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| What is
Eczema? |
There are many different forms of
eczema (also referred to as dermatitis). The skin is very dry,
caused either by external or internal factors. The severity of
the condition can range from a few dry, red, itchy patches to
huge areas of the body which can be covered in sore, inflamed,
weeping and bleeding skin which can invariably become infected.
Eczema cannot be cured, but it can be controlled. It is
especially distressing in children, but a large proportion do
grow out of it.
It is advisable to visit your GP and/or dermatologist regularly
for more detailed information.
We have updated the info on the
Eczema pages. Thanks to
New Zealand DermNet.
This is a wonderful site for those looking for more info on
Eczema. Pay them a visit.
Atopic Eczema
Atopic eczema is thought to be hereditary. If one or more
parents suffers with eczema, asthma or hay fever and therefore
atopic themselves, then their offspring has an increased chance
of becoming atopic. Atopic eczema can affect both children and
adults and it tends to be the most itchy form of dermatitis. It
tends to be most common in children and often begins in early
life - often when the child is under the age of one. It can
flare up and down from one week to the next.
Contact Dermatitis
There are two types of contact dermatitis - irritant contact
dermatitis and allergic contact dermatitis. For a more detailed
explanation than the one offered below,
click here.
Allergic Contact Dermatitis
generally develops over a
long period of time as a result of regular contact with a
substance. It is the body's immune system reacting against the
substance that causes the eczema. Typical substances a person
can become allergic to are perfume, make up, costume jewellery.
Irritant Contact Dermatitis
usually affects adults and is
due to contact with irritants to the skin, commonly on the
hands. Household detergents and chemical used around the home or
the workplace are the main culprits. New mothers often develop
this type of eczema; the arrival of a new baby inevitably leads
to more frequent hand washing.
Seborrhoeic Eczema
This can affect adults or babies. In babies it is more commonly
referred to as cradle cap and can be found in the scalp and
nappy areas and can quickly spread to the face, neck and
armpits. Unlike atopic eczema, although it looks bad, it is not
sore or itchy and generally clears up from the age of one
onwards.
In adults, men are more susceptible; it usually affects the
20-40 year old age group. It looks very much like dandruff and
can spread from the scalp to the face where flakes of skin can
originate from the eyebrows. This type of eczema is usually
associated with yeast growth.
Varicose Eczema
This is more common in women than men and tends to develop in
later life due to poor circulation. Therefore is affects the
lower legs and ankles.
Discoid Eczema
Discoid eczema, also known as nummular dermatitis, is a
skin condition which can occur at any age.
The cause of discoid eczema is
unknown.
- Minor skin injury such as an
insect bite or a burn may start it off.
- It may be termed "varicose
eczema" when it runs along the leg veins and result in
gravitational eczema.
- Hypersensitivity to bacteria
on the skin results in crusted patches.
- Dry skin in the winter months
can cause dry non-itchy round patches.
It can affect any part of the
body particularly the lower leg. One or many patches appear, and
may persist for weeks or months. The majority of patches are
round or oval, hence the name "discoid" or "nummular"
dermatitis, which means coin or disc-shaped dermatitis. They can
be several centimetres across, or as small as two millimetres.
The skin between the patches is usually normal, but may be dry
and irritable. Discoid eczema may be extremely itchy, or
scarcely noticeable. When the patches clear, they may leave
marks for some weeks of months which are darker or sometimes
paler than the normal skin tone. Sometimes patch testing is
arranged to see whether there could be a contact allergy
responsible for the dermatitis. In most cases no specific
allergy can be found. Discoid eczema does not run in families,
and unlike atopic dermatitis, it is not associated with asthma.
It does not result from food allergy. It is not infectious to
other people, although it sometimes becomes secondarily infected
by bacteria. |
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| Symptoms of Eczema |
Whatever causes your eczema, it
leads to itching and redness, and may make the skin dry and
flaky. Sometimes, itchy blisters form. When these burst, or when
scratching damages the skin, the surface may be left moist and
crusty.
Often, in the commonest form of eczema (Atopic eczema), the
problem is worst in the folds of the skin where your limbs bend.
The itch is intense, and makes you want to scratch. You should
avoid this if you possibly can, as scratching only makes the
symptoms worse. People say that if you have to do anything,
gentle rubbing, with the flat of your hands, is better than
scratching.
Whatever the cause of your eczema, the skin becomes more
sensitive, and you may well notice that you are more easily
upset by cosmetics, soaps, detergents, etc.
In adults the main symptom is dry,
scaly, inflamed and itchy skin. Children may have wet or weepy
and infected lesions with impetigo.
In mild cases, eczema is nothing more than a slightly irritating
patch of sore skin, but in severe cases extensive areas of skin
may become inflamed with unbearably itchy. It is hardly
surprising that some people with these symptoms develop problems
such as depression with low self-esteem, and have difficulty
coping at school or work. Eczema sufferers are more prone to
Herpes and wart infections of the skin.
Unfortunately, up to half of all babies with widespread Atopic
eczema will later develop asthma as the eczema improves. This
phenomenon is referred to as the Allergic March.
How to diagnose the
cause?
- If you have contact
dermatitis, you must try to identify the cause and
avoid the substance that causes it. Patch Tests are used to
identify the cause.
- If you have atopic
eczema, you may be able to find out what you are
allergic to by having special tests for respiratory and food
allergen. Once an allergen is identified, practical steps can
then be taken to avoid it.
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| Risk Indicator |
Eczema is not normally a dangerous
condition. It can however vary in severity from one individual
to another, in certain instances, requiring hospitalisation.
Always consult your Doctor if you are in doubt as to symptoms or
severity. |
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What helps? |
If you have Atopic eczema you may
find the following useful:
- Take lukewarm baths with
emollients and don't stay in too long. Pat the skin dry with a
towel, never rub eczematous skin dry.
- Avoid soap, detergents and
shampoo - use aqueous cream instead of soap.
- Wear cotton fabrics next to
your skin. Avoid wool and polyester.
- Don't wear tight-fitting
clothes.
- Clip your fingernails and
don't scratch or rub the skin
- Avoid sports that make you
sweat a lot.
- Try to stay calm and relaxed
- stress can make eczema worse.
It may shock you to discover that
one of the major irritants (SLS) found in most commercial soaps,
shampoos and shower gels is also in your toothpaste.
We strongly recommend using cosmetic,
facial and body products that are organic, and are certified as
being organic. This will not cure your eczema, but will almost
certainly prevent flare ups. Please visit
AVEA and look through a carefully
selected, Organically certified range of Cosmetics, creams, and
SLS free products.
If you have children who suffer from Eczema, please, please do
try the SLS and preservative free soaps, shampoos, creams and
ointments. These are organic products and at worst will not
aggravate a condition. At best they can offer huge relief to
itchy little bodies and prevent future flare ups. |
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Medication |
The treatment for Contact
Dermatitis is to completely avoid the substance that
triggers the rash and to treat any existing rash with low-dose
steroid ointments and Vaseline based emollients.
Emollients
Emollients keep the skin soft
and smooth, and reduce itching. Emollients should be applied to
dry skin even if it is not itchy or red. Apply an emollient
after swimming or bathing, with extra during the winter months,
and when working in an air conditioned office.
There are many suitable
emollients available from your chemist; some can be obtained
with a doctor's prescription. Try out several, applied several
times a day. Avoid highly perfumed products.
- Bath oils based on mineral
oil or lanolin
- Aqueous cream & emulsifying
ointment are well tolerated and mix with water
- Urea cream & alpha hydroxy
acid lotions are excellent for relieving dryness, but can
sting and sometimes aggravate eczema
- Wool fat (lanolin) or mineral
oil-based lotions are easy to apply, but once again, use
caution. Many people find their skin does not tolerate Lanolin
Corticosteroids
Topical steroids are very
effective anti-inflammatory agents when applied to eczema. Use
ointments for dry skin, creams for weeping skin or body folds,
and lotions or scalp applications for hair-bearing areas.
Their strength varies. The
mildest topical steroid is hydrocortisone, which can be applied
to facial skin or babies' bottoms. It is quite safe used even
for months, but should be used only intermittently on the face.
The stronger topical steroids should only be used for a few days
or weeks, except when specifically advised by your medical
practitioner. Potent or ultra potent topical steroid
preparations should be avoided on the face, armpits, groins and
bottom, because they may cause significant skin thinning and
other problems.
Topical steroids are applied to
the dermatitis once or twice daily. Often several different
preparations are prescribed for different parts of the body or
for different occasions. Make sure you understand your doctor's
instructions.
In severe eczema it is sometimes
necessary to take steroids by mouth or by intramuscular
injection; this is usually only for short periods and under the
close supervision of a doctor.
Antibiotics
Infected eczema may need
specific antimicrobial treatment.
- Antiseptics eg. potassium
permanganate soaks (Condy's), chlorhexidine cleansers,
povidone iodine, dibromopropamidine cream
- Topical antibiotics for
localised areas eg, mupirocin, chlortetracycline, sodium
fusidate.
- Oral antibiotics for
extensive flare-ups eg, flucloxacillin, erythromycin.
Antihistamines
Oral antihistamines are very
effective in reducing urticaria (hives). They can also reduce
the itch of eczema. They can be obtained from the chemist
without prescription.
The non-sedating type are
sometimes helpful and with less side effects. Eg. fexofenadine,
loratidine, cetirizine.
The conventional type of
antihistamine is cheaper, but may cause drowsiness. These are
often useful at night-time. Eg. trimeprazine, hydroxyzine,
azatidine, chlorpheniramine.
Coal tar or ichthammol
Ointments or paste bandages
containing coal tar or ichthammol are useful for chronic
lichenified patches of eczema. Coal tar smells and stains the
clothes so it is best applied at bedtime under cotton bandages
or old pyjamas. It can provoke a folliculitis (inflamed hair
follicles).
Immune suppressant medications
Severe cases of atopic
dermatitis are sometimes treated with oral cyclosporin or
azathioprine.
Ultraviolet radiation
Troublesome eczema may respond
to UVA or UVB phototherapy (ultraviolet radiation treatment) or
PUVA (a combination of a medicine, psoralens, with UVA). A
course of treatment may require 30 or more visits to a
phototherapy unit over a period of several months. |
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