🧴 Men's Health

Eczema (Atopic Dermatitis) in Nigeria

Itchy, inflamed skin — understanding and managing eczema in a tropical climate

Eczema (atopic dermatitis) is a chronic inflammatory skin condition causing intense itching, dryness, and rashes. It is common in Nigerian children (affecting up to 10%) and persists into adulthood in many. Lagos heat, dust, and humidity complicate management — but with the right treatment approach, most people can achieve long periods of clear skin.

Signs and Symptoms

✓ Intense itching — often worse at night

✓ Dry, sensitive skin

✓ Red, inflamed patches — in dark skin, eczema may appear grey, brown, or purple rather than red

✓ Thickened, leathery skin from chronic scratching (lichenification)

✓ Small, raised bumps that may weep fluid when scratched

✓ Location: inner elbows, behind knees, wrists, neck (adults); face and scalp (infants)

✓ Skin that darkens or lightens after flares (post-inflammatory hypo/hyperpigmentation)

Risk Factors

Family history of eczema, asthma, or hay fever (the atopic triad)
Triggers: sweat, heat, dust mites, pet hair, certain soaps/detergents, synthetic fabrics
Dry skin — fundamental to eczema pathophysiology
Stress — reliably triggers and worsens flares
Certain foods in young children (cow's milk, egg, peanut — discuss with doctor)
Hard water — increases skin irritation
Frequent bathing with harsh soaps stripping the skin barrier

When to Seek Help

Weeping, crusted, or infected eczemaInfected eczema (oozing pus, increasing redness and pain) needs antibiotics — see a doctor.

Eczema not responding to OTC hydrocortisone creamPrescription-strength steroids or non-steroidal agents (tacrolimus) may be needed.

Child with severe eczema affecting sleep and schoolPaediatric dermatology referral — severe childhood eczema significantly impacts quality of life and development.

Widespread eczema covering large body surface areaMay need systemic treatment (oral immunosuppressants or biologics).

Tests & Diagnosis

🧪 Clinical diagnosis

Eczema is diagnosed clinically — by pattern, distribution, and history. No blood test confirms eczema.

🧪 Patch testing

Identifies contact allergen triggers — useful for contact dermatitis mimicking or co-existing with eczema.

🧪 Specific IgE (RAST) or skin prick test

For children with suspected food or inhalant allergies contributing to eczema.

🧪 Skin swab

If infection (impetigo, eczema herpeticum) is suspected — guides antibiotic or antiviral choice.

Treatment Options

Emollients (moisturisers) — the foundation

Apply a thick, fragrance-free emollient (aqueous cream, petroleum jelly/Vaseline, shea butter) all over the body at least twice daily. Apply immediately after bathing to lock in moisture. This is more important than any prescription medicine. Nigerian shea butter (ori) is an effective, affordable emollient.

Topical corticosteroids for flares

Mild (1% hydrocortisone) for face and folds; moderate-potent (betamethasone, clobetasol) for body. Apply thinly to inflamed areas only — not all over. Use for 7–14 days for a flare, then stop. Do not use strong steroids on the face.

Avoid triggers

Wear cotton (not synthetic) fabrics. Use fragrance-free soap and detergent. Bathe in lukewarm (not hot) water. Keep bedroom cool. Use a fan rather than staying sweaty.

Antihistamines for itch at night

Sedating antihistamines (chlorphenamine) at night reduce scratching and improve sleep. Non-sedating antihistamines are less effective for itch.

Tacrolimus/pimecrolimus ointment

Steroid-sparing agents — useful for face and sensitive areas where steroids should not be used long-term. Prescription only.

Wet wrapping for severe flares

Applying emollient, then a steroid, then wrapping in wet bandages overnight — rapidly reduces severe flares. Can be done at home with guidance.

Dupilumab (biologic) for severe eczema

A monthly injectable biologic that dramatically controls severe eczema. Available in Nigeria but very expensive — not yet on NHIA formulary.

Frequently Asked Questions

Is eczema contagious?

No — eczema is not infectious and cannot be transmitted to others. It is an immune system and skin barrier disorder.

Does diet cause eczema in adults?

Food triggers are significant mainly in young children with eczema, particularly milk and egg. In most adults, diet is rarely the primary driver. Elimination diets without guidance from an allergist can cause nutritional deficiency in children.

Why does eczema get worse in the heat in Nigeria?

Sweat irritates already compromised skin barrier. Heat increases itching. Cotton clothing, fans, staying in cool environments, and bathing after sweating (followed immediately by emollient) help manage this.

Is shea butter good for eczema?

Yes — shea butter is an effective natural emollient. It moisturises, reduces inflammation mildly, and is fragrance-free in its pure form. Use unrefined, pure shea butter (ori) without additives. It is an excellent and affordable alternative to commercial emollients.

Can I use skin lightening creams on eczema-affected skin?

No — many skin lightening products contain hydroquinone or mercury, which are irritants and sensitisers that dramatically worsen eczema. Topical steroids used incorrectly for lightening also cause skin thinning. Avoid all such products on eczematous skin.