Eczema
Eczema describes an itchy, inflamed skin rash. The term eczema comes from a Greek word meaning 'to boil over'. This condition may also be called dermatitis. Eczema Overview
Eczema is a chronic, itchy rash that affects the skin. Eczema causes the skin to become sore, dry, red and thicker in some places. There are many different types of eczema, the most common being ‘atopic dermatitis.’ Eczema is occasionally described as "the itch that rashes".
Eczema usually starts in childhood but many people affected by eczema will continue to suffer from occasional flare-ups throughout their lives.
Eczema is a common condition affecting 10-20% of school children and around 5% of adults in the UK.
Eczema Symptoms
Eczema may vary in appearance from individual to individual. Typical features include itchy, red skin that may be dry thickened and cracked. Eczema commonly affects the face, neck hands and in creases of the limbs.
Symptoms may flare up and then dissapear for a period of time before reappearing. Recognising 'triggers' that cause your eczema to flare up can be an effective measure in managing the symptoms.
Eczema Causes
Though the tendency to develop eczema generally has a genetic component, certain foods (such as dairy products, eggs and yeast) and skin irritants (pet hair, detergents, wool) can act as triggers, particularly in children.
Eczema is divided into a number of types according to the main cause, even though the symptoms may be similar (see below). Atopic eczema is the most common and is linked with hay-fever and asthma.
Eczema Treatment
There are a number of very good treatments for both children and adults that can relieve the symptoms of eczema. The right treatment may depend on the cause, and it is often necessary to try several treatments before finding one that is successful.
Although there isn't a cure for eczema, there are a number of things you can do to manage it. The goal of eczema treatment is to heal the skin, keep it in good condition and manage the symptoms when they appear.
Although eczema can look unpleasant, it’s important to remember that it is not contagious.
Types of eczema
There are five main types of Eczema:
• Atopic eczema: this is the most common type of eczema. Atopic eczema sufferers may also develop asthma or hay fever or have relatives who have these conditions.
• Discoid eczema: this appears as small round circles or patches on the skin and is most common around middle age.
• Allergic contact eczema: the skin becomes sensitised to something over a period of time and an allergic reaction occurs on re-exposure.
• Irritant contact eczema: occurs when the skin comes in contact with something that strips away its natural oils and makes the skin red, dry, cracked and itchy.
• Seborrhoeic eczema: is also very common and usually shows up in areas rich in sebaceous (grease) glands, like the forehead, scalp and side of the nose.
Many children outgrow eczema around the age of seven, although they may remain susceptible to it when the body is put under stress. They can also pass the tendency onto their children.
Eczema Causes and Triggers
While the exact cause of eczema remains unclear, it is believed to result from a hyperactive response of our immune system to an irritant. It often occurs together with allergies and frequently runs in families. A family history of hay fever or asthma is frequently elicited.
Individuals with a genetic tendency to develop allergies who are additionally exposed to environmental triggers like, pollen, moulds and fungi, mites, and animal dander may develop eczema. Exposure to coarse material like wool, various cosmetics, extremes of temperature and certain foods may precipitate or worsen the condition in others.
Eliminating exposure to triggers plays an important part in managing te symptoms.
Eczema Triggers:
The following are all common eczema triggers:
• Climate changes, especiallyif exposed to cold winds or excessive heat
• Water, especially hard water
• Soaps, detergents, cleaners, bubble baths, cosmetics, perfume
• Pollen, pet hair, animal dander, dust
• Stress and anxiety
• Synthetic or wool fibres
• Certain chemicals, cids, alkalis, oxidising or reducing agents, oil, solvents
• Sweating
• Colds, flu or infections of any kind
Eczema Symptoms
Eczema symptoms are characterised by a dry, red, scaly rash, which is extremely itchy. Eczema commonly affects the face, neck hands and in creases of the limbs.
The rash usually starts off as minute pearly blisters beneath the skins surface. When it's severe the rash may weep and can cause sleeplessness due to the intense itching.
Main eczema symptoms
You may notice some or all of the following symptoms:
• Itching: Itching is usually the primary symptom and is often worse at night. Being a common feature of many conditions, itching alone doesn’t mean that you have eczema. The itching is usually accompanied by the other symptoms.
• Discoloured skin with reddish to brown-gray patches: When the skin is inflamed there is an increased blood flow to the area resulting in a red appearance. The redness may also be due to a bacterial infection.
• Thickened, leathery cracked skin: The area affected by eczema is often thicker than non affected skin. This is usually due to a protective response as a result of repeated scratching.
• 'Bubled up' skin: Tissue fluids can ooze between the cells and gather into collections or blisters. Depending on the nature of the eczema, and whether infection is present, there can also be large blisters filled with fluid or pus. Protein in this fluid crusts over when scratched
• Raw, sensitive, infected skin, due to persistent scratching
Any part of the body may be affected by eczema symtpoms. The forehead, cheeks, forearms, legs, scalp, and neck are typically affected in infants. In children and adults, eczema classically occurs on the face, neck, and the insides of the elbows, knees, and ankles.
The skin around your eyes, including your eyelids may also be involved. Scratching can cause redness and swelling around the eyes, and in disease of some duration, patchy loss of eyebrow hair and eyelashes may result.
When to see your doctor
Talk to your doctor if you develop an unexplained rash, have a family history of eczema or asthma, or have some of the symptoms associated with eczema. It is essential that you seek medical help if:
• Your discomfort levels are high, distracting you from your everyday routine and causing loss of sleep
• Over-the-counter hydrocortisone creams prove unsuccessful in treating the condition, in which case your doctor might want to try something stronger.
• Yellowish to light brown crust or pus-filled blisters form over existing patches of eczema. This could be the result of a bacterial infection that should be treated with an antibiotic.
• Having eczema puts you at increased risk of contracting the viral disorder. Be aware of this in case you are in the company of someone with cold sores, genital herpes or any other viral skin disease.
• The presence of many small, fluid-filled blisters may indicate eczema herpeticum, a rare but potentially serious complication caused by the herpes simplex virus.
Eczema Diagnosis
This is made on the basis of your symptoms and clinical signs of the disease. Pertinent features include:
• Itching, this is generally severe
• Dry skin
• Skin inflammation
• Secondary infection of the skin
• Frequent flare-ups of eczema activity
• Family history of eczema, hay fever or asthma
Patch or skin-testing may be required to identify various allergens. Blood tests like RAST and ELISA are occasionally used to identify various triggers, especially if a patient has a skin condition or is on medication like antihistamines. The latter may interfere with a skin test, but these in general do not interfere with allergy blood tests.
Eczema Treatment
Although there is no cure for eczema there are many good treatments that can help relieve the symptoms. There are also a number of things you can do at home to help keep your eczema under control.
Goals of Eczema Treatment
• Understand the condition
• Avoid the trigger factors as much as possible
• Minimize the itching and reduce inflammation
• Learn the advantages and disadvantages of your treatment choices
• Reduce frequency and severity of flare-ups
Medical Treatments for eczema
Good, sensible skin care is an important part of managing eczema. In many instances this can be enough to manage milder cases.
• First line eczema treatments: Moisturizing is one of the most important self-care treatments for sufferers of eczema. Keeping the affected area moistened can promote skin healing and relief of symptoms. Doctors will usually start patients on the most simple treatments. For example they may suggest a room-temperature bath which will help remove crusted skin. Apply a good moisturizer immediately afterwards, this will help to retain the skins natural moisture.
• Corticosteroid creams: Corticosteroid creams and ointments have been the mainstay of eczema treatment for many years. There are OTC creams available for milder cases. If your eczema is more severe your doctor may suggest a prescription only cream. In the most severe cases and usually only when other treatments have failed your doctor may prescribe oral corticosteroids.
• Immunomodulators: Newer drugs called topical immunomodulators are available to help treat eczema. These medicines help control inflammation and reduce immune system reactions when applied to the skin. Talk to your doctor about whether these may be right for you.
• Oral antihistamines: Oral antihistamines will sometimes help to relieve eczema symtpoms and can be usefull at nightime. They can cause drowsiness and may help you to sleep despite the eczema itching
• Other Treatments: In the most extreme instances of eczema, your doctor or dermatolgist may suggest ultraviolet light therapy. There are also drugs that supress the immune system and may be tried for adults. Your doctor would be the best person to talk to if other more traditional forms of treatment have not helped.
Nutritional treatments for eczema
• Food exclusion diet: There is evidence to suggest that food sensitivity is a common causes of eczema in children. A supervised food exclusion may help to identify eczema triggers and eliminate them from the diet. Food exclusion diets in children should alway be supervised by a medical professional.
• Anti-Candida diet: Some nutritionists believe that eczema can be related to an overgrowth of candida or yeast organisms. If the rash is itchy and you have an upset bowel or other symptoms of candida the anti-candida diet may be worth trying.
Supplement treatments for eczema
While there is very little conclusive evidence that proves that supplements can help with eczema, many people do find that they help. Some research has suggested that people with eczema may not process essential fatty acids from food normally, leading to low levels of a fatty acid called gamma-linoleic acid (GLA). This helps your immune system work properly, so taking a supplement could help reduce the skin inflammation associated with eczema.
• Evening primrose oil, starflower oil and blackcurrant seed oil all contain GLA. A number of studies have found that taking these supplements cold not only reduce the number of eczema flare-ups but also how severe they are and the length of time they last. An analysis of nine scientific trials found that GLA was also helpful in reducing itching. Borage Oil, another source of GLA, has show to reduce skin inflammation, dryness, scaliness, and itch in eczema patients in some studies.
• Fish Oils may also help eczema. The largest study of fish oil and eczema did not show any positive improvements, however other studies have shown that fish oils can reduce the severity of symptoms.
• B Vitamins may play a supportive role in managing eczema. Some evidence suggests that eczema may be made worse by deficiencies in Vitamin B12. Other studies suggest that a deficiency of other B Vitamins like riboflavin may be involved so taking a vitamin B complex supplement would be worth a trial for a month.
Herbal treatments for eczema
Many herbs have traditionally been used to help relieve the symptoms of eczema.
• Liquorice root contains a substance called glycyrrhizinic acid, which is believed to help reduce the symptoms of eczema. It can be taken internally or applied directly to the skin.
• Witch hazel: A cream prepared with witch hazel and phosphatidylcholine has been shown to be as effective as 1% hydrocortizone cream in at least one study.
Alternative Treatments for Eczema
Numerous trials have shown that hypnosis can be effective in reducing eczema in both children and adults that were resistant to other forms of treatment.
Moisturizers and Emollients for Eczema
Soaps and harsh detergents should not be used on skin affected by eczema as they tend to strip the skin of natural oils.
Moisturizers are helpful in restoring the skins barrier and providing a protective layer on the surface of the skin. This helps to trap water and ‘keep out’ harmful irritants and allergens. Moisturizers also help replenish natural oils in the skin. It’s very important that the moisturizer doesn’t irritate the skin and should be perfume and preservative free.
Eucerin is a very good choice and has been used successfully for a long time. It moisturizes with petroleum and mineral oil. It comes in both a crème and lotion and the manufacturer recommends it for mildly flared skin. Eucerin lotion or cream may also be helpful with itching
Moisturizers containing alpha hydroxy acids can also be helpful for scaly skin and mild eczema as alpha hydroxy acids are exfoliants. Again it’s important to ensure that they do not contain any perfumes.
Generally the drier your skin the oilier the moisturizer or emollient should be. Lighter creams may not work as well as ointments on severely dry skin. Creams are easy to apply and are quickly absorbed into the skin. They do however need to be applied more frequently. Ointments containing less water tend to stay on the skin for longer but can be messy to apply. The best moisturizer for you will depend on how dry and flaky your skin is.
