[dropcap]B[/dropcap]eneath her smooth even-toned skin and bright smile is a tale of pain and discomfort for Davine Otieno. Born 22 years ago, Davine is one of the many Kenyans who suffer from a rare health condition that is not only difficult to diagnosis but also treat.
According to medics, victims of Neglected Tropical Diseases (NTD) can only manage and live with them. In developing countries, close to a billion people suffer from such conditions. Davine, who is living with a rare condition known as eczema, has undergoned a lot of struggles in managing the condition. Her parents had to take her to several doctors before a proper diagnosis was made.
Commonly known as the “itch that scratches”, eczema is an inflammatory skin condition that affects adults and children alike. It is characterised by dry itchy inflamed skin, causing a lot of discomfort to the affected.
Moist body parts, which are the more susceptible to inflammation, include the neck, the inside of the elbows, back of the knee, the groin area and the face. The onset of an eczema flare, which is when the skin is inflamed, begins with the skin being itchy.
This leads to a rash which spreads as the surrounding patch of skin is irritated. The rashes ooze and the skin becomes crusty as intense itching takes place. One is advised to avoid itching to reduce further irritation.
“My mother says a few months after birth; the skin on my legs was very dry and would peel off. Though I received treatment over the years, it was only when I was 13 that I was given the proper diagnosis of eczema,” Davine recalls.
Previously regarded as a disease of industrial nations, that myth has been debunked with studies showing that it does not discriminate and affects people from all over the world.
Consultant dermatologist, Dr Caleb Kadima of Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu, says there are two types of eczema, one caused by intrinsic factors (atopic dermatitis) and the other caused by extrinsic factors (contact dermatitis).
Intrinsic factors in this case genetics, means that a person is born with the condition. Extrinsic factors are components within our environment that the body is hypersensitive to such as detergents and metals.
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According to Dr Kadima, a family history of the atopic syndrome, a syndrome characterised by a tendency to be hyper allergic, predisposes one to atopic dermatitis (eczema), allergic rhinitis (hay fever) or allergic asthma.
“If anyone in your family has an allergy, your chances of suffering from eczema are high. Eczema is an allergy just like asthma but the atopic syndrome manifests differently in people. This is why a person can have either eczema or asthma and in some cases both,” explains Dr Kadima.
Davine, who is a third year student at Moi University pursuing a degree in Mass Communications, says none of her immediate family members suffers from allergies. The only plausible explanation as to why she suffers from it is that her grandparents had allergies which they passed on through her parents.
Animal proteins
The more common type of eczema, atopic dermatitis is aggravated by consuming Tilapia, fingerlings (Omena), goat meat, dairy products and other foods containing animal proteins.
“One must find out what triggers their eczema inflammations to reduce chances of flares,” notes the dermatologist.
“Different people have different triggers. Once a patient can identify a trigger, treatment becomes easier because he/she will know what to avoid. Eczema is a condition that has to be managed since it cannot be cured,” says Dr Kadima.
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On the question of triggers, Davine laughs as she explains her predicament. “My triggers are dairy, wheat and scented soaps and oils. Though I’m supposed to avoid foods such as biscuits and cake, I can’t help myself!”
For contact dermatitis, people react to different elements within the environment. People react to wool, nylon, detergents, perfumed soaps and lotions and even antibacterial soaps.
Gold toned jewellery such as earrings and necklaces is common. The jewellery, whose base metal is nickel, is coated with very minimal amounts of gold.
When the skin comes into contact with the ornament, there is a negative reaction thus contact dermatitis.
According to Texas A&M University, nickel allergic contact dermatitis is the most common allergy on the North American continent.
About 14% of people suffer from this allergy, possibly because of an increase in nickel-based items in their environment. Possible symptoms include dry skin, inflamed skin, intense itching, swelling and rough patches of skin.
“I have had patients who come in saying their feet are itchy and upon further examination, we realise that the Sandak (rubber sandals) they have on is the trigger. People are allergic to different elements within the environment. Sometimes the trigger is what you least expect it to be,” he says.
Considered an infantile condition, eczema sufferers are supposed to outgrow the condition with less flare ups as they get older.
Usually children who contract it under the age of two years are not supposed to experience a flare up once they are adults but there are a few cases of recurrent childhood eczema.
Though it’s a common dermatological condition, not many studies have been done particularly in Africa to find better ways of managing it.
Lack of information is a big impediment to its treatment, as most people confuse it for other diseases or to be something of no consequence yet it can greatly lower the quality of life one leads.
The old adage, prevention is better than cure best describes the elimination method of eczema treatment.
Through this method, the patient eliminates all possible allergens for a period of time and reintroduces them one by one to see which will cause a reaction. This has proven to be more effective than any medical test to determine triggers.
“Patients I have treated who have used this method usually gain relief faster. In such instances, I don’t have to prescribe any over the counter creams. It’s the best way of managing eczema,” says Dr. Kadima.
Once there is inflammation, the main goal of any treatment is to keep the skin moisturised. Over the counter emollients include Oilatum and Epimax which are costly with cheaper alternatives being pure Vaseline and Arimis – milking petroleum jelly.
“When the skin is dry, the urge to itch can become uncontrollable. I advise my patients to avoid itching as it will worsen the condition.
A combination of antihistamine and well moisturised skin should lessen the discomfort one feels when they have a flare up,” advises Dr Kadima.
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“I have been using Candid B and Hydrocortisone creams for the past nine years. I apply the cream three times a week on my face, behind the knees and on the insides of my elbows. I can’t do without the creams. They have allowed me to lead a normal life,” she explains.
Though she believes the creams have helped manage her condition, Dr Kadima advises that long term use of Candid B is not advised because it contains steroids. Long term use of steroids has side effects such as making the skin light thus easy to tear and eventual photosensitivity.
Stigma
Just as any other misunderstood condition, eczema sufferers experience a lot of stigma from the society. A misconception that it is contagious makes many hide their condition so that they’re not shunned.
According to Dr Kadima, some of his patients have experienced stigma to the point of being asked to produce a medical letter explaining that what they have is not contagious.
“A female high school student was once asked to leave school and only return with proof that she will not infect other students. More awareness needs to be done on the condition,” he says.
For her parting shot, Davine supports the doctor’s call for more awareness campaigns.
“When I was in high school and had serious flares, some girls would avoid me saying that I was dirty and that I would ‘infect’ them.
“I wish people would educate themselves or at least ask questions rather than make assumptions and then treat us differently,” she says.
