Atopic dermatitis, or eczema, is a chronic skin disorder that causes areas of red, itchy skin. This condition usually starts in early childhood, especially when there is a family history of atopy (asthma, hay fever, conjunctivitis, or food allergies). The skin does not have enough water holding molecules, becomes dry, then inflamed, itchy and often infected. Various combinations of factors cause the dryness. Allergies leading to an overactive immune system and hereditary dry skin (ichthyosis vulgaris) are the most prominent internal and external factors.
To treat this skin condition you need to identify and reduce those factors in your or your child’s life that trigger or flare-up the disorder. These are different for each person, so no one treatment is appropriate for all eczema sufferers. You need to watch for some of the following possible exacerbating factors (click on the item to learn more).
Your skin is dry, not because it lacks grease or oil, but because it fails to retain water. Therefore, to correct dryness, you need to support the ability of your skin to hold in more water, and to retain it by occlusion with a oily substance.
Soaking the affected area, in a basin, bath, or shower, for 15-20 minutes using lukewarm water, can help to hydrate the skin. Hot water dries out the skin. Then, remove excess water by patting with a soft towel. Avoid vigorous use of a washcloth in cleansing. When toweling dry, do not rub the skin. Blot or pat dry so there is still some moisture left on the skin, and immediately apply our BIOSKINBALM.
Topical steroids are particularly useful to treat flare-ups of eczema. They help keep down the inflammation and itching. Apply them just on the rash especially after a soak or bath. Do not use topical steroids more than twice a day. Your pharmacist can provide topical steroids in large jars to reduce the cost.
Hydrocortisone ointment or cream can be used for eczema in infants and young children, or in skin folds in adults. More potent topical steroids should not be used on thin-skinned areas of the face, neck, axilla, and groin. Short, supervised courses of medium potency topical steroids creams are safe and effective for flares of eczema on other parts of the body. Adverse effects of long term topical steroids include thinning of the skin (atrophy), a change in the color of some skin (depigmentation), and acne-like eruptions.
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. People with atopic eczema are sensitive to allergens in the environment which are harmless to others. In atopy eczema 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 some types of eczema remain to be explained, though links with environmental factors and stress are being explored.
Below we take a closer look at the several different types of eczema, many of which look similar but have very different causes and treatments.
Atopic eczema is the most common form of eczema and is closely linked with asthma and hayfever. It can affect both children and adults, usually running in families. The most common symptoms of atopic eczema is itchiness (or pruritis), which can be almost unbearable and is particularly noticeable on face and scalp, neck, inside of elbows, behind knees, and buttocks. 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). Conventional treatments include emollients to maintain skin hydration, non prescription hydrocortisone and prescription steroids or natural substances that reduce inflammation but have none of the side effects of strong steroids.
Allergic contact dermatitis. This type 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 known to cause you a rash.
Irritant contact dermatitis. This is a type of eczema caused by frequent contact with everyday substances, such as detergents and chemicals, which are irritating to the skin. It most commonly occurs on the hands of adults and can be prevented by avoiding the irritants and keeping the skin moisturised.
Infantile seborrhoeic eczema. 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 recovery.
Adult seborrhoeic eczema. Characteristically affects adults between the ages of 20 and 40. It is usually seen on the scalp as mild dandruff, but can spread to the face, ears and chest. The skin becomes red, inflamed and starts to flake. The condition is believed to be caused by a yeast growth. If the condition becomes infected, treatment with an anti-fungal cream may be necessary.
Varicose eczema affects the lower legs of those in their middle to late years, being caused by poor circulation. Commonly the skin around the ankles is affected, becoming speckled, itchy and inflamed. Treatment is with emollients and steroid creams. If left untreated, the skin can break down, resulting in an ulcer.
Discoid eczema. Is usually found in adults and appears suddenly as a few coin shaped areas of red skin, normally on the trunk or lower legs. They become itchy and can weep fluid. Usually discoid eczema is treated with emollients.
Eczema Treatments. There are a number of ways to manage eczema, all of which begin with an effective skin care routine.
The following are the more commonly used treatments:
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.
Oral steroids 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.
Topical Immunomodulators. These are new drugs available for use in the treatment of atopic eczema.
Antipruritics. Itching is often the most aggravating of all your eczema symptoms. Antihistamines may provide some relief. The antihistamines reduce scratching mainly through tranquilizing and sedative effects. It takes several weeks of use on a regular basis to help. This is because scratching aggravates the eczema, keeping it from healing. Cutting nails, and using cotton gloves at night can minimize scratching. For children, knee-high socks are better than gloves, because they are harder to accidentally pull off during sleep. The topical use of antihistamines such as benadryl should be avoided, because it is ineffective and may produce allergic reactions. Menthol or Pramoxine containing products such as Aveeno cream, Pramasone cream/lotion or Prax lotion may offer additional help.
Other treatments that your doctor may discuss are wet wrap bandaging to soothe dry itchy skin.
Ultra Violet light treatment and stronger medication may be considered for very severe eczema.
Ultraviolet light (UVB or PUVA) therapy may be of some help in chronic eczema that does not respond well to other therapy. UVB and PUVA require three per week and must be used under professional supervision. However, avoid sunburn and hot or humid conditions that might make your skin even itchier. The risks of UVB or PUVA are sunburn and increased risk of skin cancers if used for too long.
Besides 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”.
Reducing the itch
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.
Reducing the effect of the house dust mite.
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.