Living with eczema

By Modupe Olubunmi Soji-Adeyemo and William Graves

Your eczema

Atopic eczema, or atopic dermatitis, is a complex and common, non-curable, non-infectious inflammatory skin condition that presents as red (erythema), dry and itchy skin (excoriation) that can sometimes become weeping, blistered, crusted, scaling and thickened (lichenification). This condition can affect any part of the skin, but most commonly affects the joint creases at the elbows, knees and sometimes the wrists and neck. It is hereditary and affects both males and females equally, with 1 in 5 children in the UK affected by eczema at some stage.

Causes

Atopic eczema emerges as a result of a combination of patient susceptibility and number of environmental factors. It is typically due to changes in the skin barrier, and overly reactive inflammatory and allergy responses. This change allows irritating substances/particles to enter the skin and cause infection and inflammation. Environmental factors such as exposure to heat, dust, woollen clothing, pets and irritants such as soaps, detergents and chemicals can aggravate your eczema. When you become unwell your eczema may also worsen (i.e. having a cold), along with dryness of skin, teething in babies, allergens in some foods, stress and bacterial and viral infections.

Symptoms

The main symptom of Eczema is itching and the response to itch is scratch. This response can lead to the cause of many visible implications on the skin. The itch when severe may interfere with sleep and cause tiredness and irritability. The severity of your eczema may change in phases, from Mild – Moderate – severe. The changes may be due to periodical exposure to the above-mentioned environmental factors.

Treatment

While eczema cannot be cured just like Psoriasis, there are several effective treatments that can help control the activities of your eczema and help live a good quality of life. These treatments include topical treatments (emollient, corticosteroid and phototherapy), and systemics and biologics therapy. The majority of children will see their condition improve by 60% by their teenage years with regular use of emollients and continuing to avoid irritants into adulthood.

Topical treatments are those that are applied to the surface of the skin. These form the basis of your treatment and are most important in the treatment of your eczema. The treatment involves the frequent application of emollients (moisturisers) and washing with an emollient soap substitute. This should be applied several times a day to support the outer barrier of your skin and prevent dryness. Emollients can come as a lotion (more water based), cream (equal oil and water based) or ointment (mostly oil-based). Ointment provides the best protection and it is best you choose your preferred ointment. If your eczema becomes infected, you may require emollient that contains antiseptic.

1 in 5 children in the UK affected by eczema at some stage or onset from childhood.

Topical steroid creams or ointments may be used to improve the redness (inflammation) and itch. Your doctor will prescribe the required strength for the severity and site of your condition. If your eczema is not responding to steroid treatment, or the site of the condition is unsuitable (i.e. face, eyelids, armpits, groin), other preparations such as calcineurin inhibitors - Tacrolimus ointment (Protopic) and Primecrolimus cream (Elidel) may be used. These may initially sting on application and should not be applied to infected skin.

If your eczema is infected; the sites become wet, weepy and crusted, antibiotics and antiseptics may be prescribed. Natural herbal preparations can be harmful, and it is advisable not to use them. Antihistamine tablets may be prescribed to help you sleep and can be taken at night. Cotton bodysuits (wet or dry) or silk vests and leggings can help to prevent moisturisers rubbing off and stop scratching. Medicated paste bandages may also be used, and your doctor or nurse will be able to provide guidance on the application of dressings.

Like many other conditions, you may benefit from phototherapy. Phototherapy is a form of treatment where fluorescent light bulbs are used to treat skin conditions because natural sunlight has been known to be beneficial in certain skin disorders for years. If your eczema is severe, oral treatments (systemics) and biologics (injections) are now used to treat severe and widespread atopic eczema not responding to topical treatment. These works by hindering the immune system and are therefore given under close supervision of a healthcare professional.

Self-help

Always follow the treatment instruction provided by your health provider and remember that ointments are highly flammable and exposure to naked flames should be avoided. Antiseptics should not be used for a prolonged period as they can cause excessive drying of the skin. Avoiding allergens such as airborne allergens from cats, dogs, pollen, grass or the house dust-mite can prevent flare of your eczema and it’s important to wash clothes in non-biological washing powders and rinse properly to remove detergent residue from clothing. Wearing loose, comfortable and cool clothing made of soft and non-irritable material (i.e. cotton) is recommended.

Food allergies may irritate the skin and dietary advice may be sought from a professional to establish which foods should be avoided. Latex allergy is also common in those who have atopic eczema and contact with rubber should be avoided if it causes irritation especially household items (i.e. gloves). Smooth moisturiser into itchy sites and avoid the urge to scratch as although it may give short relief, it can cause further damaged in the long term. Contact allergies are rare. Nevertheless, you should contact your doctor if you are experiencing a worsening of symptoms following application of creams and ointments.

See British Association of Dermatologists via their website: http://www.bad.org.uk/ for more information about atopic eczema.

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