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.

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.

Causes

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.

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.

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: For this we use 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.

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. These are only used in severe cases, and include Cyclosporin

Otherwise mainly used to stop rejection in patients receiving transplants

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

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.

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.

Some of the facts

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.

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.

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.

See also our allergy page

Always seek health advice from your doctor, or local  Health Outlet. AcuMedic will be very pleased to offer advice regarding difficulties with this condition. Please see our Clinic

Please note that although we are confident that our treatments will help the majority of our patients, we cannot absolutely guarantee a cure as the needs and difficulties of each patient can differ greatly