Things You Might Not Know about Eczema

What is eczema?

The words eczema (which comes from the Greek word meaning to boil') and dermatitis (meaning inflammation of the skin) are often used interchangeably to describe several conditions that cause the skin to become dry, itchy, inflamed or irritated. There are a number of different types of eczema but the term is most often used to refer to atopic eczema (also called atopic dermatitis). The word atopic refers to hypersensitivity reactions to something in the environment.

Atopic eczema is a very common, non-contagious, chronic (long-term) inflammatory skin condition. If you have atopic eczema, your skin barrier function (which prevents water loss and protects against allergens and irritants) is impaired or weakened. This makes the skin dry out and become more vulnerable to infections by bacteria and viruses.

What causes atopic eczema?

While the exact cause is not known, certain factors are thought to be important in its development, these include an inherited (genetic) predisposition to have a weakened skin barrier, as well as altered inflammatory and allergy responses. Atopic eczema most frequently begins in infancy but may also develop for the first time in adulthood. It affects approximately 1 in 5 children and 1 in 10 adults in Ireland.

For most children affected, the disease is mild. However, often those who have seemingly outgrown the condition will continue to have life-long sensitive skin and may have recurrences of eczema following long symptom-free spells. Atopic eczema can run in families and frequently occurs alongside other atopic conditions, including hay fever and asthma. Although there is no cure for eczema yet, treatment are available to manage the condition.

Symptoms

Symptoms include red, dry, itchy skin, which can sometimes weep, become blistered, crusted and thickened. However, the appearance of eczema and the locations of the body affected can vary greatly depending on the age of the person affected.

The main symptom is an intense itch. Scratching only provides temporary relief, and leads to more itching and scratching (the itch-scratch cycle), which can worsen eczema and make the skin more vulnerable to infection. Scratching in response to itch can cause some of the changes seen on the skin in eczema.

The intense itch is very uncomfortable, can be severe enough to interfere with sleep, and negatively impact on the quality of life of the person affected, as well as his/her family. Some people with more pronounced eczema can also experience social embarrassment due to the visibility of their condition. Typically atopic eczema goes through phases of being severe, then less severe. During a flare up', when eczema is very active, symptoms such as redness, dryness and itch worsen, while at other times, symptoms settle.

Eczema triggers

Irritants and allergens

Atopic eczema can be triggered or aggravated by exposure to a number of environmental irritants or allergens. Common irritants include soap, bubble bath, shampoo, laundry detergents, fragrances, clothing that feels itchy' next to the skin (e.g. wool), changes in temperature, or allergens like animal dander, the house dust mite or pollen, but sometimes no cause can be identified.

Stress

Emotional stress can aggravate eczema. Finding ways to reduce stress may lessen the frequency and, hopefully, the intensity of the flare-ups. Whilst stress is associated with flares of atopic eczema, it is not yet fully understood.

Infection Atopic skin is more vulnerable to infection and infection is often associated with a worsening of eczema. Seek urgent medical advice if skin becomes:

Wet or weepy, with yellow/brownish crusts
Very sore, with clusters of painful itchy blisters, particularly if there has been contact with someone who has a cold sore

Managing eczema

The main aim is to improve symptoms and achieve long-term control. In atopic eczema, the skin's protective barrier is weakened which allows moisture to be lost, and irritants and allergens to pass through the skin more easily. Some common everyday substances e.g. soap, contribute to the weakening of the skin's barrier and should be avoided.

It is important to remember that on-going (every day), frequent and generous use of emollients form the basis of eczema management, but when your eczema flares up, other treatments, such as topical steroids, are needed and are usually prescribed by your healthcare professional. For eczema, the good news is that there is a range of treatment options available, as well as on-going research examining potential new treatments. Treatment depends on the severity and location of eczema, as well as the age of the person affected. Talk with your doctor to find a treatment regimen that is most appropriate for you.

Everyday eczema skin care

Emollients Emollients are an essential part of daily care, even when skin is clear. Emollients are moisturizers that are used in two ways applied directly to the skin as a leave-on moisturizer, and as a soap substitute instead of soap or shower gel. Used several times a day, emollients help to soothe dry, itchy skin and repair the skin's barrier, thereby preventing entry of irritants and allergens, which can trigger eczema flares. Soap substitutes/emollient wash products Ordinary soaps, bubble baths and shower gels should be avoided as they dry out the skin by stripping away its natural oils. Instead, choose emollient wash products when bathing which leave the skin coated with a protective film afterwards. Choosing an emollient Emollients come as lotions, creams and ointments. Finding the right emollient is often a matter of trial and error but the best emollients are ones that you (or your child) prefer to use and will continue to use every day. Remember, a higher price doesn't necessarily indicate a better product ask your healthcare professional for advice. Some practical tips for emollient therapy

Establish a good daily skin care routine and try to stick to it.
Don't stop moisturising when your skin is clear.
Emollients tend to be bland and fragrance- free (unperfumed); ask your healthcare professional for advice.
Apply emollients in a smooth, downward motion, in the direction of the hair growth.
A child with atopic eczema often requires a minimum of 250g of leave-on' emollient per week, while an adult may need approximately 500g per week.
Remember avoid soap, bubble bath and shower gel!
Use soap free products for bathing and specially formulated shampoos.
Bathwater should be a lukewarm temperature; 5 minutes with an emollient bath additive is sufficient.
After bathing or showering, gently pat skin dry. It is a great time to apply emollient all over when the skin is still slightly humid'.
Remember to change your tub of emollient at least every six weeks, as it can become contaminated, or use a pump dispenser.

It is very important to establish the right diagnosis, so if you are concerned about your skin, you should always speak with your doctor.

Clothing & wet wraps

Sometimes it can be difficult for children or indeed anyone who suffers with eczema to find comfortable clothing, particularly when there has been a flare up of the condition. Clothing can aggravate eczema as skin can be very hot and heat increases itch.

Basic tips:

Avoid harsh synthetic fabrics
Seams
Fabrics that do not let the skin breathe
Use thin layers rather than one thick layer of clothing

Bedtime

Consider using eczema specific clothing (see below)
Consider using soft cotton or silk sheets and thin cotton blankets
Avoid woolen underlies, blankets and plastic mattress protectors
Use Anti-dust mite covers on beds, pillows etc. if an allergy is suspected