescription topical steroid creams and ointment have been inappropriately used without consulting a doctor. Please do see your healthcare provider for directions on how to use these to help settle inflammation of the skin.

Does atopic dermatitis look different in skin of colour?
Yes, eczema often does look different in those with skin of colour.

Eczema typically presents with less redness in pigmented skin, but sometimes no redness is seen at all. Instead, often grey changes are seen on the skin. Research shows that this ‘greying’ is often not recognised by dermatologists as being a sign of eczema in skin of colour so it is important to point this out to your doctor.

Eczema can also leave behind disfiguring discoloration (called post-inflammatory hyperpigmentation or hypopigmentation), which appears darker or lighter than a person’s normal skin tone.

Research shows that the severity of eczema is often underestimated in those with skin of colour which means they are often under-treated.

Skin of colour patients are also more likely to have very dry skin (because they have less ceramides (fatty acids) in the top layer of the skin) and may present with different patterns of eczema. An example of this is micropapular eczema (small dots on the skin).

What treatments other than creams are available for atopic dermatitis in Australia right now?
Narrowband phototherapy is an effective treatment especially if you have widespread Atopic Dermatitis. This safe treatment uses a specific wavelength (ultraviolet light B) to treat skin inflammation. It is most effective when used in combination with creams. The good news is that Medicare will provide a rebate for this treatment and most dermatologists in Melbourne ensure that patients are bulk billed for phototherapy.

We have also traditionally used oral medications (tablets) for very severe atopic dermatitis that doesn’t respond to general skin care measures, creams and phototherapy. These tablets suppress the immune system and can stop eczema from forming.

However, we now have access to a new injection treatment, which is recommended as the next step for patients who have severe eczema and are not responding to skin care and prescribed creams and/or phototherapy.

Can you tell us a bit more about the new injection treatment that is available for atopic dermatitis in Australia?
The name of the treatment is Dupilumab. It is the newest treatment option that has been made available for those with severe atopic dermatitis that does not respond to topical corticosteroid treatment. It is a targeted treatment (called “biologic therapy”) that works by blocking a specific receptor that trigger inflammation in atopic dermatitis.

It is a fortnightly injectable treatment, and research has shown it may reduce skin itching by 50% within 16 weeks of starting it. Before accessing the injection, your medical history, and severity and symptoms of your atopic dermatitis needs to be assessed by a dermatologist. At this time, you also need to be 12 years of age of older to access the treatment.

There are some potential side effects from this medication including red or itchy eyes but on the whole, it is a fairly well-tolerated treatment for most people. The good news is that research suggests it is helpful for people with various skin tones and types.

Are there other new treatments on the horizon for atopic dermatitis?
Janus Kinase (JAK) inhibitors are another class of oral medication which have shown promising results with treating Atopic Dermatitis. Two new JAK inhibitors, Abrocitinib and Upadacitinb, are awaiting approval to be made available on the PBS (Medicare). Hopefully, we will have more information on them soon.

It really is an exciting time for those of us that see and treat atopic dermatitis. As our understanding of atopic dermatitis increases, we will continue to have new therapeutic options for patients that relieve symptoms and clear up the skin.

For those who are interested, we have more information on eczema on our website.

The information contained in this blog post is intended as a guide only and should not substitute seeking medical attention. Please see your healthcare provider for more information on suitability of products, treatments or procedures.