Eczema is an inflammatory skin condition that involves changes in the upper layer of the skin such as redness, blistering, oozing, crusting, scaling, thickening and sometimes pigmentation.
According to the British Association of Dermatologists (www.bad.org.uk) there are several different kinds of eczema but atopic eczema is the most common. It is most often found in children and usually starts in the first weeks or months of life. It affects at least 10 per cent of infants and while it usually disappears during childhood, it can return. It occasionally develops for the first time in adulthood.
Atopic eczema usually appears on the bends of the elbows and knees as well as the wrists and neck.
The main symptom of eczema is itchiness. Eczema sufferers are likely to have skin that is very red and dry, often with scratch marks and subsequent bleeding. During a flare-up sufferers may develop small water blisters and skin may become moist and weepy. In areas that are repeatedly scratched, the skin may thicken (known as lichenification), becoming even more itchy. Itchiness may be so bad it interferes with sleep.
While the causes of atopic eczema are not fully understood, it often runs in families but is not infectious. If one or both parents suffer from eczema, asthma or hay fever, the children are likely to also.
Atopic eczema sufferers' skin does not function efficiently as a barrier to the outside world, so irritant and allergy-inducing substances enter the skin, causing dryness and inflammation. Environmental factors that make eczema worse include heat, dust and soap or detergents. Other triggers include stress, skin dryness and ill health. In addition, viruses or bacterial infections can make eczema worse. Bacterial infections may need to be treated with antibiotics.
Atopic ezcema sufferers often have allergies to cats, dogs, pollen, grass or house dust mites. Contact normally causes hay fever or asthma rather than eczema. However, nettle rash may then occur which might cause an eczema outbreak. It is also important to note that atopic eczema may be troublesome for people working in professions such as catering, hairdressing and nursing where they have contact with irritant materials.
Eczema cannot be cured, but there are many ways of controlling it. Most children with atopic eczema find that the condition improves as they get older, with 75 per cent finding that it clears by their teens. However, many eczema sufferers continue to have dry skin and need to avoid irritants such as soaps or bubble baths. Eczema may persist in adulthood but it is controllable with the right treatment.
It is always best to consult a health care professional on the best treatment for your eczema and on how long you should continue the treatment. The regime used most often to treat atopic eczema consists of moisturisers and topical steroids, although there are other ways to offer relief from the symptoms too.
Moisturisers can be bought over the counter and should be applied daily to help the outer layer of the skin act as a barrier to the environment. The dryer the skin, the more frequently moisturiser should be applied. There are a variety of moisturisers available, varying in their degree of greasiness, and it is important to choose the right one for your skin. It is a good idea to use a moisturiser when showering or bathing, especially one with an antiseptic if repeated infections are a problem.
Topical steroid creams or ointments will usually settle the redness and itchiness. They come in different strengths; mild, moderate, potent and very potent. It is important to consult your doctor on which type to use, where and for how long. If used inappropriately, topical steroids may cause side-effects such as thinning of the skin. Doctors vary in how they like to manage coming off topical steroids: some recommend an abrupt end, others like to gradually decrease the potency while others favour a maintenance regime in which they are used for a few weeks after a flare-up has settled.
Antibiotics and antiseptics may be needed if the eczema becomes wet, weepy and crusted, as the skin may have become infected. Your doctor may recommend an antihistamines to reduce itching associated with atopic eczema although some can lead to drowsiness and are not very effective if used in the long term.
Medicated paste bandages, available from pharmacists, can sometimes be very helpful, as they are soothing and prevent scratching. Some chronic eczema suffers find ultraviolet light treatment helpful. It is usually administered in a specialist hospital department and supervised by a dermatologist.
Those with very severe or widespread atopic eczema sometimes need stronger treatments such as oral steroids. These will be given under the close supervision of a health care professional.
There are lots of things you can do to reduce the risk of a flare up such as wearing protective gloves if your hands are likely to come into contact with an irritant and avoiding wearing wool next to your skin. For more information on controlling eczema, consult the website of the British Association of Dermatologists, www.bad.org.uk