- Eczema, or atopic dermatitis, is a very common inflammatory condition of the skin
- Most commonly affecting children, it does also affect adults, and is often accompanied by asthma and hay fever
- While the cause isn’t fully known, there are genetic and environmental factors which contribute to it
- It consists of a red, dry, itchy rash, sometimes with scaly skin or weeping
- It is treated with a combination of: anti-inflammatory agents (usually steroids), moisturisers, itch relief, and antibiotics (when infection is present); you should consult your doctor for the best advice on how to manage your condition
- You can live a full and normal life with eczema, it just needs some extra care and attention!
WHAT IS ECZEMA?
Eczema, also known as atopic dermatitis, is an inflammatory condition of the skin, characterised by a red, itchy, scaly rash on certain parts of the body. It is very, very common – around 1 in 5 kids has eczema, and between 2 and 5 in 100 adults have it. Most often it appears as a child, then might go away in the teen years, but for some it appears, or reappears in adulthood. It affects boys and girls equally.
People who have asthma and hay fever are more likely to have eczema – all of these conditions are termed “atopic”. Approximately one third of kids with eczema will develop asthma and/or hay fever.
Different people have different severities – for some they may not be overly bothered by it, but for others constant itch and disfiguring skin changes have a massive impact of their quality of life.
Often eczema symptoms come and go over time, returning during “flare ups”; these can have triggers, such as foods, or contact with certain chemicals, or stress, but sometimes they may happen without any obvious reason.
WHAT CAUSES IT?
Well, nobody fully understands the cause yet, but we know that a combination of factors are involved.
People with eczema tend to have defects in the skin barrier, and overly reactive inflammatory and allergy responses. This combined with environmental factors, including contact with soaps, detergents and any other chemicals applied to the skin, exposure to allergens, and infection with certain bacteria and viruses produces the signs and symptoms of the condition.
Eczema also tends to run in families; there is a gene which dictates the make-up of one of the proteins in the outer layer of the skin which is often altered in people with eczema. This results in a skin barrier that doesn’t work as well as it should, allowing irritating substances to enter the skin, resulting in itching and inflammation, and also making the skin more susceptible to infection. If your parents have this gene, then you are more likely to have it too.
ARE THERE THINGS OR EVENTS THAT MAKE IT WORSE, OR BRING ON A FLARE-UP?
Yes there are; these things can be divided into two groups, those concerning the person with eczema, and those concerning their environment:
b. Skin infections – for example with Staphylococcus, or with Herpes
c. Skin dryness
e. Sweating, e.g. from exercise
e. Soaps, detergents, other chemicals
THE SYMPTOMS AND SIGNS OF ECZEMA
The primary symptom of eczema is an itchy rash. The signs (this means the visible characteristics) include a rash, which is red, dry, and often scaly, accompanied by scratch marks and often cuts from scratching. The rash can affect any part of the body, but common areas are the creases of skin at the elbow and knees, and the wrists and neck. Some people get coin-shaped rashes on their limbs, while others get bumps forming at hair follicles.
With repeated scratching the skin can become thickened. In the initial stages of a flare-up, there may be little blisters, or weeping. Additionally, if the skin gets infected, there may be swelling and increased skin temperature. The colour of the skin can change, to become either lighter or darker.
SO IF I HAVE ECZEMA, OR MY CHILD HAS ECZEMA, WHAT SHOULD I DO ABOUT IT?
Firstly, it is good to seek advice from a medical professional. Unfortunately there is still no cure for eczema, and nor is there one single treatment or remedy that will solve all its issues. Getting on top of the condition and managing it well requires a holistic approach, and lots of support from family and friends.
If you or your child is diagnosed with eczema, there is a standard treatment algorithm to follow, which is based on controlling the inflammation (usually with topical steroid creams), moisturising and treating any infection. These treatments can be prescribed by a doctor (usually a general practitioner or family doctor can manage mild cases, more severe cases warrant seeing a dermatologist).
It is also important to tackle the itch, because scratching further increases the itch sensation, and can result in damage to the skin, though tears and cuts, which increase risk of infection and scarring, and also in the long term scratching can result in thickening of the skin, which is cosmetically undesirable. Some doctors will not be familiar with the treatment options for itch, in which case you can seek out specialist advice from a dermatologist, pharmacist, or through your own research.
Eczema cannot be prevented per se, but regular use of moisturisers can help keep the skin barrier healthy and reduce the likelihood of flare-ups. Some people also get help from eliminating certain foods from their diet: if there are known triggers these should be avoided, but some nutritionists also advise avoiding certains substances; this is an area of ongoing research, and some medical doctors may be dismissive of this approach before more definitive research is available. You should also take care to use very gentle washes for bathing, and gentle detergent for washing clothes.
Many people ask why there is no one single cure for eczema: well, hopefully there will one day be a solution, but because there are so many facets to this condition, it will not likely be a single magic pill.
TREATMENTS FOR ECZEMA
1. Most treatments, except in more severe cases, are topical, meaning they are applied directly to the affected skin
2. To treat the inflammation, steroids and calcineurin inhibitors are used – these are both prescription medicines in most countries
a. Steroids come in different strength, your doctor will advise the correct product and how to use it
b. Many people fear the side effects of steroids, such as thinning of the skin; however, the risk of side effects is mostly with improper use of steroids, such as too much for too long a period; used wisely and carefully, they do more good than harm
c. Weaker steroids are used for thin / sensitive areas of skin, such as the face
d. Calcineurin inhibitors have fewer side effects, but are generally not as effective as more powerful steroids; your doctor can advise you on which is best for your condition, because no two people are the same or have the same eczema
3. Dryness is managed with moisturisers; however, not all moisturisers are the same
b. Ideally, choose a moisturiser that you are happy to apply often; you should be moisturising several times a day, once is not sufficient for eczema skin
c. Some moisturisers have ingredients, such as ceramides or filaggrin breakdown products, that help repair the skin barrier – these are ideal choices
d. Avoid aqueous cream, which can irritate the skin and make your eczema worse
4. Itch is often neglected, but is very important to manage well; the less you scratch, the less itch you will have, and the better the other treatments can work
b. Anti-histamines tend not to work well for eczema itch
c. Calamine lotion should be avoided, because it is very drying to the skin
d. At night time, kids might benefit from wearing mitts, which lessen the damage to the skin from involuntary scratching during sleep
5. Antibiotics may be required if there is concurrent skin infection
6. Bandages and wraps are sometimes used to prevent scratching and aid moisturising
7. UV light therapy is useful for some adults with eczema
8. Avoidance of triggers and things that will exacerbate your eczema
b. Food allergies – seek out dietary advice from a professional to identify and eliminate potential allergens
c. As best you can avoid contact with harsh chemicals, soaps and detergents
d. Use a non-biological clothes detergent, and rinse clothes twice if possible
e. Avoid use of soaps – choose a non-soap based sensitive skin wash instead
f. Wear non-rubber, non-powdered gloves doing household chores
g. Maintain a healthy mind – stress is a well known trigger; avoiding stress can involve enlisting the help and support of family, friends, and even colleagues at work
9. Overall, aim to keep your skin well moisturised over the longer term (which requires ongoing moisturising between flare-ups), and treat flare-ups as early as possible
WHAT IS THE LONGER TERM PICTURE?
While there is no cure for eczema, you can still live a normal and full life with the condition. It requires some thought, planning and care, but it should not stop you doing the things you love, or being an active member of society. Never let anybody tell you otherwise!