What is atopic eczema and its treatment?
Atopic eczema (atopic dermatitis) is the commonest form of eczema and is closely linked with asthma and hayfever. It can affect both children and adults, usually running in families. One of the most common symptoms of atopic eczema is its itchiness (or pruritis), which can be almost unbearable. Other symptoms include overall dryness of the skin, redness and inflammation. Constant scratching can also cause the skin to split, leaving it prone to infection. In infected eczema the skin
may crack and weep ('wet' eczema). Treatments include emollients to maintain skin hydration and steroids to reduce inflammation.
The main symptom, as with all types of eczema, is itch. Generally the skin is dry but the most affected skin looks red, with a slightly raised but ill-defined margin when the eczema is active. Lumps or blisters, some oozing of fluid from the skin surface and scaling of the skin are all features of flare-ups. After the acute episodes the skin will settle down to a less active longer-term appearance, which is a bit less angry looking but shows more in the way of thickening, scoring and darkening of the skin where it is most scratched. In infants and children the affected skin is mostly the face and as they get a bit older the rash spreads to the body and limbs. The napkin area is usually spared although it may be inflamed from the effect of urine or the overgrowth of yeast organisms on the skin (thrush). White children tend to get the most trouble on the ‘flexures’ – the skin creases on the meeting surfaces of the joints. Elbows, wrists, behind the knees and fronts of the ankles are typical. Black and Asian children tend to be affected on the opposite side of the joints, such as the point of the elbow or front of the knees. Adults show more involvement of the face and trunk again.
Superficial infection of the skin causes increased redness and heat, weeping and perhaps crusting. Small blisters may contain pus. Infected eczema does not usually give signs of general infection such as a raised temperature.
The cause is not known. Some cells of the immune system release certain chemicals under the skin surface which causes the inflammation. But it is not known why this occurs. Atopic eczema (atopic dermatitis) has become more common in recent years. There are various theories for this. Factors which may play a role include: changes in climate, pollution, allergies to house dust mite or pollens, diet, infections, or other 'early-life factors'. However, there is no proven single cause. There may be a combination of factors which causes the immune system to react and cause inflammation in the skin.
The three common treatments for atopic eczema are: Avoid irritants to the skin wherever possible; Moisturisers - use every day to help prevent inflammation developing; Steroid creams - use when there is a flare-up of skin inflammation.
Avoid soaps, bubble baths, etc, when you wash. Instead, use a soap substitute plus a bath or shower emollient (see below). Wear cotton clothes next to the skin rather than irritating fabrics such as wool. However, it is probably the smoothness of the material rather than the type of the material which helps. Some smooth man-made fabrics are probably just as good as cotton. Avoid getting too hot or too cold. After you wash clothes with detergent, rinse them well. Some 'biological' detergents are said by some people to be irritating. But there is little proof that commonly used detergents which are used in the normal way make eczema worse.
Moisturisers (emollients) are the most important part of the day-to-day treatment. Dry skin tends to 'flare-up' into inflammation. This can often be prevented by keeping the skin supple and moist. This is hard work and tedious, but worthwhile. You can apply moisturisers as often as you need. This may be twice a day, or several times a day if your skin becomes very dry. Water and soap tend to dry out the skin as they wash away the natural oils. Moisturisers work by replacing these body oils, and keeping a layer of 'oil' on the skin. As a general rule, the more greasy and thick the moisturiser is, the better and longer it works, but the less pleasant they are to use. Children may not mind greasy ointments. Adults may prefer less oily creams, but perhaps apply them more often. Apply liberally to all areas of skin which tend to be affected. A common mistake is to stop using moisturisers when the skin appears good. Patches of inflammation, which may have been prevented, may then quickly flare-up again.
If inflammation flares up, a topical steroid is usually advised. Steroids work by reducing inflammation in the skin. Topical steroids come in differing strengths. In general, you should use the lowest strength which works. Follow the instructions as directed by your doctor. Apply sparingly, but include all areas of inflamed skin. Twice daily application is common (but follow the instructions for your particular one). Dont forget to use moisturisers as well (after putting on the steroid). Stop using the topical steroid when the inflammation has settled. If the inflammation does not start to settle within a few days, you are likely to need a stronger preparation. If needed, return to see your doctor for a new prescription.
Carefully controlled ultraviolet light treatment can be useful but needs to be rationed to limit the increased risk of skin cancer in the long term. Oral drugs that dampen the immune system are the main treatments for severe eczema and can be used in the medium to long term, provided they are monitored for the occurrence of side effects. This usually can be done by periodic blood tests. Short courses of steroids by mouth at fairly high dose are sometimes also used to bring active eczema under control. Evening primrose oil/gamolenic acid capsules have now been discontinued as treatment for eczema as there has been no convincing evidence that it works. Chinese herbal treatment is also potentially problematic for various reasons. Despite some apparent successes, the way in which it works is unclear. Some Chinese herbal products have been found to contain added steroids and there is no regulation controlling either the safety of such products or the qualifications of those prescribing them; therefore, at the moment one can’t recommend them with any confidence.
More information on eczema
What is eczema? - Eczema is a heterogeneous group of different non-infectious skin diseases. Eczema occurs in both children and adults, but usually appears during infancy.
What types of eczema are there? - There are various types of eczema, including atopic eczema (atopic dermatitis), contact dermatitis, varicose eczema, discoid eczema, nummular eczema, stasis dermatitis.
What are the symptoms of eczema? - Symptoms of eczema are itching and redness, and may make the skin dry and flaky. Eczema makes the skin more sensitive.
What causes eczema? - The most common cause of eczema is a general allergic over-sensitivity. Other types of eczema arise as a result of causes within the body.
How does eczema affect people? - In eczema, the main problems occur in the epidermis where the keratinocytes become less tightly held together.
How is eczema diagnosed? - Eczema is usually diagnosed through a physical examination. Further tests may include skin biopsy or patch tests.
What are the treatments for eczema? - Avoidance of the aetiological factors is one important therapeutical approach. Symptomatic treatment includes topical and systemic treatment regimens.
How can eczema be prevented? - Eczema flare-ups can be prevented by avoiding exposure to extreme temperatures, dry air, harsh soaps and bubble baths.
How to deal with infant or baby eczema? - For mild to moderate baby eczema, the application of moisturizer on a regular basis can be very helpful. Avoid as many eczema triggers as possible.
What is atopic eczema and its treatment? - Atopic eczema (atopic dermatitis) is the commonest form of eczema and is closely linked with asthma and hayfever.
What is dyshidrotic eczema? - Dyshidrotic eczema is a form of eczema often seen on the hands and feet where tiny blisters of serum form just below the skin's surface.
What is nummular eczema? - Nummular eczema is a chronic eczema characterised by coin-shaped, sharply demarcated lesions. Nummular eczema is more common in males.
What is hand eczema (hand dermatitis)? - Hand eczema, also called hand dermatitis, is a skin condition in which the hands develop a rash and become red, dry, cracked, and inflamed.
What is varicose eczema? - Varicose eczema is due to increased pressure within the veins in the leg. Varicose eczema affects the lower legs people in their middle to late years.
What's seborrhoeic eczema? - Seborrhoeic eczema is a common skin disease affecting any sebum-(natural oil) producing area of the skin.