Eczema

Posted in News on 13th April 2020

Eczema

Eczema is a general term for dermatitis, which simply means inflammation of the skin. All types of eczema cause itching and redness and some will blister, weep or peel.

There are several types of eczema. Atopic dermatitis is considered a severe and chronic (long-lasting) form.

The term “eczema” is often used interchangeably with “atopic dermatitis.” However, each type of eczema, including atopic dermatitis, has somewhat different triggers, symptoms and treatments. That’s why it’s important to know which type or types (since a person can have more than one type at the same time) you have, so that you are best able to manage it.

If your skin itches and turns red from time to time, you might have eczema. This skin condition is very common in children, but adults can get it too.  Approximately one in five children under six years of age suffer from eczema.  Children often grow out of it and as a result only one in twelve adults have eczema.

There are several different types of eczema;

  1. Atopic Ezcema/Atopic Dermatitis- a type of eczema that occurs more in children and may have a genetic element
  1. Contact Dermatitis- a type of eczema that occurs when the body comes into contact with a particular substance
  2. discoid eczema – a type of eczema that occurs in circular or oval patches on the skin
  3. varicose eczema – a type of eczema that most often affects the lower legs and is caused by problems with the flow of blood through the leg veins
  4. seborrhoeic eczema – a type of eczema where red, scaly patches develop on the sides of the nose, eyebrows, ears and scalp
  5. dyshidrotic eczema (pompholyx) – a type of eczema that causes tiny blisters to erupt across the palms of the hands

There are also some common symptoms for all types of eczema:

  • dry, scaly skin
  • redness
  • itching, which may be intense

 

The most common two forms are Atopic Dermatitis and Contact Dermatitis.

 

 

Atopic Dermatitis

This is the most common form of eczema. It usually starts in childhood, and often gets milder or goes away by adulthood. Atopic dermatitis is part of what doctors call the atopic triad. “Triad” means three. The other two diseases in the triad are asthma and hay fever. Many people with atopic dermatitis have all three conditions.

Symptoms

In atopic dermatitis:

  • the rash often forms in the creases of your elbows or knees
  • skin in areas where the rash appears may turn lighter or darker, or get thicker
  • small bumps may appear and leak fluid if you scratch them
  • babies often get the rash on their scalp and cheeks
  • your skin can get infected if you scratch it

The severity of eczema can vary a lot from person to person.

People with mild eczema may only have small areas of dry skin that are itchy every now and again.

In more severe cases, eczema can cause widespread red, inflamed skin all over the body. It also causes constant itching.

Scratching can disrupt your sleep, make your skin bleed, and cause secondary infections. It can also make itching worse.

A cycle of itching and regular scratching may develop – the itch-scratch cycle. This can lead to sleepless nights and difficulty concentrating.

Part of skin affected by eczema may also turn darker or lighter. This can happen after the condition has improved. This is more noticeable in people with darker skin.

It’s not a result of scarring or a side effect of steroid creams. It can be more of a “footprint” of old inflammation and eventually returns to its normal colour.

Signs of an infection

Areas of skin affected by eczema can become infected. Signs of an infection can include:

  • your eczema getting a lot worse
  • fluid oozing from the skin
  • a yellow crust on the skin surface or small yellowish-white spots appearing in the eczema
  • the skin becoming swollen and sore
  • a high temperature (fever) and generally feeling unwell

Causes

Atopic dermatitis is likely caused by a combination of factors such as:

  • genes – you may be born with a higher chance of developing eczema. This could be because of the genes you inherit from your parents. If either of your parents or siblings had eczema, you are more likely to develop it.
  • dry skin – People with eczema often have very dry skin. This is because their skin is unable to hold on to moisture. This dryness may make the skin more likely to react to certain triggers, causing it to become red and itchy.
  • an immune system problem
  • triggers in the environment – Atopic dermatitis happens when your skin’s natural barrier against the elements is weakened. This means your skin is less able to protect you against irritants and allergens.

Eczema isn’t infectious, so it can’t be passed on through close contact.

Eczema can be mild and so just in a few small areas on the body or it can be very severe causing all over skin inflammation and irritation.

Eczema triggers

There are a number of things that may trigger your eczema symptoms. These can vary from person to person.

Common triggers include:

  • irritants – such as soaps and detergents, including shampoo, washing up liquid and bubble bath
  • environmental factors or allergens – such as cold and dry weather and dampness. More specific things such as house dust mites, pet fur, pollen and moulds may also be a trigger
  • food allergies – such as allergies to cows’ milk, eggs, peanuts, soya or wheat
  • certain materials worn next to the skin – such as wool and synthetic fabrics
  • hormonal changes – women may find their symptoms get worse in the days before their period or during pregnancy
    skin infections

Some people also say their symptoms get worse when the air is dry or dusty. Symptoms may also get worse when people are stressed, sweaty, or too hot or too cold.

 

Diagnosis

There is no diagnostic test for eczema. Your GP will be able to tell just by looking at your skin if you have eczema.

Treatments

Treatments for eczema (atopic eczema) can help to ease the symptoms.

There’s no cure, but many children find their symptoms improve as they get older.

The main treatments for eczema are:

  • emollients (moisturisers) – used every day to stop the skin becoming dry
  • topical corticosteroids – creams and ointments used to reduce swelling and redness during flare-ups

Emollients

Emollients are moisturisers and you apply them to your skin. They then help to reduce water loss by covering your skin with a protective film.  They make the skin feel less dry and may also help protect against inflammation.  Emollients also help to reduce the number of flare-ups you have.

Choosing an emollient

Several different emollients are available.

Your GP may tell you to use a mix of emollients, such as:

  • an ointment for very dry skin
  • a cream or lotion for less dry skin
  • an emollient to use instead of soap
  • an emollient to add to bath water or use in the shower
  • one emollient to use on your face and hands, and a different one to use on your body

The difference between lotions, creams and ointments is the amount of oil they contain.

Ointments contain the most oil so they can be quite greasy. But they are the most effective at keeping moisture in the skin.

Lotions contain the least amount of oil so aren’t greasy, but can be less effective. Creams are somewhere in between.

If you have been using a particular emollient for some time, it may become less effective or may start to irritate your skin.

If this is the case, you may find another product suits you better.

It can often be a case of trial and error to find the one that suits you best.

Always look out for emollients without Sodium Lauryl Sulphate or SLS as this ingredient can worsen eczema.

My favourite emollients which I recommend all the time are Avene Xeracalm (available in a cleansing oil, cream and balm), Diprobase and Hydromol.  Try to use a pump dispenser rather than a tub to avoid contamination.

How to use emollients

Use your emollient all the time, even if you’re not experiencing symptoms.

Many people find it helpful to keep separate supplies of emollients. You might keep a supply at work or school, or a tub in the bathroom and one in a living area.

To apply the emollient:

  • use a large amount
  • don’t rub it in – smooth it into the skin in the same direction the hair grows
  • after a bath or shower, pat the skin dry and apply the emollient while the skin is still moist to keep the moisture in, within 3 minutes if possible

You should use an emollient at least twice a day if you can, or more often if you have very dry skin.

During a flare-up, apply generous amounts of emollient even more frequently. But remember to treat inflamed skin with a topical corticosteroid. Emollients used on their own aren’t enough to control it.

Topical corticosteroids

If your skin is sore and inflamed, your GP may prescribe a topical corticosteroid (applied to your skin). This can reduce the inflammation within a few days.

Topical corticosteroids can be prescribed in different strengths. This depends on the severity of your eczema and the areas of skin affected.

They can be:

  • very mild (such as hydrocortisone)
  • moderate (such as clobetasone butyrate)
  • even stronger (such as mometasone)

If you need to use corticosteroids frequently, talk to your GP. They can check the treatment is working and you’re using the right amount.

How to use topical corticosteroids

Don’t be afraid to apply the treatment to affected areas to control your eczema.

Follow the directions on the patient information leaflet that comes with your medication. This will give details of how much to apply.

Most people only have to apply it once a day as there’s no evidence there’s any benefit to applying it more often.

When using a topical corticosteroid:

  • apply your emollient first and wait 30 minutes until the emollient has soaked into your skin. You might also prefer to apply the corticosteroid at a different time of day (such as at night)
  • apply the recommended amount of the topical corticosteroid to the affected area
  • continue to use it until 48 hours after the flare-up has cleared so the inflammation under the skin surface is treated

Side effects

Topical corticosteroids may cause a mild stinging sensation for less than a minute as you apply them.

In rare cases, they may also cause:

  • thinning of the skin – if the strong steroids are used in the wrong places, such as the face, for several weeks
  • changes in skin colour – usually, skin lightening after many months of using very strong steroids. Most lightening after eczema is a “footprint” of old inflammation and nothing to do with treatments
  • acne (spots) – especially when used on the face in teenagers
  • increased hair growth

Most of these side effects will improve once treatment stops.

Your risk of side effects may be increased if you use a strong topical corticosteroid:

  • for many months
  • in sensitive areas such as the face, armpits or groin
  • in large amounts

Your GP should prescribe the weakest effective treatment to control your symptoms.

Antihistamines

Antihistamines are a type of medicine that block the effects of a substance in the blood called histamine.

They can help relieve the itching associated with eczema.

They can either be sedating, which cause drowsiness, or non-sedating.

If you have severe itching, you may try a non-sedating antihistamine.

If itching during a flare-up affects your sleep, talk yo your pharmacist or GP about taking a sedating antihistamine.

Sedating antihistamines can cause drowsiness into the next day. It may be helpful to let your child’s school know they may not be as alert as normal.

Bandages and wet wraps

In some cases, your GP may prescribe special medicated bandages, clothing or wet wraps to wear over areas of skin affected by eczema.  Even wearing a tubigrip over the skin after applying your emollient overnight may prove very beneficial.

These can be used either over emollients or with topical corticosteroids to prevent scratching. They allow the skin underneath to heal, and stop the skin drying out.

Steps to ‘Soak and Seal’

1.Fill bath with warm water and soak for 5 to 10 minutes

  1. After bathing, pat the skin lightly with a towel, leaving it slightly damp
  2. Apply prescription topical medication to the eczema-affected areas of skin as directed

4.Within three minutes, liberally apply a moisturizer all over the body

  1. Wait a few minutes to let the moisturizer absorb into the skin before dressing or applying wet wraps

THINGS TO REMEMBER

-DO NOT use excessively hot or cold water

-DO NOT scrub the skin with a loofah or rough washcloth

-DO NOT wait longer than 3 minutes after bathing to apply moisturizer

-DO avoid using soap, harsh bubble baths or perfumed bath washes

-DO Soak and Seal several times a week or as your schedule

Lifestyle

Wearing cotton may improve symptoms for some patients

Keeping your bedroom cool at night and using only a light bed sheet may be beneficial

Careful selection of washing powders and detergents may be helpful

Some foods may trigger flare ups so keeping a food diary may be helpful to identify these.

Moderate exposure to sunlight may allieviate symptoms of eczema, however may not benefit everyone as heat and sweat are also common flare up triggers.  If exposing the skin to sunlight, always practice safe exposure.  Start by limiting the exposure to 5 minutes per day and see how the skin reacts.  Avoid the sun between 11am and 3pm, and use a high SPF sunscreen.  I recommend Avene SFP50 or Elave SPF50.

 

 

 

 

 


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