Eczema in African Adults: Diagnosis and Treatments

 

By: Foluke Akinwalere. Freelance Health Writer. With medical review and editorial support by the DLHA Team.

African man applying moisturiser on his face. Image from Freepik

 

 

Introduction

 

Eczema, also medically known as atopic dermatitis, is a common and chronic inflammatory skin disorder characterised by intense itching and linear breaks in the skin due to scratching, with dryness in the skin, thickening of the first layer of the skin, cracking and an increased risk of skin infections.  

 

Eczema is caused by many factors such as family history, environmental triggers, and immune system factors.  Understanding the various types of eczema is important for accurate diagnosis and effective treatment. 

 

In this article, you will learn how to recognise and diagnose eczema in African adults and explore the various treatment options aimed at reducing symptoms and preventing flare-ups.

 

 

Diagnosis of Eczema in African Adults

 

Diagnosing eczema in African adults follows similar principles of diagnosing eczema in any other population, but there are some unique considerations to take into account.

 

1. Clinical Presentation

 

Eczema typically presents with characteristic symptoms such as itching, dryness, and inflammation of the skin.  However, in African adults, variations in skin pigmentation and cultural practices may influence the symptoms. Your healthcare provider will look for specific patterns of eczema such as flexural involvement (involvement of the fold of the skin), lichenification (thickening of the skin), and papules or vesicles.

 

2. Medical History

 

Taking a thorough medical history is very important for diagnosing eczema. Your healthcare providers will inquire about how it began, its duration, and progression of the symptoms, as well as any previous treatments or triggers that may have worsened or improved the condition.  Your provide will also obtain any past medical and  family history of atopic conditions such as asthma, hay fever, or eczema.

 

3. Physical Examination

 

A comprehensive physical examination will be conducted to check the extent and severity of eczema lesions. The skin will be examined for signs of inflammation, scaling, and the presence of characteristic eczematous patches. Your provider may also check for secondary changes such as crusting and infection.

 

4. Differential Diagnosis

 

It is important to differentiate eczema from other skin conditions that may mimic its symptoms. This includes conditions such as psoriasis, fungal infections, allergic contact dermatitis, and scabies. Your doctor will carefully check the clinical features and may perform additional tests if necessary to rule out other diagnoses. 

 

5. Diagnostic Tests

 

While eczema is primarily diagnosed based on clinical evaluation, additional tests may be used to support the diagnosis or identify potential triggers. This may include:

 

• Skin patch testing for allergens

• Skin biopsy for histological examination

• Imaging studies to assess for secondary complications.

 

6. Cultural Considerations

 

Healthcare providers should be sensitive to cultural beliefs and practices that may influence the symptoms and management of eczema in African adults. They should engage in open communication with patients and inquire about any cultural remedies or treatments they may be using and incorporate cultural considerations into the treatment plan.

 

 

What are the Treatment Options for Eczema in African Adults?

 

Whether conventional or nonconventional, guidelines for eczema treatment are similar globally. [1] In African adults, it involves many approaches aimed at reducing inflammation, alleviating symptoms, and improving skin barrier function. 

 

I. Topical treatments

 

Topical treatments are typically the first-line treatments of eczema but are generally used for a limited period of time because they come in various strengths. It is important to follow the prescribed instructions, as improper use of topical steroids can lead to side effects or worsen the condition. You skincare provider should choose the right one for your skin type and the severity of your condition. 
 

• Topical corticosteroids:  These anti-inflammatory medications are commonly used to reduce itching and inflammation associated with eczema flare-ups e.g cortisone cream 1%, betamethasone dipropionate ointment or gel 0.05% or hydrocortisone cream and lotion 2.5%. Topical steroids come in a range of strengths. The greater the potency of a topical steroid, the greater the risk of side effects such as skin thinning, easy bruising, and stretch marks in the armpits or groin.  

 

• Calcineurin inhibitors: Topical calcineurin inhibitors, such as tacrolimus (for treating moderate to severe eczema) and pimecrolimus (for mild to moderate eczema) [2] are alternative anti-inflammatory agents used for eczema management, particularly in sensitive areas like the face and neck.

 

• Topical antimicrobials: In cases of secondary bacterial or fungal infections, topical antimicrobial agents may be prescribed. They are chemical substances that can be applied to the skin directly to stop the growth or destroy any microorganism, either fungi, virus, or bacteria. They can be antiseptics and antibiotics. [3] Examples of topical antimicrobials for eczema are gentamicin and bacitracin cream. Its side effects may include burning or stinging where the medication is applied.

 

• Emollients and moisturisers: Regular application of moisturisers in cream, lotion or ointment forms help  to restore and maintain skin hydration, reducing dryness and itchiness. Emollients and moisturisers enriched with ingredients like shea butter, cocoa butter, and natural oils can effectively hydrate and soothe the skin, addressing dryness and reducing the risk of flare-ups.

 

II. Systemic Treatments

 

Systemic treatments may be used for severe cases of eczema if topical treatments fail to achieve control or are poorly tolerated. [4] A systemic medication means that a person either takes it by mouth or receives it as an injection or intravenous (IV) medication.

 

Unlike topical medications, which a person applies directly to the area of skin affected, these medications affect the entire body. This means that they can have some side effects than a topical medication because the entire body is involved.  For this reason, only short-term use, for a few weeks, is advised to treat severe acute cases of eczema.
 

• Oral corticosteroids: In severe cases or during acute flare-ups, short term oral corticosteroids may be prescribed to rapidly reduce inflammation and symptoms.

 

• Systemic immunomodulators:  Systemic immunomodulatory medications are reserved for people with moderate to severe eczema. People whose eczema affect a large area of their skin and are significantly affecting their quality of life. Drugs like cyclosporine and methotrexate may be considered for these cases of eczema. 

 

• Biologic therapies: Biologic drugs, such as dupilumab, target specific parts of the immune system that are primarily involved in eczema, with the aim of reducing unwanted side effects. They are increasingly being used for moderate to severe eczema treatment.

 

III. Phototherapy

 

Phototherapy, including UVB or PUVB (psoralen plus ultraviolet A), can be an effective treatment option for eczema, particularly in cases where topical or systemic therapies are ineffective or contraindicated.

 

Phototherapy uses ultraviolet (UV) light to help reduce inflammation and alleviate symptoms. It is administered in a controlled setting under the supervision of a healthcare professional. Although phototherapy can be beneficial for some, you should discuss this treatment option with your skincare professional to determine its suitability and potential risks before you start the treatment.

 

IV. Complementary, Alternative, and Integrative Therapies

 

Recently, there is a growing interest in complementary and alternative medicine (CAM) as a primary, maintenance, and treatment  for many skin conditions, including eczema.[5] They are used to provide additional avenues to patients for symptom relief and improved quality of life.

 

Complementary therapy or medicine is one that is used in conjunction with conventional medicine or western-based medicine. If complementary medicine is used in place of conventional medicine, it is considered as “alternative medicine”. 

 

CAM contains a variety of healthcare approaches, practices, and products that are not typically part of conventional medicines. Examples are:
 

• Acupuncture: A traditional Chinese medicine, involves the insertion of fine needles into specific points on the body to stimulate healing and restore healthy energy balance.

 

• Aromatherapy:  This therapy uses essential oils, distilled from plants, to treat emotional disorders, such as stress and anxiety.  It is often used complementary with other non-conventional therapies, such as acupuncture and herbology by administering it to the body via direct massage into the skin, inhalation, or distillation in baths.

 

• Bath therapy: Involve immersing the skin in a variety of substances for the purpose of removing crusts or scales, washing away old medications, or relieving dryness, inflammation, and itchiness of the skin. They can help reduce eczema severity when used in combination with conventional topical antimicrobial treatment. [6]

 

• Herbal remedies: It is also referred to as phytotherapy. Herbal remedies such as chamomile, calendula flower, and licorice root have been traditionally used for their anti-inflammatory and soothing properties, offering relief for itching and inflammation associated with eczema flare-ups. Natural remedies, such as aloe vera gel, honey, and acupressure, may help manage eczema. 

 

• Chromotherapy: This involves the therapeutic use of colour, light, and relaxation technique, which reduce the feelings of tensions and the effects of stress that causes eczema.

 

• Homoeopathy remedies: Treatment is tailored to the individual’s unique symptoms, emotional state, and overall  health. Some frequently prescribed remedies are graphites, sulphur, and arsenic album.

 

Before considering a complementary or alternative therapy for eczema or any other condition, it is important to consult with your dermatologist (skin doctor) to avoid any potential adverse effects or interactions with your current medication.

 

IV. Lifestyle Modifications and Self-care Strategies

 

Encouraging lifestyle modifications, such as maintaining a healthy diet, avoiding tobacco smoke, and practising good skincare habits, can help manage eczema symptoms and improve overall well-being. Additionally, educating patients about self-care strategies, including proper moisturisation, stress management, and trigger avoidance, empowers individuals to actively participate in their treatment and management of the disease.

 

 

What are the Challenges of Diagnosing and Managing Eczema In African Adults?

 

Diagnosing and managing eczema in African adults can present unique challenges due to several factors.
 

• Skin diversity: Firstly, the diversity of skin types among individuals of African descent can lead to variations in eczema pigmentations, often differing from the classic symptoms commonly observed in lighter-skinned populations. 

 

• Culture: Additionally, cultural perceptions of skin conditions may influence the willingness of patients to seek medical attention, potentially delaying diagnosis and treatment initiation.

 

• Access: Limited access to healthcare resources and dermatological expertise further complicates the diagnostic process, particularly in underserved communities.

 

• Overlapping symptoms: Furthermore, misdiagnosis or underdiagnosis of eczema in African adults may result from overlapping symptoms with other skin disorders prevalent in this population, such as fungal infections or pigmentary disorders.

 

• Cost: Treatment compliance in African adults with eczema is often hindered by financial limitations.  Medications, doctor visits, and other necessary resources may be unaffordable, leading to inconsistent treatment and management of the condition.

 

• Low awareness and cultural beliefs: Many African adults may lack awareness of eczema or hold cultural beliefs that discourage seeking conventional care.  Traditional remedies or superstitions may prevail, resulting in reluctance to adhere to allopathic treatments and management plans.

 

• Late presentation: African adults with eczema tend to seek medical help at later stages of the condition’s progression. Delayed presentation can worsen symptoms, complicate treatment, and diminish the likelihood of successful management.
  
   
• Substandard medications: The prevalence of counterfeit or substandard medications in certain regions can lead to treatment failures and distrust in healthcare providers.  African adults may experience ineffective treatments due to the use of fake drugs, undermining their confidence in allopathic care for eczema.

 

Addressing these challenges requires increased awareness, culturally sensitive approaches to healthcare delivery, and improved access to dermatological care, ultimately enhancing the timely and accurate diagnosis and treatment of eczema in African adults.

 

 

Conclusion

 

In conclusion, diagnosing and treating eczema in African adults present unique challenges starting from the diversity of skin types, cultural perceptions, and limited access to healthcare resources. Despite these obstacles, it is necessary to prioritise early diagnosis and effective management to lessen the burden of eczema on affected individuals. By raising awareness, improving access to dermatological care, and promoting culturally sensitive approaches to healthcare delivery,  providers can enhance the timely identification and treatment of eczema in African adults, ultimately reducing the impact of this chronic skin condition on the quality of life of eczema sufferers.

 

 

Frequently Asked Questions (FAQs)

 

Is eczema common among African adults?

 

Yes, eczema affects people of all ethnicities, including African adults. While prevalence rate may vary, it is a significant concern in many African communities.

 

How can I differentiate eczema from other skin conditions?

 

Eczema typically presents as inflamed, and itchy patches of skin. However, it’s essential to consult a healthcare professional for an accurate diagnosis, as conditions like psoriasis or fungal infections can mimic eczema.

 

What role does skin pigmentation play in eczema diagnosis and treatment?

 

Skin pigmentation can affect how eczema appears on the skin, making it challenging to diagnose, especially in individuals with darker skin tones.  Dermatologists with experience in treating diverse skin types are essential for accurate diagnosis and treatment.

 

Does eczema affect African adults differently than other populations?

 

While the basic symptoms of eczema are similar across populations, factors such as environmental exposures, genetics, and cultural practices can influence how the condition manifests and is managed.

 

How can an eczema sufferer protect their skin from environmental factors?

 

Protective measures such as wearing breathable clothing, regular use of moisturisers, and avoiding harsh soap or detergents can help protect the skin from environmental triggers commonly present in African climates.

 

How often should I see a skin docto for my eczema?

 

The frequency of your visit to the dermatologist depends on the severity of your eczema and how well it is managed. In general, people with moderate to severe eczema may need regular follow-ups to adjust treatment as needed.

 

Is stress a significant factor in eczema flare-up?

 

Yes, stress can trigger or worsen eczema flare-ups in some people.  Stress management techniques such as therapy may help reduce symptoms.

 

References

 

1. Al-Afif KAM, Buraik MA, Buddenkotte J, Mounir M, Gerber R, Ahmed HM, Tallman AM, Steinhoff M. Understanding the Burden of Atopic Dermatitis in Africa and the Middle East. Dermatol Ther (Heidelb). 2019 Jun;9(2):223-241. doi: 10.1007/s13555-019-0285-2. Epub 2019 Mar 8.

2. National Eczema Society. Calcineurin Inhibitors (Internet Accessed: MArch 8, 2024  Available from: https://eczema.org/information-and-advice/treatments-for-eczema/topical-calcineurin-inhibitors/

3. Porras-Luque JI. Topical Antimicrobial Agents In Dermatology  [Topical antimicrobial agents in dermatology]. Actas Dermosifiliogr. 2007 Sep;98 Suppl 1:29-39. Spanish. doi: 10.1016/s0001-7310(07)70179-5.

4. Sawangjit R, Dilokthornsakul P, Lloyd?Lavery A, Chua S, Lai NM, Dellavalle R, Chaiyakunapruk N. Systemic Treatments For Eczema: A Network Meta-Analysis. Cochrane Database Syst Rev. 2018 Nov 28;2018(11):CD013206. doi: 10.1002/14651858.CD013206. PMCID: PMC6516820.

5. National Library of Medicine. Complementary and alternative medicine treatments for atopic eczema. Cochrane Database Syst Rev. 2017 Sep; 2017(9): CD010938. Published online 2017 Sep 11. doi: 10.1002/14651858.CD010938.pub2.

6. Huang JT, Abrams M, Tlougan B, Rademaker A, Paller AS.  Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics 2009;123(5):e808?14. PMID: 19403473  DOI: 10.1542/peds.2008-2217

 

 

 

Related:

Eczema In African Adults: Causes, Types, and Symptoms

5 Common Skin Diseases In Africa

 

 

 

Published: March 17, 2024

© 2024. Datelinehealth Africa Inc. All rights reserved.

Permission is given to copy, use and share content freely for non-commercial purposes without alteration or modification and subject to attribution as to source.