Patient information – eczema
We will now describe information for patients on eczema. Let’s start with the basics.
1. What is atopic eczema?
Atopic eczema is a very common skin condition characterised by skin inflammation.
‘Eczema’ is a word which comes from the Greek word ‘to boil’; and is used to describe red, dry, itchy skin which can become weeping, blistered, crusted, scaling, cracked and thickened.
Typical flexural (i.e. in the creases) eczema
Atopic eczema (atopic dermatitis) is the most common form of eczema. The words eczema and dermatitis mean the same thing – and so, atopic eczema is the same as atopic dermatitis.
The term ‘atopic’ is used to describe a group of conditions, which include asthma, eczema and hay-fever and food allergy. These conditions are all linked by an increased activity of the body’s immune system.
Approximately one third of children with atopic eczema will also develop asthma and/or hay fever.
2. What causes atopic eczema and is it contagious?
Atopic eczema is a complex condition and a number of factors are important for its development, including genetic susceptibility and environmental factors. Patients typically have alterations in their skin barrier, and overly reactive inflammatory and allergy responses.
Environmental factors include contact with soaps, detergents and any other chemicals applied to the skin, exposure to allergens, and infection with certain bacteria and viruses.
Regarding genetic factors, a tendency to atopic conditions often runs in families (see below). An alteration in a gene that is important in maintaining a healthy skin barrier has been linked to the development of eczema. This makes the skin of patients with eczema much more susceptible to infection and allows irritating substances/particles to enter the skin, causing itching and inflammation.
AE is not contagious and cannot be caught from somebody else.
3. Who gets atopic eczema and is it hereditary?
It may start at any age but often in childhood, often developing before their first birthday. 1 in every 5 children in the UK is affected by eczema at some stage. It may also start later in life in people who did not have AE as a child.
It’s usually a long-term (chronic) condition, although it can improve significantly, or even clear completely, in some children as they get older.
AE affects both males and females equally.
Atopic eczema tends to run in families. If one or both parents have eczema it is more likely that their children will develop it too.
4. What are the symptoms of atopic eczema?
The main symptom is itch. Scratching in response to itch may cause many of the changes seen on the skin. Itch can be severe enough to interfere with sleep, causing tiredness and irritability.
Typically AE goes through phases of being severe, then less severe, and then gets worse again. Sometimes a flare up can be due to the reasons outlined below, but often no cause can be identified.
5. What does atopic eczema look like?
Atopic eczema can affect any part of the body. But it tends to appear on the front of the elbows and backs of the knees (i.e. opposite of psoriasis) in a flexural pattern.
It can also affect the hands, wrists and neck, and the face and scalp in children.
There are several different types that look quite different.
For example there can be coin-sized areas of inflammation on the limbs (a discoid pattern), or numerous small bumps coinciding with the hair follicles (a follicular pattern).
Affected skin is usually red and dry, and scratch marks (accompanied by bleeding) are common. When AE is very active, it may become moist and weep fluid (during a ‘flare-up’) and small water blisters may develop especially on the hands and feet.
In areas that are repeatedly scratched, the skin may thicken (a process known as lichenification), and this may cause the skin to itch more. Sometimes affected areas of the skin may become darker or lighter in colour than the surrounding, unaffected skin.
Eczema and psoriasis are different. Psoriasis is white and flaky, and tends to affect the back of the elbows. Eczema is red and itchy, and affects the front.
6. How is atopic eczema diagnosed?
AE is usually easily recognised by doctors, health visitors, and practice nurses. Blood tests and skin tests are usually not necessary.
Occasionally the skin may need to be swabbed (by rubbing a sterile cotton bud on it) to check for bacterial or viral infections.
7. What makes atopic eczema flare-up?
- Environment factors include heat, dust, woollen clothing, pets and irritants such as soaps, detergents and other chemicals
- Being unwell, e.g, a common cold
- Infections with bacteria or viruses can worsen AE. Bacterial infection (usually with a bacteria called Staphylococcus) makes the affected skin yellow, crusty and inflamed, and may need specific treatment. An infection with the cold sore virus (herpes simplex) can cause a sudden painful widespread (and occasionally dangerous) flare-up of AE, with weeping small sores
- Dryness of the skin
- Teething in babies
- Food allergens
- Stress.
8. Can atopic eczema be cured?
No, it cannot be cured, but there are many ways of controlling it. Most children with atopic eczema will see their AE improve with 60% clear by their teens.
However, many of these people continue to have dry skin; and so need to continue to avoid irritants such as soaps, detergents and bubble baths.
AE may be a problem for people in certain jobs that involve contact with irritant materials; such as catering, hairdressing, cleaning or healthcare.
In later life, AE can present as hand dermatitis. And as a result, exposure to relevant irritants and allergens needs to be avoided both in the home and at work.
9. Can atopic eczema be prevented?
Regular use of medical moisturisers can help restore the skin’s barrier in children who might otherwise develop AE.
Although breast-feeding has been advocated for the prevention of eczema in susceptible infants, there is no evidence that this is effective. There is also no evidence that organic dairy products help to reduce the risk of eczema, or that eating fish oil during pregnancy helps to prevent eczema in childhood.
For some patients who flare-up frequently, intermittent use of a topical steroid or calcineurin inhibitors (see below) may reduce the number of flare-ups.
Can someone with atopic eczema lead a normal life?
Yes. You can lead a full life including sports, swimming and travel. You may need to make minor changes such as keeping moisturiser with you at school, work or when away from home.
10. How can atopic eczema be treated?
Treatments for atopic eczema can help to ease the symptoms. There is no cure, but many children find their symptoms naturally improve as they get older.
The main treatments for atopic eczema are:
- Emollients (moisturisers) – used every day to stop the skin becoming dry:
- These should be applied several times every day to help the outer layer of your skin function better as a barrier to your environment
- The drier your skin, the more frequently you should apply a moisturiser. Many different ones are available, varying in their degree of greasiness. The best one to use is the greasiest one you are prepared to apply
- Moisturisers containing an antiseptic may be useful if repeated infections are a problem.
- Topical corticosteroids – creams and ointments used to reduce swelling and redness during flare-up.
Other treatments include:
- Topical pimecrolimus or tacrolimus – for eczema in sensitive sites not responding to simpler treatment
- Antihistamines – for severe itching
- Bandages or special body suits – to allow the body to heal underneath
- More powerful treatments – offered by a dermatologist (skin specialist)
‘Topical’ means ‘applied to the skin surface’. Most eczema treatments are topical; although for more severe eczema some people need to take ‘oral’ medication (by mouth) as well.
Summary
We have described information for patients on eczema. We hope you understand it better now.
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