Eczema

Eczema

What is atopic eczema?

Atopic eczema is a very common skin condition due to skin inflammation. It may start at any age but the onset is often in childhood. 1 in every 5 children in the UK is affected by eczema at some stage. It may also start later in life in people who did not have AE as a child.

The term ‘atopic’ is used to describe a group of conditions, which include asthma, eczema and hay-fever and food allergy. These conditions are all linked by an increased activity of the allergy side of the body’s immune system. ‘Eczema’ is a term which comes from the Greek word ‘to boil’ and is used to describe red, dry, itchy skin which can sometimes become weeping, blistered, crusted, scaling and thickened.

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What does it look like?

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Main body location

Widespread

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Can it appear anywhere?

Yes

What causes atopic eczema?

Atopic eczema is a complex condition and a number of factors appear important for its development including patient susceptibility and environmental factors. Patients typically have alterations in their skin barrier, and overly reactive inflammatory and allergy responses. Environmental factors include contact with soaps, detergents and any other chemicals applied to the skin, exposure to allergens, and infection with certain bacteria and viruses. A tendency to atopic conditions often runs in families (see below) and is part of your genes. An alteration in a gene that is important in maintaining a healthy skin barrier has been closely linked to the development of eczema. This makes the skin of patients with eczema much more susceptible to infection and allows irritating substances/particles to enter the skin, causing itching and inflammation. AE cannot be caught from somebody else.

Is atopic eczema hereditary?

Yes. Atopic eczema tends to run in families. If one or both parents have eczema it is more likely that their children will develop it too. Approximately one third of children with AE will also develop asthma and/or hay fever. AE affects both males and females equally.

What are the symptoms of atopic eczema?

The main symptom is itch. Scratching in response to itch may cause many of the changes seen on the skin. Itch can be severe enough to interfere with sleep, causing tiredness and irritability. Typically AE goes through phases of being severe, then less severe, and then gets worse again. Sometimes a flare up can be due to the reasons outlined below, but often no cause can be identified.

What does atopic eczema look like?

Atopic eczema can affect any part of the skin, including the face, but the areas that are most commonly affected are the creases in the joints at the elbows and knees, as well as the wrists and neck (called a flexural pattern). Other common appearances of AE include coin-sized areas of inflammation on the limbs (a discoid pattern), and numerous small bumps that coincide with the hair follicles (a follicular pattern).

Affected skin is usually red and dry, and scratch marks (accompanied by bleeding) are common. When AE is very active, it may become moist and weep fluid (during a ‘flare-up’) and small water blisters may develop especially on the hands and feet. In areas that are repeatedly scratched, the skin may thicken (a process known as lichenification), and this may cause the skin to itch more. Sometimes affected areas of the skin may become darker or lighter in colour than the surrounding, unaffected skin.

How is atopic eczema diagnosed?

The features of AE are usually easily recognised by health visitors, practice nurses and doctors, when they assess the skin. Blood tests and skin tests are usually not necessary. Occasionally the skin may need to be swabbed (by rubbing a sterile cotton bud on it) to check for bacterial or viral infections.

What makes atopic eczema flare-up?

  • Many factors in a person’s environment can make AE worse; these include heat, dust, woollen clothing, pets and irritants such as soaps, detergents and other chemicals.
  • Being unwell, for example having a common cold cancause a flare-up.
  • Infections with bacteria or viruses can worsen AE. Bacterial infection (usually with a bacteria called Staphylococcus) makes the affected skin yellow, crusty and inflamed, and may need specific treatment. An infection with the cold sore virus (herpes simplex) can cause a sudden painful widespread (and occasionally dangerous) flare-up of AE, with weeping small sores.
  • Dryness of the skin.
  • Teething in babies.
  • In some, food allergens may rarely cause a flare up
  • Stress

Can atopic eczema be cured?

No, it cannot be cured, but there are many ways of controlling it. As they get older, most children with atopic eczema will see their AE improve with 60% clear by their teens. However, many of these people continue to have dry skin and so need to continue to avoid irritants such as soaps, detergents and bubble baths.

AE may be troublesome for people in certain jobs that involve contact with irritant materials, such as catering, hairdressing, cleaning or healthcare work. In later life, AE can present as hand dermatitis and as result exposure to irritants and allergens must be avoided both in the home and at work.

Can atopic eczema be prevented?

Regular use of medical moisturisers can help restore the skin’s barrier in children who might otherwise develop AE.

Although exclusive breast-feeding has been advocated for the prevention of eczema in susceptible infants, there is no evidence that this is effective. There is also no definite evidence that organic dairy products help to reduce the risk of eczema, or that eating fish oil during pregnancy helps to prevent eczema in childhood.

For some patients who flare-up frequently, intermittent use of a topical steroid or calcineurin inhibitors (see below) may reduce the number of flare-ups.

Can someone with atopic eczema lead a normal life?

Yes. You can lead a full life including sports, swimming and travel. You may need to make minor changes such as keeping moisturiser with you at school, work or when away from home.

How can atopic eczema be treated?

‘Topical’ means ‘applied to the skin surface’. Most eczema treatments are topical, although for more severe eczema some people need to take ‘oral’ medication (by mouth) as well.

‘Complete emollient therapy’ is the mainstay of treatment for all patients with eczema as the most important part of their treatment – this means regular application of a moisturiser (also known as an emollient) and washing with a moisturiser instead of soap (known as a soap substitute).

Self care (What can I do?)

  • Moisturise your skin as often as possible, ideally at least 2-3 times each day. The most greasy, non-perfumed moisturiser tolerated is best. This is the most important part of your skin care. Smooth it on in the direction of hair growth. Do not put your fingers back and forth into the pot of moisturiser, as it may become contaminated and be a source of infection. It is best to remove an adequate amount to cover the skin with a spoon or spatula and put this on a saucer or piece of kitchen roll.
  • Wash with a moisturiser instead of soap (known as a soap substitute), and avoid soap, bubble baths, shower gels and detergents.
  • Wear non-powdered non-rubber gloves (e.g vinyl gloves) to protect your hands and avoid contact with irritants, such as when doing housework.
  • Rinse well after swimming and apply plenty of your moisturiser after drying. Make sure that the shower at the swimming pool contains fresh water and not chlorinated water from the swimming pool.
  • Wear comfortable clothes made of materials such as cotton and avoid wearing wool next to your skin.
  • Try to resist the temptation to scratch. It may relieve your itch briefly, but it will make your skin itchier in the long term. Smooth a moisturiser onto itchy skin.
  • Avoid close contact with anyone who has an active cold sore as patients with eczema are at risk of getting a widespread cold sore infection.
  • Do not keep pets to which there is an obvious allergy.
  • Keep cool. Overheating can make eczema itch more.
  • Treat eczema early – the more severe it becomes, the more difficult it is to control.
  • Wash clothes with a non-biological washing powder and use a double rinse cycle to remove detergent residues from the clothing.

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This information is provided by the British Association of Dermatologists.


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