Eczema

Eczema is a term used interchangeably with dermatitis. Atopic eczema is the genetic form of eczema which typically starts in childhood and is associated with a family history of atopy (the genetic tendency to develop eczema, asthma and hay fever). Many eczema sufferers improve or clear with age but in some cases, the symptoms persist or even worsen in adulthood. Eczema is not infectious but can become secondarily infected with bacteria or viruses.  

Eczema presents as a rough, red, scaly or bumpy rash. When severe it can become weeping and crusted. The most common areas affected are the flexures (inside elbows and behind knees) and the head and neck in children, but eczema commonly affects all other body areas. It is extremely itchy for most people.

Despite a known genetic cause, the exact mechanism and factors involved in the formation of eczema are yet to be fully understood. What we do know is that there is a dual problem of skin barrier dysfunction (compromised skin barrier allowing increased penetration of environmental irritants and allergens through the upper layers of the skin) and an excessive immune reaction (causing release of inflammatory mediators in the skin resulting in redness, itch and swelling). This combination acts as a vicious cycle resulting in further breakdown of the skin barrier and worsening of the eczema. The severe itch makes scratching very difficult to resist, further contributing to the broken skin barrier and setting up an itch-scratch-cycle typical in eczema.

There are many other less common forms of eczema or dermatitis.

These include:

• Irritant dermatitis: skin barrier breakdown due to physical or chemical irritation on the skin eg excessive hand washing
• Allergic contact dermatitis: delayed hypersensitivity reaction to chemical in direct contact with the skin eg nickel allergy (costume jewellery), allergy to components of creams, hair dyes etc
• Asteatotic eczema: skin barrier disruption due to dryness and loss of integrity of the skin typically seen in older age

Eczema varies greatly between sufferers in both presentation and triggers. All people will have individual reasons for eczema breakouts and flare-ups. Some of the more common exacerbating factors include:

• Stress
• Viral illnesses
• Weather (especially cold dry climates)
• Heat
• Environmental allergens (eg dust mite, pollens, grasses)
• Friction/skin irritation (eg saliva or dummy in infants)
• Foods salicylates
• Bacterial infection or overgrowth on the skin

Treatment varies greatly depending on the type, extent and severity of the eczema and also the age and personal preferences of the patient.

Of utmost importance is avoidance of exacerbating factors and protection of the impaired skin barrier in order to break the inflammatory cycle prevent progression. It is important to understand however that if the inflammation is not also reduced, then this will prevent the skin from being able to completely repair and thus the cycle will continue.

Treatment can be broadly divided into:

Prevention and protection of the skin barrier:

• Avoid irritants such as soaps and solvents that deplete the skins natural protection
• Avoid physical irritation such as sand or excessive water
• Minimise temperature changes and avoid excessive heat especially in babies and young children
• Protect the skin as often as possible with bland, fragrance free moisturisers and barrier creams to areas exposed to irritation
• Cover areas with dressings or wet wraps to reduce scratching and relieve itch
• Bleach baths reduce bacterial overgrowth on the skin, a common exacerbating factor especially in children
• Skin care and anti-ageing treatments should be specifically tailored to eczema prone skin.

Reduction of inflammation:

• Topical corticosteroids as directed by your doctor to reduce inflammation and itch and allow the skin to heal
• Wet wraps
• Narrow-band UVB therapy (in clinic treatment at Complete Skin Specialists which safely reduced skin inflammation using UV light)
• Immune-suppressing therapy – oral corticosteroids or steroid-sparing agents are required in some people.