Basic information and background about Eczema

Eczema

The word `Eczema' comes from a Greek word meaning 'to boil'. What a suitable description! The skin of the eczema sufferer feels hot, with very tiny blisters appearing on the skin which itch intensely. The patient may scratch the skin so severely that bleeding can occur, and then infection may set in. Having said that, let me reassure you that eczema is a condition that responds very well to modern medical treatments.

It is important to realise that eczema is not one single condition. There are many different types of eczema. Some have no obvious cause, whilst others are caused by specific, easily recognised, external factors.

In its mildest form, eczema is simply a tendency to suffer from dry skin, but in severe cases it can affect the whole body, causing itching, inflammation, infection, extreme discomfort and, if left untreated, permanent scarring. However, eczema is NOT infectious. You cannot catch it from someone else!!

Eczema affects over five million people in the UK. It is often referred to as dermatitis. It can develop at any age, with about one in eight young children being diagnosed. Thankfully, it often clears as the child grows older. The most common types of eczema are:

1. Atopic eczema.
2. Seborrhoeic eczema.
3. Contact eczema.
4. Pompholyx eczema.

Atopic eczema

This is the most common form of eczema. Often referred to as 'infantile eczema' because symptoms occur in the first two years of life. There is often someone else in the family with this condition, or with hay fever, asthma or other allergic conditions. This group of conditions are all closely related, and a child could be burdened with all three; eczema , hay fever and asthma.

The rash of eczema may first appear on the face, scalp or the nappy area. Patches of eczema then appear in the skin creases on the front of the elbow, front of the wrist and the back of the knee joint. The backs of the fingers and hands may also be affected. The skin may itch intensely at night, when it becomes hot under the bedclothes.

Seborrhoeic eczema

Seborrhoeic eczema occurs in babies, children and adults. Cradle cap is a type of seborrhoeic eczema of the scalp, often seen during the early months of a baby's life. The skin of the scalp is covered in thick, yellowy, crusty layers. It looks horrific to the mother, but rarely troubles the baby, and usually clears by the age of two!

With seborrhoeic eczema, flakiness and redness of the skin is seen on the neck, especially at the back at the level of the hair line, behind the ears, on the face, and even under the armpits. This type of eczema usually clears quickly once treatment is started.

Contact eczema

In this type of eczema, the skin reacts after being in contact with certain substances. The skin becomes reddened, inflamed and itchy at the site of contact with the irritant. Contact eczema is seen more often in adults than in children.

Pompholyx eczema

This is a long standing and recurring condition which results in tiny blisters affecting the palms of the hands , sides of the fingers and the soles of the feet. As with all eczemas, the skin is very itchy. Warm weather commonly provokes this condition which is often misdiagnosed. It is more common in adults than children.

What causes eczema?

The precise cause of eczema is not fully known. However, we do know that in many patients it is a type of allergic condition, in which hereditary plays an important role. There is a strong association between eczema, hay fever, asthma, urticaria (heat lumps) and even migraine. If there is a history of these 'allergic' conditions in you or your partner's family, your child may be more prone to developing eczema.

Atopic eczema can be brought on by exposure to cats, dogs or other furry animals. The house dust mite is a common cause of eczema flare ups. Certain foods can cause intense reactions in the skin of susceptible children with eczema.

Contact eczema is brought by contact with a substance which the skin of the sufferer is particularly sensitive. Some of the most common reactions occur to:

* Nickel. Many items of jewellery, and metal fasteners on clothing contain the metal nickel. So any reaction in a specific isolated area of skin that has been in contact with a cheaper type of jewellery or a metal zip or clothes stud will probably be due to contact eczema. Pure gold or silver does not produce this type of eczema, only the cheaper metal alloys.

* Leather in shoes, gloves or watch straps. The eczema is a reaction by the skin to a chemical called chromate, used in the curing of leather.

* Cosmetics and perfumes.

* Rubber.

* Crease resistant fabrics. These contain a substance called urea formaldehyde, which affects some sensitive skins.

* Antihistamine creams can cause marked skin reactions.

* Woollen clothing is a common cause of contact eczema flare ups.

* Lanolin can also produce an inflammation in the skin so beware using creams for the treatment of eczema, which contain lanolin. They may make the condition worse, rather than curing it!

Children with eczema facts

* Children with atopic eczema have dryer skin and itch more when they are in contact with wool.

* They also itch when they sweat.

* 90% of children with atopic eczema are free of the condition by the time they are eight years old.

* It's more common in families where other members may have asthma, hay fever, urticaria (heat lumps) and other allergic tendencies.

* A child with eczema may be more prone to migraines in later years.

Tips for reducing childhood eczema

If there is a genetic tendency for your child to develop eczema because there is a strong family history of this skin complaint, then you cannot completely prevent the disorder from developing. However, you should be able to reduce the severity of the condition, by following these steps:

Breast feeding. If possible, fully breast feed your baby for the first 4 to 6 months. Do not give the baby any other feed at all, except for water if the weather is hot.

Weaning. At 4 to 6 months wean onto milk free baby rice, baby vegetables, baby fruits, meat and baby cereals.

Foods. For the first 12 months avoid cow's milk, eggs, orange juice. Also avoid all wheat products e.g bread, cake and biscuits. Check the baby food labels for these forbidden items! Continue breast feeding, if possible, during baby's first year. Later, certain foods can cause a worsening of eczema. Potatoes, tomatoes, eggs, milk and products containing milk (read the labels!), wheat containing foods and cheese and even orange juice are common culprits. Colouring agents in foods e.g., the orange/red colourant tartrazine, can also adversely affect eczema.

Irritants. Avoid coloured or perfumed soaps on the child's skin. Use only very mild shampoos. Also avoid creams containing Lanolin and biological and low temperature washing powders.

Buy pure cotton or cotton mix clothes. Avoid direct wool contact on your child's skin. Financial aid may be available. Contact your local Social Security Office. Cotton mittens are available to prevent little ones scratching themselves. Also avoid clothes with metal fasteners and zips, as baby may develop a contact allergy to metal.

Smoke free atmosphere. Do not smoke during pregnancy. Try to bring up your baby in a home free of tobacco smoke.

Other tips for people with eczema:

Pets. Do not allow cats, dogs or any furry animals in the house.

House dust. House dust should be very carefully controlled.

Plants. Avoid certain plants than can bring on eczema. Primulas and chrysanthemums are common culprits.

Medical dressings. Be wary of adhesive skin plasters. Instead use `Hypoallergenic' dressings.

Cosmetics. Women with sensitive skins may have to use cosmetics that are labelled as Hypoallergenic. Even nail varnish can cause eczema of the neck, face and eyelids, because of direct contact from the fingernails!

Jewellery. Avoid cheap jewellery as this may contain nickel which can cause an eczema flare up. Only use pure gold or silver!

Work. Certain professions should be avoided by sufferers of eczema, because of the possibility of repeated exposure to irritant substances and chemicals. For example; hairdressing, nursing, building, and garage work.

Treatment

Most treatments for eczema are available on prescription from your GP. Remember that there is no cure for eczema. In other words, no treatment is available that will get rid of eczema permanently. However, the condition can most certainly be very well controlled with a combination of dedication from the patient and the family doctor.

The key to eczema control is to keep the skin soft , and promptly treat any eczema flare ups. If the skin is allowed to dry, it becomes itchy. The patient then scratches and breaks the skin surface, which may then become infected, sore, and even more irritating. The skin can be kept soft, and drying out of the skin can be prevented by the use of 'emollients'.

Emollients are mixtures of oils, fats and water which restore the natural oil balance and moisture content of the skin. They are available as creams, lotions, ointments and bath oils which are rubbed into the skin. Emollients must be used frequently every day. The more often an emollient is applied to the skin, the less severe and the less obvious the eczema will be. If the eczema is flaring up, apply the emollient every hour if possible!! Even if the eczema is under control, the emollient should be gently rubbed into the skin three times a day. Remember that putting the oils back into the skin will help to prevent the eczema from recurring. Emollients can be bought over the counter and are also available on prescription. Apply the emollient to the skin immediately after bathing, as this aids absorption. Some emollients contain lanolin, which can make some eczema patients worse, so read the label!!

Emollient bath oils. Do not bathe in water alone. This dries out the skin, so always add an emollient bath oil to the water. Stay in the water for at least twenty minutes. The longer the skin is exposed to the emollient bath oils the better. Beware, as emollients make the bath very slippery! Try and avoid using ordinary soaps to cleanse the skin. The chemicals and perfumes they contain can irritate the skin. Two soap substitutes, such as Aqueous cream and Emulsifying ointment are available over the counter and on prescription. Pat the skin dry with a soft towel gently. Always apply your eczema creams after a bath.

Steroid creams. People with eczema will frequently be prescribed preparations containing corticosteroids or 'steroids'. These are available in the form of ointments, lotions and creams to be applied directly onto the skin and are called topical steroids.

Topical steroids are carefully designed anti- inflammatory drugs which can be used to bring the condition under control quickly. They soothe inflammation and itching and are useful in the treatment of eczema.

Topical steroids are available in a range of different strengths. These will be prescribed depending upon the severity of the condition, the area of skin affected and the age of the patient. They should only be used under the supervision of a doctor and it is essential to use the appropriate strength and quantity of topical steroid prescribed.

Milder steroids are designed for routine, longer term use, but from time to time more effective treatments may be prescribed to control more severe outbreaks of eczema. The GP/dermatologist will provide detailed instructions regarding the amount to use and the treatment period. It is important to follow this advice carefully. Using less than the recommended dose for the recommended period of time could prolong the duration of the flare up, while overuse can, in some instances, lead to unwanted side effects.

From time to time steroids receive adverse publicity relating to unpleasant side effects associated with their misuse. It is true that inappropriate, long term use of potent steroids can cause damage to the skin. However, it is important to remember that if they are correctly used, the risks of side effects are minimal and the relief they provide can be dramatic. If it is under treated, eczema itself can lead to damaged skin and patients sometime need to be hospitalised for more intensive treatment.

Topical steroids should not be confused with other types of steroids, such as those which are used illicitly by some athletes to improve their performance. Steroid creams have been used for almost three decades and a great deal of knowledge regarding safety and correct use has now been accumulated. 'Correct use' means using the appropriate strength of steroids to treat each flare up within the minimum length of time, then stepping down to a lower potency steroid or using other treatments such as emollients to control the eczema.

To obtain the best effects from topical steroids, patients should follow these guidelines:

Correct use of steroids for treating eczema

* Do not use steroids on the area immediately around your eyes.

* Do not use steroids on your face unless instructed to do so by your doctor.

* Inform your doctor if you are pregnant or planning to start a family.

* Do not use the steroids for longer than instructed, unless you have been provided with a mild steroid cream which can be used 'as needed'.

* If there is no improvement within one week, contact your doctor for advice.

* If your eczema worsens during the course of treatment, you may have a skin infection or be allergic to the steroid. Stop using it and contact your doctor as soon as possible.

* Remember to keep topical steroids and all other medicines out of the reach of children.

Useful Tip. A bad patch of eczema on a limb can be cleared more quickly by applying the emollient or steroid ointment to the affected limb, then covering the area with simple polythene cut into a strip from a plastic bag (or 'cling film' which is softer). The ointment can then only be absorbed into the skin.

Alternative medicine

If orthodox medicine fails to provide a satisfactory treatment for eczema, some people turn to alternative medicine. Acupuncture, aromatherapy, clinical ecology, clinical nutrition, Chinese herbal remedies, homeopathy, hypnotherapy, naturopathy and reflexology have all been tried with varying degrees of success. It is essential that anyone seeking alternative treatments should only approach an adequately qualified and experienced practitioner.

Antihistamines

Antihistamine creams should not be used as they can cause skin reactions. However, certain antihistamine syrups or tablets may be useful in controlling the 'itch scratch itch' cycle.

Older antihistamines can cause marked drowsiness, which may be considered as a benefit when the medication is given at night. Problems may arise from drowsiness during the day in drivers, or those operating machinery.

However, the new generation of antihistamines are free from the above side effects and are certainly worth considering, as they are easy to use. On a once daily dosage, they do not cause restlessness or irritability, and they do not usually produce drowsiness or a 'hangover' effect. Your GP will advise you accordingly.

Evening primrose oil

The oil of the evening primrose plant has been found to have a beneficial effect upon some patients with eczema, though not all. It is more effective in the treatment of atopic eczema, and patients don't get an immediate effect, as it may have to be taken for a few weeks before any obvious result is seen. In some eczema patients it has had a dramatic improvement, but should not be used in patients with epilepsy.

Living with eczema

Eczema can be severe enough to prevent a child from attending school, and can force an adult to stay away from work or even leave his/her job.

The psychological effects of eczema can be equally difficult to cope with. When people are first diagnosed as having eczema, they are often confused. They may find it difficult to cope with their condition and to understand how to use the variety of treatments available. Often GPs do not have sufficient time to answer all the patients questions, and they may need a great deal of support from family and friends.

In severe cases, eczema can be disfiguring, and may cause a person to avoid social situations, leading to a feeling of isolation and then depression.

However, remember, with an adequate programme of management, most forms of eczema can be well controlled.

So, in summary

1. Avoid those substances that are known to provoke eczema.

2. Use emollient creams/ointments freely.

3. Bathe regularly using bath oils.

4. Use soap substitutes.

5. As steroid creams are very effective, don't be afraid to use them, but do adhere to your doctors advice on their use.

6. Oral antihistamines and Evening Primrose capsules, may help.

An extremely useful organisation that provides help and advice to eczema sufferers and their families is:

The National Eczema Society http://www.eczema.org


IMPORTANT NOTICE : This content is from the Dr Chris Steele personal archive and is provided for convenience only. Information contained here may no longer agree with the most up to date medical advice. Please check with a medical professional before taking any action.

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