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Eczema

What is Eczema?
Eczema is an inflammation of the skin which may cause dryness, flakiness, heat and  itching. Another often-
used word: Dermatitis, is a term which is sometimes connected in people's minds with exposure to
chemicals. It really only means inflammation of the skin, and could be used interchangeably with eczema,
as it often is by doctors.

Eczema can be caused by a number of different factors, and may result in just a small patch of skin being
affected or sometimes larger areas. It can affect skin anywhere on the body.

Three in a hundred people will experience eczema at some time in their lives. The root cause of this skin
condition is something of a mystery to modern medicine. What we do know is that it is a frustrating and
persistent ailment that is usually "cured" by simply outgrowing it. By controlling the symptoms, we can
lower the risk of complications and, more importantly - minimize the suffering.

Three-quarters of patients who have eczema have also endured other allergic disorders. Approximately
30% of those with eczema have asthma, and up to 60% experience allergic rhinitis.

Eczema often occurs during infancy and the early childhood years. In most cases the symptoms will
decrease, and usually disappear by about the age of six. In about a third of the cases however, the
condition will linger, often through adolescence and beyond.

What causes Eczema?
Many things cause eczema. The most common is a general allergic over sensitivity (atopy). This sort of
eczema is known as atopic eczema, and it is linked with asthma and hay fever. These conditions can often
be part of your heredity. The other possible causes include:
  • Infantile eczema which affects young babies. This may lead to a patch below their chins, and is
    particularly distressing.
  • Contact with substances which irritate the skin chemically. This is caused by direct contact
    between the skin and the substance, which might be such things as detergents, soaps, diesel or
    engine oils, strong chemicals, cleaners etc.

Contact with substances which the body has become allergic to: Commonly this involves nickel, rubber
etc. Where plastics have be used in place of these materials, they have helped to overcome this risk, but
jewellery and watches are still a common cause.
Varicose veins can lead to a form of eczema affecting the lower legs. This is known as varicose or
gravitational eczema. As well as treatment of the skin, it is important to improve the blood circulation in
the legs, and for most people this includes wearing support stockings and staying active on your feet. Your
doctor will discuss the options.

Symptoms
Whatever the causes of eczema - it usually leads to itching and redness, and may make the skin dry and
flaky. Sometimes itchy blisters form.  Often, in the most common form of eczema, (atopic eczema) the
problem is worst in the folds of the skin where your limbs bend.

The itch can be intense - making you want to scratch more. 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.

In the end,  the skin can become more sensitive, and you may well notice that you are more easily upset
by cosmetics, soaps, detergents etc.

In infants, symptoms include small red patches that appear on the face, torso, and outside of the arms and
legs. Older children may experience these patches in the creases of the elbows, knees, and on the wrists,
ankles, and feet. Skin may become drier, thicker, and have deeper creases. Patches may scale, crust, or
ooze. Patients are very susceptible to bacterial and viral skin infections while experiencing these symptoms.

Diagnosis
The doctor will usually easily diagnose the problem by examination. If in doubt, or if he or she feels that
you need further tests, then you may be referred to a skin specialist (dermatologist).

Further tests may include blood tests, patch tests (where little patches of different substances are stuck to
your skin for a few days, to see if you react to any of them) and other similar allergy tests.
                                                                                                                                                  
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Treatment
There is essentially no cure for eczema. It is mostly caused by a sensitivity of the skin that you are likely to
have to some degree from now on. There are, however, a number of approaches which help to minimise
your symptoms:
  • Moisturising the skin: creams, ointments and shower and bath oils which help to replenish the skin's
    natural protective oils. Always discuss these types of products with your doctor, nurse or pharmacist.
  • Washing tends to dry out the skin and make eczema worse. It helps to use an emollient cream as a
    substitute for soap, and you can apply it liberally at other times during the day. The special bath
    oils and shower gels also leave a coating of oils on the skin.
  • Some of the creams and oils contain an antiseptic, as it has been found that eczema often flares
    up as a result of a germ infecting the skin.
  • If your eczema is a result of a specific allergy or sensitivity, then it is wise to avoid the thing which
    causes it, if you can.

Your doctor may prescribe a cream or ointment containing a steroid. These are very effective at reducing
inflammation and itch. Your doctor will want you to use this sparingly, and only while the eczema is bad.
There are different strengths of steroid applications, and the tendency is to use the lowest strength that the
skin requires at the time, in order to minimise the risk of possible side effects of using steroids.

Antihistamines taken by mouth may be helpful in reducing the itch. Your doctor will advise.
If the skin becomes obviously infected, which it is more likely to do, as its normal protective surface has
been damaged, your doctor will prescribe antibiotics.

There are a number of older fashioned remedies which are still effective and may be suggested by your
doctor or specialist. For example tars, menthol.

Evening primrose oil supplements are used for eczema, and are a safe treatment, but have not consistently
proved to be effective in research trials. It would appear that the evidence may not support them being any
more effective than capsules or medicine containing no active ingredient (placebo).

If the skin is not responding well, your doctor will probably ask a skin specialist (dermatologist) to see you.
There are a number of options that the specialist may use. These may include:
  • Bandages and wet wraps
  • Drugs to suppress the immune system, otherwise mainly used to stop rejection in patients receiving
    transplants. These are only used in severe cases.
  • Phototherapy. Ultra-violet light treatment (UVB and PUVA) can be used in the treatment of atopic
    eczema. Ultra-violet therapy potentially increases the risks of skin cancer, so it is only used in
    severe cases.

While we cannot cure eczema, we can provide significant relief. Eczema patients must develop a
systematic treatment program to keep skin moist, and to alleviate itching. By managing the symptoms we
can minimize discomfort and complications until the patient outgrows the ailment.

Prevention
  • Use the cream or ointment which your doctor recommends on a regular basis, and as a soap
    substitute to keep the skin supple and to prevent drying.
  • Avoid scratching when you itch. If you cannot stop yourself, then gentle rubbing - with the flat of
    your hand is less likely to do damage.
  • Avoid exposure to chemicals and strong detergents. It is usually better to avoid using biological
    agents altogether. Use protective gloves when you use such things in the house or at work.
  • If you have been found to be allergic to a specific substance, avoid contact with it, if this is
    feasible.
  • Use your treatments according to the instructions from your doctor, and the pharmacist.

                                                                                                                                          
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