October 2020
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TRANSCRIPT: Live online session organized

TRANSCRIPT: Live online session organized

#LivingWithEczema is a pioneering nationwide initiative launched in the UAE to help raise awareness about Atopic Dermatitis (AD) – a chronic skin condition most commonly known as eczema, by driving key conversations among various communities. Led by the Dubai Health Authority (DHA) and supported by Sanofi – a global biopharmaceutical company and health journey partner, the initiative aims to empower individuals suffering from the condition, tackle misconceptions around AD, and enable healthcare professionals to take informed actions for treatment, given the recent and significant progress being made in the treatment of this condition.

Sheding light on the different aspects of dealing with atopic dermatitis was Dr. Khadija Aljefri, a board member at the Emirates Dermatology Society and a lecturer at Dubai Medical College and consulting dermatologist at DermaMed Clinic Dubai

Joining her in the session was Dr. Anwar Al Hammadi, President of Emirates Dermatology Society, Adjunct Clinical Associate and Professor of Dermatology at MBRU, Dubai and a consulting dermatologist at DermaMed Clinic Dubai.

Introduction

We might have talked last year but now there is more awareness and understanding about eczema and how to live with it. And as we mentioned before that this disease does not affect only children, it may affect adults and the elderly. Thank God we now have treatments available for different age groups, depending on the case.

We are now with you in this live session because today is the World Eczema Day, and of course there must be continuous awareness throughout the year, especially as the disease affects children more.

Most of the cases when they visit the clinic, they forget certain questions about the disease, and this is an opportunity if you have any questions, so our goal as dermatologists is to completely cure this disease because it is a disturbing disease as it affects the quality of life because patients suffering from eczema suffer from itching and difficulty in sleeping. Many complain about the recurrence of the disease after treatment, but this is the nature of the disease, as it recurs.

My son suffers from eczema and I stopped feeding him eggs, but he is still suffering from the disease

Dr Hammadi: Is there a relationship between eczema and food .. 70% there is no relationship, 30% yes, some foods irritate and increase the severity of the case, but it is not the main cause of the disease. Observation is important, so if you notice that stopping some foods contributes to alleviating the situation, then stop feeding your children these foods for some time, but you must be careful because this may lead to malnutrition if this food is not the reason behind the severity of the situation. But we go back and say not every rash is eczema, we have seen many cases that were thought to be eczema, but it was psoriasis.

If the case is eczema, it is accompanied by asthma, spring allergy, and sinuses (nasal polyps), and these are all symptoms of eczema, especially asthma, but not everyone who suffers from eczema has asthma. And in the treatments that we started using 4 years ago, the Eczema injection treats asthma and sinuses. This treatment has made a real change in the lives of people with severe cases. Now with confidence, I assure patients with severe cases that their lives will improve as there are treatments, not just creams.

While I was pregnant with my son, I was suffering from liver enzymes. Was this the cause of my child’s illness with eczema, and when we are in a dusty place, does the severity of the case increase?

Dr Al Hammadi:  There is a type of eczema called pregnancy eczema, so the pregnant woman suffers from dryness, which leads to itching, but liver enzymes have nothing to do with the disease, and eczema is mainly a hereditary disease. In response to the second part of the question, yes dust can increase the severity of the case. There are many other factors that cause irritation, including weather conditions (very cold or very hot), sand, wool, non-cotton clothing, and scents.

Now, due to the spread of Corona pandemic, the increasing use of sterilizers leads to dry hands and thus irritation of eczema, and we advise those with the disease to reduce the use of sterilizers if they are not forced to. We call on everyone to use a moisturizer immediately after washing hands or using a sanitizer.

The treatment of eczema is based on the severity of the case, light eczema can be treated with moisturizers. There is a common question about the best type of moisturizer, but we say there is no such thing called best type, as most types are good, so if you try one and it shows good results, keep using it. And as the doctor said, it is better if it is odorless.

Whenever my daughter plays and sweats, she starts itching, is that okay?

Dr Al Hammadi:  This is normal, she is a child, and after she feels hot and sweaty, she may start itching, but she cannot be deprived of playing for this reason, and many families when going to the sea keep the person with the disease away from the sea, and we agree with her only if the case is severe.

Are biological injections a treatment to eczema?

Yes, it is a treatment for eczema, but as we mentioned, eczema is a chronic disease, and the injection must be taken every 2 weeks or every 4 weeks, depending on the age of the patient, because the treatment of eczema must be continuous.

Eczema and yeast infection in females (Genital Eczema)

Dr Al Hammadi:  Yeast is completely different. It is not related to eczema; however, we have one kind of eczema that we call seborrhoeic dermatitis or seborrheic eczema. This kind of eczema is usually seen in newly borns, has yellowish scaling, or as dandruff on the scalp, or eyebrows or around the nose. We call it spontaneously resolving, it goes away by itself. For this type of eczema, we can use antifungal preparation, any kind of antifungal shampoo or claim can help. Although we call it, eczema, this is a different type of eczema.

But the kind of dermatitis we are talking today is ‘atopic dermatitis.’ This type of dermatitis is usually chronic, it is recurrent. We use topical treatment such as emollients, shampoos. For severe cases, persistent cases that did not respond to conventional therapy, we have an injection for eczema. This is a new therapy, biological therapy, used intradermally once every 2 weeks for adults. It is also now approved for use from age of 6 onwards. We started 4 years ago, for adults, age 18 and above, year or 2 years ago for adolescent age 12 and now we are using for 6 years. It is very effective and safe.

For me as a dermatologist or as a doctor, when I look for therapy. I look for two things – safety and effectiveness. What is the point of having something safe but not effective, also what the point of having something very effective but has lots of complications, liver issue or kidney issue.

Other good news that you want to hear is that there are lot of things that are going to come in the future for treatment of eczema whether in topical or oral therapy

Eyelid eczema

Dr Aljefri:  We use constant moisturizing, avoid any triggers such as smells, make-up reaction, even using hand sanitizers can affect your eyelids, mild steroids for short period of time to calm the eczema down.

Eczema in the whole body despite taking pills, using creams and body lotion

Dr Al Hammadi:  This is what we call tailored treatment. One message that all those suffering from eczema should know is that there is no benefit of using antihistamines such as Zyrtec, Telfast, Zyzal for treating eczema

Antihistamines are used for allergic reaction, food allergy, contact dermatitis etc of if I have a child who is not sleeping when I want to sedate the child, here I would recommend sedative effect of antihistamine. Please do not use antihistamines either in kids or adults to treat eczema.

If you have it all over the body, probably you would be a good candidate for a systemic therapy such as the injection or used much less these days is phototherapy, some people may benefit from ultraviolet rays, what we call narrow-band UVB, this may be a good choice in selective cases.

Choosing the right treatment depends on the severity and the areas that are affecting the person

Does eczema appear as yellow scale and redness behind the ears and dandruff on the scalp?

Dr Al Hammadi:  Having a scaly or dandruff on the scalp behind the ears, inside the ears in the chest area, that’s usually a sign seborrheic dermatitis, which is different than atopic dermatitis here where we use anti dandruff antifungal shampoos, we use sometimes also topical steroid lotion. So this is completely different than atopic dermatitis. And again, this can be stubborn in adults. In kids, sometimes called cradle cap card usually disappear on its own.

Types of dermatitis

Dr Aljefri:  I think one important message that we want to give out today that there are many types of eczema. It is good to know what type of eczema you have so that you know which treatment to follow. And the, of course, today we’re talking about atopic dermatitis but there’s also another type that’s considering dermatitis that has a fungal element.

Can you please talk about juvenile plantar dermatosis?  

Dr Al Hammadi:  Juvenile plantar dermatosis usually you see it in kids going to school might be related to access and sweating. It might be related to the shoes the child is wearing. It is usually self resolving. Probably they need to change the type of the shoes. It usually appears as scaly or the skin peeling on the plantar surface of the foot. It is again a different kind of presentation that’s different than atopic eczema.

Dr Aljefri:  This is usually related to excessive sweating. If you reduce the excessive sweating by changing the type of socks, using products to absorb the sweat, it can also get better

Dr Aljefri: Thank you for much for joining us today. We answered most of your questions. If you have any extra questions, please communicate with Living With Eczema. This is not just a platform for doctors but it’s also for the eczema community to connect and learn from each other. Don’t advise each other to use medication though but to communicate. If you have questions, please post it on Instagram or facebook and remember world eczema day.

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