Alice Uwase, a mother of two, has come to seek medical attention for his son who is one-and-a-half-year old at La Nou Velle Clinic in Remera, but looks confused and discouraged, perhaps, because of his deteriorating condition.

"My son doesn’t sleep at night, his body is always itchy and has sores all over his body. Letting him play with other kids is tricky because apart from harming him, some parents also don’t want their children to associate with mine due to his condition,” Uwase explains.

After examination of the baby, Dr Janvier Rusizana, who works at the clinic, says Uwase’s son is suffering from atopic eczema.

What’s atopic eczema?

Rusizana explains that atopic eczema, also known as dermatitis, is a skin condition which tends to flare up from time to time. It usually starts in early childhood.

"It’s mostly associated with athsma, allegic rhinitis or bronchitis, and it mostly occurs in children who have the history of other family members who suffered from one or more of these conditions,” he says.

Hereditary conditions are the main cause of eczema, but it is aggravated by allergy. It starts manifesting as early as two to three months of age.

"Allergy can be triggered by something present in atmosphere like plant pollen, fungal spores and dust. It can also be due to food substances, mostly proteins in the diet, chemicals used as additive, flavouring, emulsifying agents or preservatives,” says Dr Rachna Pandey, a medic at Ruhengeri Hospital.

She adds that dryness of the skin also predisposes one to atopic eczema., and that mental stress precipitates and aggravates the condition.

However, Pandey warns against using some cosmetics like soaps and shampoos, as well as using nylon clothes on the babies, as this could be the main factors that may lead to the child to suffer from the condition, especially if they are allergic to one of them.

Symptoms such as dryness of the skin, red angry looking rashes or vascular eruption with oozing, itchy skin which leads to scratching, stress, and sweats are clear signs of atopic eczema.

"The symptoms and signs start when an individual is exposed to an allergen, most commonly cold, but varies in individuals. Fragrances, powder, chalk, cold shower and some flower grains may aggravate the symptoms,” says Dr Achille Manirakiza of University Teaching Hospital Kigali (CHUK).

Managing the condition

Manirakiza adds that one should exclude foods that cause the condition from their daily diet for at least three to four days, and then include them again.

"Eczema will be induced by consuming the implicating food substances. It is best to avoid junk and ready-to-eat foods and bottled juices. One should also be cautious with high protein food like soya beans and meat. Rather, one should opt for foods like bananas, potatoes, sprouted green lentils and green onions as they help in fighting eczema due to their chemical composition,” he says.

Treatment is by using anti-allergic substances.

"Treatment consists of use of anti-allergy ointments or lotions along with steroid ointments. In severe cases, anti-allergy tablets are used. Oral steroids are also used for severe eczema,” says Pandey.

Rusizina advises that one should avoid allergy producing substances.

He says suitable moisturising creams and lotions should be applied on damp skin to help in retaining moisture, as well as to avoid the dryness of the skin.

Scratching the dry, itchy skin can lead to secondary bacterial infection, causing boils. Skin infections caused due to certain strains of streptococci can lead to swelling of legs due to secondary lymphangitis and lymphedema. Also, the skin can become dry and scaly causing discomfort and giving an ungainly appearance.

Prevalence

Dermatitis is a common diagnosis in dermatology in Rwanda; and surveys show some 10-15% of patients were diagnosed with it. Contact dermatitis is very common. The cause is often traditional medication of botanical origin externally applied or highly allergenic topical medication such as penicillin ointment or neomycin-containing preparations.

Rusizana says they treat about eight cases in a month at La Nou Velle Clinic.

Atopic dermatitis is very common worldwide and increasing in prevalence. It affects males and females equally and accounts for 10%-20% of all referrals to dermatologists.

Scientists estimate that 65% of patients develop symptoms in the first year of life, and 90% develop symptoms before the age of 5. Onset after age 30 is less common and often occurs after exposure of the skin to harsh conditions. People who live in urban areas and in climates with low humidity seem to be at an increased risk for developing atopic dermatitis.

About 10% of all infants and young children experience symptoms of the disease. Roughly 60% of these infants continue to have one or more symptoms of atopic dermatitis even after they reach adulthood. This means that more than 15 million people in the United States have symptoms of the disease.