Eczema
Download MySkinDoctor today
What is eczema?
Eczema is a very common skin condition due to skin inflammation. Eczema (or inflammation of the skin) can affect anyone at any time in their lives. One in every five children in the UK is affected by eczema at some stage. It may also start later in life in people who did not have Atopic Eczema as a child.
'Eczema’ is a term which comes from the Greek word ‘to boil’ and is used to describe red, dry, itchy skin which can sometimes become weeping, blistered, crusted, scaling and thickened.
What does eczema look like?
Eczema can affect any part of the skin, including the face, but the areas that are most commonly affected are the creases in the joints at the elbows and knees, as well as the wrists and neck (called a flexural pattern). Other common appearances of Eczema include coin-sized areas of inflammation on the limbs (a discoid pattern), and numerous small bumps that coincide with the hair follicles (a follicular pattern).
Affected skin is usually red and dry, and scratch marks (accompanied by bleeding) are common. When Eczema is very active, it may become moist and weep fluid (during a ‘flare-up’) and small water blisters may develop especially on the hands and feet. In areas that are repeatedly scratched, the skin may thicken (a process known as lichenification), and this may cause the skin to itch more. Sometimes affected areas of the skin may become darker or lighter in colour than the surrounding, unaffected skin.
Is eczema hereditary?
Yes. Eczema tends to run in families. If one or both parents have eczema it is more likely that their children will develop it too. Approximately one third of children with Eczema will also develop asthma and/or hay fever. Eczema affects both males and females equally.
What are the symptoms of atopic eczema?
The main symptom is itching. Scratching in response to itching may cause many of the changes seen on the skin. Itch can be severe enough to interfere with sleep, causing tiredness and irritability. Typically, Eczema goes through phases of being severe, then less severe, and then gets worse again. Sometimes a flare up can be due to the reasons outlined below, but often no cause can be identified.
How is eczema diagnosed?
The features of Eczema are usually easily recognised by health visitors, practice nurses and doctors, when they assess the skin. Blood tests and skin tests are usually not necessary. Occasionally the skin may need to be swabbed (by rubbing a sterile cotton bud on it) to check for bacterial or viral infections.
What makes eczema flare-up?
- Many factors in a person’s environment can make Eczema worse; these include heat, dust, woollen clothing, pets and irritants such as soaps, detergents and other chemicals.
- Being unwell, for example having a common cold can cause a flare-up.
- Infections with bacteria or viruses can worsen Eczema. Bacterial infection (usually with a bacteria called Staphylococcus) makes the affected skin yellow, crusty and inflamed, and may need specific treatment. An infection with the cold sore virus (herpes simplex) can cause a sudden painful widespread (and occasionally dangerous) flare-up of Eczema, with weeping small sores.
- Dryness of the skin.
- Teething in babies.
- In some, food allergens may rarely cause a flare up.
- Stress
Can eczema be cured?
Eczema cannot be cured, but there are many ways of controlling it. As they get older, most children with eczema will see an improvement with 60% clear by their teens. However, many of these people continue to have dry skin and so need to continue to avoid irritants such as soaps, detergents and bubble baths.
Eczema may be troublesome for people in certain jobs that involve contact with irritant materials, such as catering, hairdressing, cleaning or healthcare work. In later life, Eczema can present as hand dermatitis and as a result exposure to irritants and allergens must be avoided both in the home and at work.
Can eczema be prevented?
Regular use of medical moisturisers can help restore the skin’s barrier in children who might otherwise develop Eczema.
Although exclusive breast-feeding has been advocated for the prevention of eczema in susceptible infants, there is no evidence that this is effective. There is also no definite evidence that organic dairy products help to reduce the risk of eczema, or that eating fish oil during pregnancy helps to prevent eczema in childhood.
For some patients who flare-up frequently, intermittent use of a topical steroid or calcineurin inhibitors (see below) may reduce the number of flare-ups.
How can eczema be treated?
‘Topical’ means ‘applied to the skin surface’. Most eczema treatments are topical, although for more severe eczema some people need to take ‘oral’ medication (by mouth) as well.
‘Complete emollient therapy’ is the mainstay of treatment for all patients with eczema as the most important part of their treatment - this means regular application of a moisturiser (also known as an emollient) and washing with a moisturiser instead of soap (known as a soap substitute).
Self care (What can I do?)
- Moisturise your skin as often as possible, ideally at least 2-3 times each day. The most greasy, non-perfumed moisturiser tolerated is best. This is the most important part of your skin care. Smooth it on in the direction of hair growth. Do not put your fingers back and forth into the pot of moisturiser, as it may become contaminated and be a source of infection. It is best to remove an adequate amount to cover the skin with a spoon or spatula and put this on a saucer or piece of kitchen roll.
- Wash with a moisturiser instead of soap (known as a soap substitute), and avoid soap, bubble baths, shower gels and detergents.
- Wear non-powdered non-rubber gloves (e.g vinyl gloves) to protect your hands and avoid contact with irritants, such as when doing housework.
- Rinse well after swimming and apply plenty of your moisturiser after drying. Make sure that the shower at the swimming pool contains fresh water and not chlorinated water from the swimming pool.
- Wear comfortable clothes made of materials such as cotton and avoid wearing wool next to your skin.
- Try to resist the temptation to scratch. It may relieve your itch briefly, but it will make your skin itchier in the long term. Smooth a moisturiser onto itchy skin.
- Avoid close contact with anyone who has an active cold sore as patients with eczema are at risk of getting a widespread cold sore infection.
- Do not keep pets to which there is an obvious allergy.
- Keep cool. Overheating can make eczema itch more.
- Treat eczema early - the more severe it becomes, the more difficult it is to control.
- Wash clothes with a non-biological washing powder and use a double rinse cycle to remove detergent residues from the clothing.
This is a common type of eczema and is also known as varicose, stasis or gravitational eczema. It is a very common skin condition developing in older patients and is more common in women. In more severe cases, eczema of the legs will trigger widespread eczema at other sites.
It affects one or both lower legs producing skin redness. The skin is typically red, scaly and can be itchy. It may be misdiagnosed as a skin infection called cellulitis. Skin infection differs from varicose eczema in that the skin usually feels hot, tender and the patient will normally feel unwell. Varicose eczema commonly affects both legs, whilst cellulitis just one leg.
Varicose eczema is due to leaky blood vessels in the lower legs. The vessels leak due to damage to the venous system due to the increased pressure associated with trauma, previous blood clots in the lower leg (DVT), immobility, obesity, and past skin infections. The pressure in the veins builds up to release chemicals that cause the skin changes. There may be associated increased pigmentation of the skin and a purplish-red discolouration due to iron (haemosiderin) deposition from leaking blood.
Any associated leg swelling can make the skin appear like orange-peel and can blister occasionally. More chronic damage results in white irregular scars surrounded by red spots (atrophie blanche) and thickening of the skin of the lower leg with narrowing around the ankles (lipodermatosclerosus). Some patients will develop venous ulcers and can also have varicose eczema develop intermittently.
Varicose eczema causes inflammation of the lower skin of the leg that will typically respond to a potent topical steroid ointment called Dermovate® ointment (Clobetasol Propionate 0.05%). This is the most effective treatment and will normally switch off the eczema in a few days but needs to be applied for a minimum time period of 2-weeks.
Discoid eczema is a common form of eczema characterised by disc shaped areas of inflammation and more generalised eczema at different body sites. It can develop in any age group but is common in young children and men aged 45-80 years of age. It can present for the first-time with no past-history of eczema especially in older age groups.
Patches of discoid eczema may be coin-shaped or much larger. They are usually intensely itchy. Widespread eczematous itchy red skin can develop on the whole body. Many of these areas will be red, sore and angry looking. When very established, and if left untreated, they may weep.
Most patients find that lesions come and go at different body sites in cycles. Some areas are more persistent than others. They typically affect the limbs and body sparing the face. In children they may be very well-circumscribed and look like open sores – so called nummular eczema.
The cause of discoid eczema is unknown. Similar appearances can occasionally occur in other forms of eczema, including childhood atopic eczema, allergic contact eczema, and irritant eczema due to contact exposure to allergens or irritants such as soaps but these are not true discoid eczema. It is not hereditary.
Discoid eczema is usually diagnosed clinically. Investigations are usually unnecessary but are sometimes performed to rule out other conditions e.g. by taking a skin biopsy (small sample of the skin cut under local anaesthesia) from one of the patches. It is rare to need other tests.
Discoid eczema will often last several months before burning itself out. Some patients develop more persistent disease and need to treat areas for long durations of time. Most patients find that treatment is effective. Treating new areas for 3-5 days when they first develop, helps to avoid getting more lesions.