This information was kindly contributed by the National Eczema Society. Links to their website can be found on our Educational Resources page.
Eczema, or dermatitis as it is sometimes called, is a group of skin conditions which can affect all age groups. In the United Kingdom, up to one fifth of all children of school age have eczema, along with about one in twelve of the adult population. The severity of the disease can vary. In mild forms the skin is dry, hot and itchy, whilst in more severe forms the skin can become broken, raw and bleeding. Although it can sometimes look unpleasant, eczema is not contagious. With treatment the inflammation of eczema can be reduced, though the skin will always be sensitive to flare-ups and need extra care.
The causes of eczema are many and varied, and depend on the particular type of eczema that a person has. Atopic eczema is thought to be a hereditary condition, being genetically linked. It is proposed that people with atopic eczema are sensitive to allergens in the environment which are harmless to others. In atopy there is an excessive reaction by the immune system producing inflamed, irritated and sore skin. Associated atopic conditions include asthma and hayfever. Other types of eczema are caused by irritants such as chemicals and detergents, allergens such as nickel, and yeast growths. In later years eczema can be caused by a blood circulatory problems in the legs. The causes of certain types of eczema remain to be explained, though links with environmental factors and stress are being explored.
There are several different types of eczema, many of which look similar but have very different causes and treatments. The first step in effective treatment of eczema is a correct diagnosis. It is very important to see a general practitioner in the first instance, who may make a referral to a specialist dermatologist for further diagnosis and treatment.
Atopic eczema is the commonest form of eczema and is closely linked with asthma and hayfever. It can affect both children and adults, usually running in families. One of the most common symptoms of atopic eczema is its itchiness (or pruritis), which can be almost unbearable. Other symptoms include overall dryness of the skin, redness and inflammation. Constant scratching can also cause the skin to split, leaving it prone to infection. In infected eczema the skin may crack and weep (‘wet’ eczema). Treatments include emollients to maintain skin hydration and steroids to reduce inflammation.
Develops when the body’s immune system reacts against a substance in contact with the skin. The allergic reaction often develops over a period of time through repeated contact with the substance. For example, an allergic reaction may occur to nickel, which is often found in earrings, belt buckles and jeans buttons. Reactions can also occur after contact with other substances such as perfumes and rubber. In order to prevent repeated reactions it is best to prevent contact with anything that you know causes a rash.
A common condition affecting babies under one year old, the exact cause of which is unknown. Also referred to as cradle cap, it usually starts on the scalp or the nappy area and quickly spreads. Although this type of eczema looks unpleasant, it is not sore or itchy and does not cause the baby to feel uncomfortable or unwell. Normally this type of eczema will clear in just a few months, though the use of moisturising creams and bath oils can help to speed this along
There is currently no cure for eczema though research continues to shed new light on the condition. However, there are many ways to minimise the discomfort and distress which eczema can bring, the foundation of which is an effective skin care routine. A wide range of treatments is available, either over the counter at the pharmacy, or on prescription from a doctor. Many complementary therapies are available, which some people find helpful. In addition, there are ways of minimising environmental allergens commonly found in the home.
There are no guarantees that a child will grow out of eczema. However, research has shown that 60-70%of children are virtually clear of the condition by the time they reach their mid-teens.
There are a number of ways to manage eczema, all of which begin with an effective skin care routine. Having access to accurate information is important as this allows the person with eczema, or their carer, to make informed choices when managing the condition. The following are the more commonly used treatments. Further information on any of these can be obtained through the National Eczema Society.
Emollients are necessary to reduce water loss from the skin, preventing the dryness normally associated with eczema. By providing a seal or barrier, the skin is less dry, itchy and more comfortable. Emollients are safe to use as often as is necessary and are available in various forms: ointments for very dry skin, creams and lotions for mild to moderate or ‘wet’ eczema. Some are applied directly to the skin, whilst others are used as soap substitutes or can be added to the bath. The range of emollients available is enormous and it may be necessary to try several before the most suitable one is found. Testing a small amount on the skin first is advisable, as emollients contain substances to which some people are sensitive.
When eczema is under control only emollients need to be used. However in flare-ups, when the skin becomes inflamed, a steroid cream may be needed. Steroids act by reducing inflammation and are used in most types of eczema. Topical steroids come in four different strengths, mild, moderately potent, potent and very potent. The strength of steroid cream that a doctor prescribes depends on the age of the patient, the severity of the condition and, the size of the area and part of the body to be treated. Topical steroids are applied thinly to the affected area, as directed by the prescribing doctor. Your eczema should be reviewed regularly if topical steroids are being applied. It is important to use only the steroid cream prescribed for yourself and not to lend or borrow (what may be) an unsuitable cream from someone else. Many people have concerns regarding the use of topical steroids and their side-effects. As long as steroids are used appropriately and as directed by your doctor, the likelihood of side effects is very rare. Reported side-effects have been largely due to the use of very potent steroid preparations over long periods of time.
are sometimes prescribed in very severe cases and usually under the direction of a consultant dermatologist, when topical steroids have been found to be ineffective. These can have possible side-effects and the doctor should ensure close monitoring when prescribed.
These are new drugs available for use in the treatment of atopic eczema:
• Tacrolimus ointment (Protopic™) is an ointment applied to the skin. It is not a steroid.
• Tacrolimus modulates or ‘changes’ the immune system in some way.
• Tacrolimus ointment is licensed in the UK for patients aged 2 years and over with atopic eczema.
• Tacrolimus ointment 0.1% and 0.03% can be used for the treatment of moderate to severe atopic eczema that is unresponsive to conventional therapy.
• The ointment is available on prescription only from dermatologists and doctors who have experience in the treatment of atopic eczema.
• Pimecrolimus cream (Elidel™) is a cream applied to the skin. It is not a steroid.
• Pimecrolimus cream works on the same principles as Tacrolimus, but is probably weaker.
• Pimecrolimus cream has been specially developed to treat and manage mild to moderate atopic eczema.
• Pimecrolimus cream is licensed in the UK for patients aged 2 years and over with atopic eczema.
• Pimecrolimus cream 1% can be used at the first signs of ‘flare’ or for established eczema.
• Pimecrolimus cream is available on prescription only from dermatologists or GP’s experienced in treating people with atopic eczema.
that your doctor may discuss are anti-histamines to reduce inflammation and wet wrap bandaging to soothe dry itchy skin. Ultra Violet light treatment and stronger medication may be considered for very severe eczema.As well as using emollients and steroids there are several other ways which may help to reduce the severity of atopic eczema. It should be stressed, however, that what works for one person, will not always work for another. Eczema is a highly individual condition, which is why it is so difficult to find a "cure-all".
For children in particular, the itchiness of eczema can be very distressing. There are many methods of reducing the itchiness of the skin and minimising the damage from scratching. Cotton clothing and bedding keep the skin cool and allow it to breathe, whereas synthetic fabrics and wool can irritate. The use of a non-biological washing powder and avoidance of fabric softeners, can also help to reduce the itchiness of the skin. Children’s nails should be kept short. During the day, distraction is often the best way of reducing the amount of scratching. At night-time, cotton mittens over children’s hands can be helpful in reducing damage to the skin occurring during sleep.
It is thought that people who have atopic eczema may be affected by allergens in the droppings of the house dust mite. This mite thrives in warm and moist environments and unfortunately likes to live in bedding, mattresses, curtains and carpets. It is believed that reducing the amount of house dust mites in the home may improve the condition of the skin. This can be achieved in a number of ways, from effective and regular vacuuming, to damp dusting and airing of bedding.
The role of diet in the management of eczema has not been ascertained. Generally changes in diet are only considered in severe cases, when conventional treatments are failing. Dietary changes can be quite helpful in babies and young children, though the effects on older children and adults are less conclusive. When considering altering the diet of a baby or child it is important to seek advice from a dietitian, or a nutritional therapist, in order to ensure that the child continues to receive adequate nutrients. Sometimes it can be useful to keep an accurate diary of foods eaten and the condition of the eczema and, when weaning babies, to do so very slowly observing for skin reactions. This is a large and complex topic. Further information can be obtained from the National Eczema Society.
Many people prefer to explore the use of complementary therapies in addition, or as an alternative, to conventional treatments. Complementary therapists offer a holistic approach which is usually based upon the individual’s needs. Evening primrose oil is now commonly used and other treatments such as aromatherapy, relaxation and homeopathy are readily available. Chinese herbal treatments may be used, but should only be tried after consultation with your doctor or dermatologist.
Though many people have found the use of complementary therapies helpful, there has only been limited scientific evaluation of complementary treatments and so it is important to consider the following:
It is essential to let your doctor know if you are starting another course of treatment, since interactions can occur between certain medications. Conventional treatments should not be stopped suddenly, without consulting your doctor.
Ensure that the practitioner is properly qualified and registered with the appropriate regulatory body.
Remember that a treatment which is described as natural or herbal is not guaranteed to be safe.
What works for one person will often not work for another.