The topic of skin allergy is always a difficult one, as often one may equate allergies to sensitive skin, or eczema of the skin. Others may also describe “wheals and flares” (also known as Urticariae) as an allergic skin reaction.
There are several common skin ailments, namely: atopic eczema, rosacea, sun allergies and urticariae.
1. Atopic Eczema
Eczema or dermatitis is a chronic, inflammatory disease of the skin that is caused by many different external and internal factors. Atopic eczema is the eczema that is partly due to allergic disease. It can present in patients that have other allergic or atopic diseases such as asthma or hayfever. It is often a childhood disease and can resolve in the teenage years, and then resurface in adulthood.
It primarily focuses on areas such as the hands, breasts or any other areas of the skin. In some children, this disease continues into adulthood and presents on the cubital fossae and behind the knees. The cause of this is multifactorial, including a large genetic component – as well as external factors such as dust mites, grass pollens, pollutants etc.
Often in times of seasonal change, one can develop a flare of their eczema. This presents in three stages, namely:
• Acute: red, itchy fluid-filled blisters or vesicles;
• Subacute: red itchy bumps with scaling;
• Chronic: thickened, lichenified skin.
Treatment would be to consult your dermatologist for options ranging from moisturisation - to topical steroids and ultraviolet therapy.
2. Rosacea
Rosacea is a chronic inflammatory disease that often leaves the skin red and raw, with dilated vessels. It is extremely sensitive to products and may be confused with allergic skin. This occurs in 3 stages:
1. Redness and dilated vessels;
2. Acne form pimples and pustules - as well as dilated vessels and redness;
3. Rhinophyma - which is thickened tissue (especially involving the nose).
The causative factors are once again multifactorial, which includes hormones, genetics, environmental factors and certain food triggers. Treatment: consult your dermatologist for topical oral and laser treatments (including the pulse dye laser.)
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3. Sun allergies
Sun allergies often present as a reddish, itchy rash involving sun exposed areas – usually quite soon after sun exposure. One may notice there is a clear demarcation, and areas that were not exposed to the sun are not affected.
Often sun allergies may also present with sensitivity to sunscreens. Treatment will include using chemically-free sunscreens, topical corticosteroids and exceptional sun protection (which is never a bad thing especially in South Africa).
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4. Urticariae
This is an allergic skin reaction presenting itself with “wheals and flares” or often “welts.” These look like red raised itchy bumps on the skin (on a normal skin surface) and it generally disappears within a few hours.
Urticaria is divided into 3 types:
1. Physical: this is in relation to a physical substance e.g.: food, pressure, vibration, exercise. Physical urticariae can be found in both acute and chronic urticariae.
2. Acute Urticariae: these have symptoms lasting less than six weeks. This is usually due to food, toxins, medication and parasitic infections. It is often treated with oral corticosteroids and antihistamines.
3. Chronic urticariae: this lasts for more than six weeks. An extremely difficult subtype to treat as often the cause is unknown.
Antihistamines are used however this is often refractory to treatment.
Angioedema should always be mentioned when discussing urticariae. This presents with swelling of the deeper tissues of the skin, but with no surface change. This is a medical emergency as swelling of the throat tissue can result and requires urgent attention.
Written by A2 Expert Panel member: Dr. Noori Moti-JoosubMBChB After qualifying as a Medical Doctor and Dermatologist, Dr Noori Moti-Joosub completed her registrarship in Dermatology at the Johannesburg Hospital. Although she does practice in general dermatology, Moti-Joosub’s focus lies in aesthetic practice and sun protection skin care. She brings a comprehensive Dermatological Consultancy to the Laserderm Dunkeld branch as well as the exclusive procedure of Mole-Mapping. Visit the website for more info www.laserderm.co.za
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Written by A2 Expert Panel member: Dr Anton Potgieter, MBBCh (Wits), FC (Plast Surg) SA
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Written by Dr Julian de Swardt MBA, PhD Acp, an A2 Magazine Contributing Doctor
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Written by A2 Expert Panel member: Dr Noori Moti-Joosub MBChB 
