Eczema

What is eczema?

Eczema or dermatitis are two medical terms used to describe numerous skin conditions. The word eczema comes from the Greek and means ‘to boil over’. Like many allergic conditions the severity and type of the condition can vary from person to person. Although it can sometimes look very unpleasant eczema is not contagious.

What are the symptoms of eczema?

The main symptoms of eczema is skin that is dry, red and inflamed. The area of skin that is affected is often very itchy and in some cases small blisters may form, which can weep and become crusted. Eczema is usually found on the face, hands, the insides of the elbows and the backs of the knees, but it can cover most of the body. Flare up’s, when the condition gets worse can occur when the immune system responds to external triggers or at times of stress.

What causes eczema?

The cause of eczema depends on what type you have, read below for more information on the different types. However, in adults, eczema can be triggered off by certain chemicals so care may need to be taken in some jobs. Areas of work with a high risk include: hairdressing, nursing, cleaning, engineering, animal handling or plastering.

The skin

To understand eczema more clearly it might be helpful to know more about your skin. The skin is the largest organ of the body and has three layers. Our skin protects us from the elements, regulates body temperature and permits sensations of touch, heat and cold.

The three layers of skin are the epidermis this is the outer most layer and provides us with our skin tone and provides a waterproof barrier. The dermis is under the epidermis and contains nerve endings, blood vessels, hair follicles as well as oil and sweat glands. The dermis secretes oil to keep it smooth and regulates temperature. Then the deepest layer is the hypodermis made mostly of fat this layer as a cushion and insulates the body.

Healthy skin works as a shield and protects the body from infection it also regulates temperature. In people with eczema the skin’s shield doesn’t work as well allowing irritants to enter this might by because it does not produce as much fat and oils as other people.

Types of eczema

There are many different forms of eczema, which may look and appear very similar but have very different causes.

Two of the most common types of eczema are atopic eczema and contact dermatitis:

Atopic eczema

Atopic eczema also known as atopic dermatitis is probably the most common form of eczema and is believed to affect up to 1 in every 5 children. Atopic eczema is thought to be a hereditary condition and people with eczema may also develop hay fever and/or asthma.

Both adults and children can be affected by atopic eczema though children will often grow out of it by the time they reach their teens.

People who have atopic eczema are sensitive to things found in the environment, these are known as allergens and may include any of the following:

• House dust mites – they occur in all homes all over the world and are commonly found in mattresses, bedding, carpets and soft toys. They are completely harmless and many of us are totally unaware of their presence.
• Animals – e.g. cats or dogs.
• Grass, tree or weed pollens.
• Occasionally foods, such as milk, eggs, chocolate or nuts.

The main symptom of atopic eczema is the unbearable itchiness, then the constant scratching  can cause your skin to split, leaving it prone to infection. Other symptoms include, dry skin, redness and inflammation. Factors, such as stress and infections, like the common cold have been known to make the symptoms of atopic eczema worse. Atopic eczema is commonly seen in areas where the skin creases such as elbows or behind knees.

Contact dermatitis

Contact dermatitis develops when the skin has been in frequent contact with an everyday irritant or allergen in the environment. These are the 2 types of contact dermatitis, allergic or irritant, both have similar symptoms to atopic eczema. The main differences between the two types is the area affected, in allergic contact dermatitis a larger area of the body can be affected even if it hasn’t been in direct contact with the allergen. In irritant contact dermatitis the irritation is usually limited to the area of the body that has been in contact with the irritant, it is usually the hands that are affected. The other main difference is the reaction time, in irritant dermatitis the reaction can be straight away but with allergic dermatitis there can be over a 24 -72 hour delay in the reaction.

It is not known why some people develop an allergic reaction to a substance when to others it remains harmless. Irritant dermatitis is more common in some professions such as hairdressers, cooks, nurses, cleaners and machine operators.

Symptoms, when they appear, may include itching, redness, flaking and cracking of the skin. An example of contact dermatitis is, a rash that appears on the wrist after wearing a watch that contains nickel. Nickel is the most common cause of allergic dermatitis in women.

Common allergens include:

• Nickel – e.g. spectacle frames, cheap jewellery or belt buckles.
• Wet cement.
• Rubber and latex e.g. condoms or rubber gloves.
• Cosmetics, hair dyes and perfumes.
• Plants and flowers- e.g. dahlias, poison ivy or chrysanthemums.

Common irritants include:

• Paints
• Petrol
• Washing-up liquid, soaps and fabric conditioner.
• Shampoo
• Cosmetics
• Cleaning chemicals such as disinfectants and bleaches.

In order to prevent reactions occurring, you must try to avoid contact with any allergen or irritant that you know causes your eczema symptoms to flare up.

Are there any complications with eczema?

Eczema can have a huge impact on your wellbeing, it can affect your self-confidence and cause sleepless nights due to itchy skin so it is important to treat it effectively.

To avoid complications the most important thing to do if you have eczema is to keep the skin moisturised to prevent it from drying out. If the skin is dry it becomes a good home for the bacteria Staphylococcus aureus. If the eczema becomes infected with Staphylococcus the skin may become very red, weep a lot and produce yellowish dry crusts. You may also notice blisters filled with a yellow pus. If this condition develops it will need to be treated with antibiotics, such as penicillin.

One of the most serious complications with atopic eczema is eczema herpeticum, this develops when eczema becomes infected with the herpes virus. Eczema herpeticum is a serious condition and medical help must be sought. The symptoms of eczema herpeticum may include a high temperature, an extensive rash with small skin blisters filled with yellow pus and you may generally feel unwell. The rash can cover the whole of the skin surface. Eczema herpeticum can occur when anyone with eczema, especially if it is sore and open, has skin to skin contact with someone who has active facial (cold sores) or genital herpes. Eczema herpeticum is treated with oral anti-virus antibiotics. However, considering how common the herpes simplex virus and atopic eczema are, this condition is fortunately quite rare.

If at any time the skin is very sore, weepy or you develop small blisters with pus then the eczema may have become infected, you should visit your doctor for advice and treatment.

What tests will I have to diagnose eczema?

Eczema is usually diagnosed from the appearance of the skin alone. It might also be recommended that you have an allergy test to find out what the irritant or trigger is. To purchase an allergy test or for more information on allergy tests click, see below.

Occasionally if eczema is severe your doctor might carry out a swab of the skin to check for infection.

What treatments are available?

There is no cure for eczema but there are many treatments available, the treatment you require will depend on the severity of your symptoms. The aim of treatment is to reduce the inflammation and ease the discomfort of itchy skin. However, even after treatment the skin will always be sensitive and will often need special care. Remember, as with all types of allergies the best treatment is to find out what causes the eczema and then avoid it! Treatments available to minimise your eczema symptoms may include any of the following:

Emollients

Emollients are moisturisers that provide the skin with a protective barrier and prevent moisture loss. This barrier soothes the skin making it feel more comfortable. Emollients are available in many forms – ointments for very dry skin, creams and lotions for moderate eczema, gels for eczema that is under the hair and bath oils. As there is such a wide range of emollients available, it may be a case of trial and error before the most suitable one is found for you. Like all new products, it is advisable that you test a little on your skin first to ensure no irritation occurs. Emollients should be used at least twice daily and you may need to use a range of different ones. Apply the emollient liberally you can never apply too much.

Topical steroids

When eczema flares up and skin is very sore a steroid cream may be needed to reduce the inflammation. Topical steroids come in four different strengths: mild, moderate, potent and very potent. Your doctor will decide what treatment is needed for you. The cream is applied thinly to the affected area. Topical steroids should only be used as directed by your doctor or nurse. The mildest steroid is available over the counter at pharmacies and is called hydrocortisone, ask you pharmacist for advice. You can purchase hydrocortisone from our website, click here for more information or to buy.

Steroid creams should only be used during a flare-up and then stop the use when the flare-up has cleared.

Oral steroids

If eczema is severe a short course of oral steroids could be prescribed, this is usually in situations when topical steroids have failed to improve the eczema.

Other treatments

If other methods have failed and your eczema is severe your doctor may discuss the use of ultraviolet light treatment but only for older children and adults. Antihistamine tablets to reduce severe itching, stronger medication or wet wrapping are other treatments that your doctor may recommend. Wet wrapping is when a bandage is applied to the affected area to help sooth skin and help the emollient absorb into the skin. Bandages can also prevent the sufferer from itching irritated skin.

You should remember what works well for one person might not work well for another. Eczema is a very individual condition.

How can I prevent flare-ups?

To minimise the symptoms and avoid further attacks the most important thing is to avoid the trigger as much as possible. Exercise and sweat can make the skin itchy so try to shower as soon as possible after exercise. You should also do the following;

• Regularly dust and vacuum your house to reduce the population of house dust mites.
• Wash your child’s soft toys frequently to kill dust mites.
• Avoid scratching yourself and keep your child’s nails short to minimise skin damage.
• Keep to a strict skin care routine.
• Sleep in a fresh, cool room. Central heating dries out the skin.
• Avoid smoking and smoky conditions.
• Take lukewarm baths with emollients and don’t stay in too long.
• When swimming, shower straight after as chlorine irritates the skin.
• Apply only advised or prescribed moisturisers instead of highly perfumed products.
• Wear cotton fabrics and avoid clothes made of wool and other rough fibres.
• Dry yourself thoroughly after washing by patting the skin, rather than rubbing.
• Keep your skin moisturised with your chosen emollient.
• Use gloves when handling chemicals, solvents and detergents.