Eczema affects one in 12 adults and one in five children.

 

Atopic eczema often runs in families.  Atopic eczema is sometimes called ‘infantile’ or ‘childhood’ eczema.  You may also hear eczema called ‘dermatitis’.  They are the same thing.  Other types of eczema are called numular or discoid (round patches), seborrhoeic (face, chest and scalp) and hand and foot eczema.

 

Why Does it Occur?

Atopy (atopic condition) is where the body’s immune system overreacts to things that would not normally do any harm leading to the skin redness and itching of eczema or swelling of nose in hayfever and lung lining in asthma.  These substances can be everywhere, from the world around us and the foods we eat, to house-dust mites.

Eczema is often linked to asthma and hay fever, though it does not always mean that you will develop either of these conditions if you have eczema.

 

When Can it Occur?

Atopic eczema occurs in one in five babies in the UK, sometimes as early as six weeks old.  It often starts on the face and scalp but may then appear on other areas of the body.  Usually it affects skin folds of the body such as the back of the knee and the inside of the elbow, but it can appear anywhere. 

Less commonly it continues into teenage and adult life.  Some children have it until they are adults, others may find that their eczema goes away during their childhood, only to come back in later life.  Another frequent “trigger” for eczema  in adults is stress.

 

What Does it Look Like?

Adult Eczema

Eczema can look different in each patient.  Usually the skin is very itchy - the main sign of eczema - and you may see people rubbing their faces, arms or legs.  This skin may start to itch before the rash begins.

The skin may look very dry and red or it may be weepy and swollen, sometimes with blisters.  In African Caribbean and Asian patients, the skin can look either darker or paler.  Many have dry skin, which is easy to look after while others may need a lot of treatment.  You will get to know what your eczema looks like and will know when to consult a dermatologist.

If the eczema gets worse, or looks different, you should see a Dermatologist to have the skin looked at.

 

Practical Management

There are many other things that can be done to make you more comfortable and less itchy.  Here are a few tips:

 

Children

  • Distract your child as much as possible by playing with them rather than telling them to ‘stop scratching’.
  • Keep nails short and for young children try scratch mittens or all-in-one sleep suits at night.
  • Find moisturisers, lotions or creams that your child likes – a good cream for some can sting others – keep trying to find one they like the feel of.
 

Adults and Children

  • Keep your home cool as overheating makes the itching worse.
  • Avoid soaps and detergent.  When bathing use moisturising lotions to wash.
  • When washing clothes, double rinse to remove all residue.
  • Use gentle, soft, eczema clothing to reduce friction, for example, light cotton but avoid wool or rougher clothing.
  • If you think stress is a factor for your eczema ask about stress reduction programmes such as meditation.

 

Treatments for Eczema

Your doctor may prescribe an anti-histamine to help you sleep at night and reduce itching.  These are meant to be used for a short time when the eczema has flared up and not as a long-term measure.

In some situations, like cold weather, eczema can get much worse on the face and hands, so apply moisturising creams or lotions frequently as these will help protect the skin.

Protect and maintain your skin barrier.  Recent research on eczema shows that maintenance of the protective skin barrier with emollients, moisturisers and washes helps improve eczema.  Ask about creams with natural moisturising factors including lipids, niacinamide and pantothenic acid.

Emollients are moisturisers that soothe and soften the skin, for example:

  • Lotions, creams and ointments to moisturise
  • Soap substitutes
  • Bath oils
 

Prescription Treatments for Eczema

  • Topical steroids should be used according to the instructions of your dermatologist.  Stronger steroid creams used continually over too long a time can cause skin thinning and bruising.
  • Non steroid creams and ointments may be prescribed for example Elidel or Protopic.  These are often used in delicate areas like around the eyes and skin folds and often prescribed for eczema in children.
  • Newer non cortisone creams are in development.
  • If there is no improvement or if there is worsening, contact your dermatologist for advice.

 

Other Treatments for More Severe Eczema

Twice weekly artificial utraviolet treatments can be very helpful for patients with more widespread eczema.  A dermatologist will advise if this is suitable and safe for you.

For more severe eczema, there are proven oral medicines good for those that need them such as ciclosporine or methotrexate which dermatologists can prescribe and monitor. 

We now have a new treatment for severe eczema called the Dupilimab injection which is a very effective targeted anti-eczema medicine.

 

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