The many faces of ECZEMA
In the summer months, some of my patients complain about fine, itchy bumps on their face which worsen with heat. I explain to them that this is seborrhaic eczema (SE). My patients are astonished by the diagnosis, thinking that they are too old for eczema. Often, people confuse SE with childhood eczema which is called atopic eczema (AE). I will discuss AE in a subsequent article.
SE is frequently associated with a burning sensation when sweating. Pale discoloration is also visible along the hairline, in front of and behind the ears as well as around the mouth, nose and eyebrows. In some cases the discolouration extends down the front of the chest, between and beneath the breasts. In severe cases, the discoloured rash (described as pitchy-patchy) may extend from the nape of the neck to the entire back! Some patients erroneously describe the rash as "liver spots".
In some patients, instead of a pale rash, SE shows up as a dark rash on the forehead extending along the side of the face to involve the laugh line and chin. This type of SE is also associated with dark patches on the neck, underarm as well as between the thigh and groin. ( see photos)
Seborrheic eczema is an inflammatory disease in which a type of yeast (pityrosporum) has been proven to play a key role. These yeasts are Lipophilic organisms and are normally found on the skin where there are many sebaceous (oil) glands. In large quantities, these yeasts invoke an inflammatory(eczema) response which causes the symptoms.
There are several factors that contribute to the high incidence of seborrhaic eczema in Jamaica.
1. GENETIC — this condition is hereditary. A mother, father, daughter or son has this condition.
2. CULTURAL PRACTICES — the reluctance of women with expensive hairstyles to wash their hair more than twice a month. The natural oil deposits in addition to the oiling of the scalp to hide the flakes give rise to the perfect environment for the multiplication of these yeasts.
3. ENVIRONMENT — heat worsens this condition. The tropical climate here provides the ideal temperature for growth of these yeasts. These organisms grow best between 27-30° C, which incidentally is our average temperature in the summer when this condition is most prevalent! Change of climate also precipitates this condition by travelling from hot to cold weather or vice -versa.
4. STRESS — Stress causes the oil glands to be more active and to produce more oil for yeast multiplication. It is no coincidence that a stressful individual relapses often, eg police, accountants, lawyers, reporters, executives and students studying for exams.
5. HORMONAL — SE relapses more often near menstruation as well as during pregnancy.
Seborrheic eczema can be effectively treated but can reoccur when the above factors are present. This condition is not contagious and requires no blood test for diagnosis. It can affect any age group once the contributing factors are present. To help prevent the reocurrence of SE, wash the scalp more often and oil your hair not the scalp! Avoid hot humid conditions and stay cool. Avoid stressful environments or cope with meditation.
Next week I will speak on the summer gremlins: mosquito bites!