What is Eczema ?

Eczema (atopic dermatitis) is a recurring, non-infectious, inflammatory skin condition affecting up to one in three people at some stage throughout their lives. The condition is most common in people with a family history of an atopic disorder, including asthma or hay fever.

Atopic eczema is the most common form of the disease. The skin becomes red, dry, itchy and scaly, and in severe cases, may weep, bleed and crust over, causing the sufferer much discomfort. Sometimes the skin may become infected. The condition can also flare and subside for no apparent reason.

Although eczema affects all ages, it usually appears in early childhood (in babies between two-to-six months of age) and disappears around six years of age. In fact, more than half of all eczema sufferers show signs within their first 12 months of life and 90 per cent of people develop eczema before the age of five.

Although most children grow out of the condition, a small percentage may experience severe eczema into adulthood. The condition can not only afflict the individual sufferer, but also their family, friends and health practitioners.

Symptoms of Eczema.

• Moderate-to-severely itching skin (this symptom separates eczema from other skin rashes).
• Recurring rash - dry, red, patchy or cracked skin. (In infants and toddlers, the rash usually appears on the face, elbows or knees. In older children and adults, the rash appears less often on the face, and more commonly on the hands, neck, inner elbows, backs of the knees and ankles).
• Skin weeping watery fluid.
• Rough, "leathery," thick skin.
• Lesions which may be infected by bacteria or viruses.

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

Allergic contact dermatitis

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.

 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 this along.

 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.  

 Varicose eczema

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. If left untreated, the skin can break down, resulting in an ulcer.

Discoid eczemas

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.

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, 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.

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". 

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.