Understanding Eczema: Triggers, Treatment, and Care
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On JustGospel's Medical Monday with Lindi Tshabangu, Dr. Matla unpacked eczema (atopic dermatitis)—a chronic genetic skin condition requiring careful management and understanding.
What is Eczema?
Building on previous allergy discussions, eczema occurs when the immune system reacts to non-problematic triggers, causing rashes with itching, redness, and inflammation. "It's of chronic nature," Dr. Matla explained. "Even if the rash goes away, it doesn't die off. People say they've outgrown eczema, but when they encounter a trigger later in life, it comes back—it's within their system."
The rash appears mainly on flexure areas (skin folds and bends): elbows, wrists, knees (behind), ankles, face (especially cheeks and forehead), neck, back of hands, and trunk. Sometimes thin, sometimes thick and scaly.
The Atopic Family
Eczema is part of the "atopic family"—genetic conditions including asthma, allergic rhinitis, and conjunctivitis (cloudy, teary, itchy eyes). "Where there's one, you'd likely find the other."
While primarily genetic, environmental factors—pollution, climate changes—mean people without family history can develop eczema. It usually presents in children under five (even infancy), though it can appear in adolescence or adulthood. Most children outgrow it, but for many, it persists or returns with triggers.
Common Triggers
Products: Harsh soaps (especially antibacterial or scented), perfumes, wool clothing (irritates skin—cotton preferred)
Allergens: Cow skin, grass, dust
Stress: Studies show stress alone can trigger eczema
Climate: Winter's dry air causes skin to crack and become irritable; extreme cold or hot weather; hot baths (causes moisture evaporation)
Food Allergens: Fish, shellfish, wheat products, sesame, nuts, milk, eggs—especially if person has proven allergies
Note: Lactose and gluten intolerance cause stomach irritation, not eczema.
Prevention Strategies
"It's difficult to prevent eczema itself," Dr. Matla clarified. "What you prevent is exposure to triggers, worsening, or recurrence." Breastfeeding over formula feeding may reduce risk.
Management Tips:
Bathing: Quick 2-5 minute showers/baths with lukewarm (not hot) water—prolonged water exposure dries skin
Moisturize: Use emollients to keep skin moist; dry skin cracks and worsens eczema
Clothing: Cotton only; avoid wool
Stress Management: Reduces flare-ups
Temperature Balance: Avoid extreme cold or heat
Treatment Approach
First Step: Local pharmacy for over-the-counter medication—topical steroids or oral antihistamines (tablets or liquid for children)
When to See a Doctor:
If rash doesn't improve after one month
Some conditions mimic eczema (like psoriasis—an autoimmune disease) requiring different treatment
Blood tests or skin biopsy may be needed for diagnosis
Steroid Warning: Don't use steroids long-term without consulting a doctor. Topical steroids cause skin thinning (making capillaries visible); oral steroids lower immune system and cause bone issues like avascular necrosis.
Emotional Impact
"Eczema can cause emotional distress because of appearance," Dr. Matla emphasized. "And stress triggers eczema—creating a vicious cycle. Parents must understand it's not just a rash. It affects self-image, especially in children. It really needs to be under control."
The Bottom Line
While prevention is limited, controlling triggers is key: avoid harsh products, wear cotton, manage stress, maintain strict skincare with moisturizers, and identify food allergens. If over-the-counter treatments fail after one month, seek medical help. Don't stay on steroids long-term—they cause more damage than benefit.
"We can't prevent eczema, but we can prevent triggers and keep it under control," Dr. Matla concluded.
What is Eczema?
Building on previous allergy discussions, eczema occurs when the immune system reacts to non-problematic triggers, causing rashes with itching, redness, and inflammation. "It's of chronic nature," Dr. Matla explained. "Even if the rash goes away, it doesn't die off. People say they've outgrown eczema, but when they encounter a trigger later in life, it comes back—it's within their system."
The rash appears mainly on flexure areas (skin folds and bends): elbows, wrists, knees (behind), ankles, face (especially cheeks and forehead), neck, back of hands, and trunk. Sometimes thin, sometimes thick and scaly.
The Atopic Family
Eczema is part of the "atopic family"—genetic conditions including asthma, allergic rhinitis, and conjunctivitis (cloudy, teary, itchy eyes). "Where there's one, you'd likely find the other."
While primarily genetic, environmental factors—pollution, climate changes—mean people without family history can develop eczema. It usually presents in children under five (even infancy), though it can appear in adolescence or adulthood. Most children outgrow it, but for many, it persists or returns with triggers.
Common Triggers
Products: Harsh soaps (especially antibacterial or scented), perfumes, wool clothing (irritates skin—cotton preferred)
Allergens: Cow skin, grass, dust
Stress: Studies show stress alone can trigger eczema
Climate: Winter's dry air causes skin to crack and become irritable; extreme cold or hot weather; hot baths (causes moisture evaporation)
Food Allergens: Fish, shellfish, wheat products, sesame, nuts, milk, eggs—especially if person has proven allergies
Note: Lactose and gluten intolerance cause stomach irritation, not eczema.
Prevention Strategies
"It's difficult to prevent eczema itself," Dr. Matla clarified. "What you prevent is exposure to triggers, worsening, or recurrence." Breastfeeding over formula feeding may reduce risk.
Management Tips:
Bathing: Quick 2-5 minute showers/baths with lukewarm (not hot) water—prolonged water exposure dries skin
Moisturize: Use emollients to keep skin moist; dry skin cracks and worsens eczema
Clothing: Cotton only; avoid wool
Stress Management: Reduces flare-ups
Temperature Balance: Avoid extreme cold or heat
Treatment Approach
First Step: Local pharmacy for over-the-counter medication—topical steroids or oral antihistamines (tablets or liquid for children)
When to See a Doctor:
If rash doesn't improve after one month
Some conditions mimic eczema (like psoriasis—an autoimmune disease) requiring different treatment
Blood tests or skin biopsy may be needed for diagnosis
Steroid Warning: Don't use steroids long-term without consulting a doctor. Topical steroids cause skin thinning (making capillaries visible); oral steroids lower immune system and cause bone issues like avascular necrosis.
Emotional Impact
"Eczema can cause emotional distress because of appearance," Dr. Matla emphasized. "And stress triggers eczema—creating a vicious cycle. Parents must understand it's not just a rash. It affects self-image, especially in children. It really needs to be under control."
The Bottom Line
While prevention is limited, controlling triggers is key: avoid harsh products, wear cotton, manage stress, maintain strict skincare with moisturizers, and identify food allergens. If over-the-counter treatments fail after one month, seek medical help. Don't stay on steroids long-term—they cause more damage than benefit.
"We can't prevent eczema, but we can prevent triggers and keep it under control," Dr. Matla concluded.
