It is a disease characterised by flare-ups and remissions and cannot be caught from other people.
What Causes Eczema?
Eczema often proves to be something of a puzzle since there is often no obvious cause for it. Some eczema is due to allergies but may just as readily be triggered by stress or emotional upsets. Sufferers are especially prone to irritation from chemicals, so care is needed with the choice of job in an adult with eczema.
What Are The Signs And Symptoms Of Eczema?
The typical appearance is of an inflamed area of skin, which becomes dry and then cracked. There may be small blisters at this time but the main symptom is of intense itching - a fretful scratching child is commonly seen as a result. This itching sets up what is known as the 'itch-scratch' cycle where scratching makes the itching worse and aggravates the skin inflammation. This can lead to wet, bleeding patches on the skin as well as infection due to the skin being broken. In chronic eczema, scratching may thicken the skin - this is known as lichenification. Atopic eczema usually affects the face, neck, inside of the elbows and back of the knees, where the skin folds or clothes rub and it is usually the scratching of the skin itself rather than the patch of eczema which causes symptoms.
Will I Have Any Tests Or Investigations?
Most eczema is diagnosed simply from the appearance of the skin alone. In adults, where there may be a question as to whether any work chemicals or other irritants are causing the skin irritation, patch testing is sometimes used. This is where small patches of different possible allergens (anything which may cause a skin reaction such as pollen, nickel or dyes) are stuck on the skin for 48 hours, then removed. Any positive reactions are noted, along with what has caused them, and there is a further examination at 96 hours to detect any further reaction.
What Treatment Might I Need?
The main aim of all treatment is to stop the itch-scratch cycle. Each treatment is tailored to the individual concerned, but there are several general principles;
¤ Small children and babies can wear cotton mittens to prevent them causing more damage to the skin by scratching.
¤ Cotton underclothes and socks should be worn, and wool should be avoided since sharp fibres irritate the skin.
¤ Avoid frequent hot baths or showers. In place of soap, aqueous cream or emulsifying (softening) ointment should be used.
¤ When bathing, bath oils will prevent the skin from drying out.
¤ Steroid-based creams may be used to relieve the itching, such as 1% hydrocortisone. This may be used in addition to antibiotics if the skin is infected, and for more severe eczema, the strength of the steroid cream can be increased. Such strong creams should only be used for limited periods however, since prolonged use of these - for weeks or months on end - can cause the skin to thin and age prematurely.
¤ Creams containing coal-tar extracts are well known and often effective, but smell rather strongly of tar and so are often passed over in favour of other creams.
¤ Antihistamine tablets can help reduce severe itching, and in young children can be used to have a sedative effect to help the child sleep.
What Course Will The Illness Follow?
Most cases of atopic eczema in children clears as childhood progresses, and is absent in adulthood. It is not dangerous in any way, but follows a pattern of flares and remissions, often with superficial infection of the skin caused by scratching triggering attacks. By the age of seven, 50% of children with eczema have grown out of it, and less than 10% still have eczema by the age of thirteen.
Can I Do Anything To Help Myself?
If the eczema can be linked to allergy, then this should be avoided. With babies who suffer from eczema, changing their milk from cow's to breast milk (or goat's milk or soya milk if the mother cannot breastfeed or the baby is being weaned) reduces the possibility of allergic eczema. Avoid certain plants such as primulas, ivy or chrysanthemums which can trigger skin reactions. It is always very important to avoid anyone suffering from cold sores since the herpes virus which causes these easily infects patches of eczematous skin. As a general rule, avoid as much stress as possible although this is sometimes very difficult to achieve.
Tell Your Doctor
1. Does it itch?
2. Do you have to scratch it, however hard you try not to?
3. Is it usually on specific parts of the body, such as behind the knees?
4. Do any foods or anything else seem to make it worse?
5. Do you suffer from asthma or hay fever?
Ask Your Doctor
1. Will I have this condition for life?
2. Will I have to change my job?
3. Should I change my diet?
4. How much steroid cream should I be using?
5. Will alternative treatments (such as Chinese herbal treatment) be of any use?
By Dr Roger Henderson, MB BS Lond., LMSSA Lond.