Eczema is the most common inflammatory disease of the skin and affects many
millions of adults and children world-wide.
It is typically a chronic contagious inflammatory condition that
appears as dry, red, scabbed, scaly, or blistering skin. Eczema can't be cured, but it can be managed. Other names for eczema include atopic dermatitis and atopic eczema.
Atopic eczema is most common in children and is one of the so-called sensitivity
conditions which also include
asthma and hay fever. These disorders tend to run
in families of people who are prone to allergic reactions.
Symptoms of Eczema
skin (this symptom separates eczema from
other skin rashes). Some people with the disease develop red, scaling skin
where the immune system in the skin is becoming very activated.
Recurring rash - dry, red, patchy or cracked skin. (In infants and
toddlers, the rash usually appears on the face, elbows or knees. In older
children and adults, the rash appears less often on the face, and more
commonly on the hands, neck, inner elbows, backs of the knees and ankles)
Skin weeping watery fluid
Rough, "leathery," thick skin. This condition is called lichenification.
Lesions which may be infected by bacteria or viruses.
Although the exact cause of eczema is unknown, it appears to be linked to the
following internal and external factors:
A family history of eczema,
asthma or hay fever (the strongest predictor) - if both
eczema, there is an 80 per cent chance that their children will too.
Particular food and alcohol (dairy and wheat products, citrus fruits,
eggs, nuts, seafood, chemical food additives, preservatives and colourings)
Stress. Emotional stress is a
well-known trigger of eczema flare-ups. Patients can have difficulties with
anxiety, anger and hostility caused by having eczema. This only adds to the
problem. Learning to reduce stress may lessen the frequency and, hopefully,
the intensity of the flare-ups.
Test for Eczema
tobacco smoke, chemicals,
weather (hot and humid or cold and
dry conditions) and air conditioning or overheating. Avoid materials that feel
"itchy," things like wool, burlap, etc. Try to wear soft fabrics like cotton,
which tend to be less irritating. It's also a good idea to wash all new
clothes, linens, and towels before using them for the first time.
Allergens - house dust
mites, moulds, grasses, plant pollens, foods, pets and clothing, soaps,
shampoos and washing powders, cosmetics and toiletries.
Ingredients such as alcohol,
astringents, and fragrances may trigger or worsen eczema.
A medical professional can usually identify eczema by looking at the rash and
asking questions about how it appeared. He or she may scrape some scales off the
rash and look at them under the microscope to make sure the rash is not caused
by fungus. Other types of infection also must be ruled out.
The three key elements in identifying eczema are:
Characteristic scaly rash.
To help you find out whether that itchy rash is actually eczema, check out the
risk assessment questionnaire.
Atopy, or a personal or family tendency toward asthma, hay fever, and
There are all kinds of
different creams and compounds that give relief to and even remove the symptoms
of eczema. Some of these are more chemical based and others focus on more
Treatment options for eczema include:
Emollient creams are designed to add moisture to the skin. Apply
moisturisers regularly each day to clean, dry skin. It is especially
important to moisturise after showering and bathing, and when living or
working in an air-conditioned or heated environment. You may need to try
several different brands until you find the emollient that works best for
you. See your doctor, dermatologist or chemist for advice.
Histamine is a chemical produced by the body that is responsible for many of
the symptoms of inflammation including redness, swelling and itching.
Antihistamines block the action of histamine and help to reduce eczema
symptoms, particularly itching. Generally, oral antihistamines are best taken
around half an hour before bed to help guarantee a good night's sleep,
uninterrupted by the urge to scratch. Antihistamines are available from
chemists without prescription, but remember that some types may cause
drowsiness. Antihistamine creams should be avoided, as they can trigger an
allergic skin reaction.
Since eczema is an inflammatory condition, it responds well to topical
steroids (corticosteroids). These anti-inflammatory creams come in various
strengths, and are available by prescription from your doctor. Generally, it
is better to use the lowest dose you can. Using high dose topical steroids
for extended periods of time, especially on delicate areas like the face,
can cause side effects including thinning of the skin. It is best to apply
the cream to the reddened areas after bathing, but make sure the skin is
In severe cases of eczema, a short course of oral corticosteroids may be
necessary. This must be done under careful medical supervision because
symptoms may become worse once the tablets are stopped.
Evening Primrose Oil
primrose oil (or star flower oil) contains gamma linolenic acid.
This type of
fatty acid is thought to play an important role in maintaining
healthy skin. Some studies have found that it is lacking in some people with
eczema. If evening primrose oil is effective in controlling symptoms in
those people, it may reduce the need for medicated creams such as topical steroids. Evening primrose oil
is applied directly to the skin or can be
taken orally in capsules.
Another way to reduce the itch associated with eczema is to apply coal tar
directly to the affected areas. Coal tar isn't a very 'user-friendly'
product, since it has a strong smell and tends to stain any fabric it
touches. Coal tar can irritate some people's skin. It should only be used
under supervision of a doctor who is experienced in managing eczema.
In most cases, diet is thought to play no part in eczema but, occasionally,
a person's symptoms are aggravated by eating certain foods such as dairy
products. It is important to seek professional advice from your doctor or
dietitian, and to undergo proper allergy tests. Avoid, Self-diagnosis and
self-imposed dietary restrictions for they might lead to unnecessary nutritional
Ultraviolet Radiation Therapy (Phototherapy)
ultraviolet radiation can help reduce the symptoms of chronic
eczema. Exposure under medical supervision can be carefully monitored with
the use of specially designed 'cabinets' - the patient stands naked within
the cabinet and fluorescent tubes lining the device emit ultraviolet
radiation, in a similar fashion to a solarium. The risks of unsupervised
ultraviolet radiation therapy can be the same as for sunbathing -
ageing of the skin and increased risk of
skin cancer. A person
with stubborn eczema may need up to 30 sessions.
Cyclopsorin Oral Medication
Cyclopsorin is an immune system depressant. It helps to manage the symptoms
of severe eczema by preventing the immune system from launching special
cells called lymphocytes into the affected areas of skin. Without
lymphocytes, the inflammatory aspect of eczema is dramatically reduced. The
side effects of this powerful drug can include
high blood pressure, kidney
problems, increased susceptibility to all types of infections, and a
suspected increased risk of skin cancer. Because of the risk of significant
side effects, and the need for close and regular monitoring, oral cyclosporin is only considered in severe cases of eczema that are difficult
to control with other therapies.
How to Manage Eczema
There are ways to alleviate the child's distress. It will help if you:
Gain the child's cooperation
- Try to prevent scratching (by distracting the child)
- Get to know your child's responses to environmental conditions
- Read about the condition
- Educate others (siblings, friends, relatives) to be sympathetic
- Reduce associated stress for yourself and child.
- Avoid wearing tight-fitting, rough, or
See your doctor if the eczema gets worse.
Keep the skin moist
Moisturisers can be used as often as necessary
Use oisturiser or bath oil instead of soap in bath or shower
Apply cool moisturising cream (keep in fridge) before bed
Sorbolene and Aquasol are common moisturising creams
Use moisturiser before and after
Avoid skin irritants
Many things can irritate the skin. It will help if you:
Avoid dummies, dribbling and/or food around the mouth.
Don't let your child overheat, particularly in bed or on long car
Avoid prickly materials (such as woollen or acrylic jumpers, car seat
Use cotton one-piece pyjamas and mittens.
Don't use detergents, soaps, bubble baths or antiseptics.
Avoid contact with pets.
People with skin infections like cold sores should not touch the child.
Medicines and creams
Doctors may prescribe a range of creams:
Cortisone-based creams can control eczema
Different strength creams may be prescribed
If bacteria infect lesions, antibiotics may be needed
Medication to relieve itching may be required.
Dated 18 November 2010