Eczema (atopic dermatitis) is a recurring, inflammatory, non-infectious skin condition that affects one in three Australians at some stage throughout their lives. This skin condition is most common in people with a family history of an atopic disorder, which includes hay fever or asthma.
Usually appearing in early childhood, patches of skin become red, scaly and itchy. In severe eczema cases, there may be weeping, bleeding or crusting over of the skin patches. This skin condition can flare and subside for no apparent reason, causing the eczema sufferer a lot of discomfort and pain.
Weeping skin is skin that the atopic dermatitis has become infected, usually with the bacterium Staphylococcus aureus (‘golden staph’). It’s important to note that eczema is not contagious.
While eczema affects all ages, it generally materialises in early childhood (in babies between 2 to 6 months of age) and can improve with age. A small percentage of eczema sufferers can experience severe eczema into adulthood. Adult eczema can be very hard to treat as it’s often caused by factors including medications. While eczema can be effectively managed and treated, there are no cures currently available.
Even though people with eczema to can have or will develop other allergies, (suggesting that inherited factors increase the tendency to develop eczema) it doesn’t mean that allergies will result in someone developing eczema.
Eczema results from an inability to repair damage to the skin barrier that has been caused by a gene mutation called filaggrin. If people have a mutation in the gene called filaggrin, the skin barrier will not be formed completely. Usually every cell in the skin will have two copies of the filaggrin gene. For people who are susceptible to eczema they only have one copy of this gene.
While you only need only one copy of the gene to create a normal skin barrier, two copies are vital for skin barrier repair. A person with only one copy of the filaggrin gene may find that their ability to repair the skin barrier is limited their skin is exposed to irritants or their skin barrier is disrupted.
The skin barrier in people who have eczema is different from those people who do not have eczema. In people with eczema the skin barrier does not work as well. The skin has less water retaining properties, so the moisture is easily lost from the skin, causing it to dry out easily. Increasing the amount of water intake will not rectify this. While the exact cause of eczema is unknown it appears to be linked to the following internal and external triggers:
Usually starts in the first 6 months of life. Symptoms include an itchy, red and dry rash on the skin. Infantile eczema usually improves significantly between the ages of 2 to 5 years.
Can start after infantile eczema or appear for the first time between the ages of 2 to 4 years. The dryness and rash are usually found behind the knees, in the creases of the elbows and across the ankles. It may also involve the neck, ears and face. This type of eczema usually improves with age. While most children will completely outgrow their eczema, some continue with a tendency for sensitive and dry skin into adulthood.
Is similar to that of older children where areas of very dry, itchy, reddened skin form at the elbow creases, wrists, neck, ankles and behind the knees. This skin may also weep. Adult eczema can improve in middle age and usually resolves in older age.
Eczema affects the skin, causing itching, redness and oozing of the skin. Patients report that eczema is usually itchy. For many people, this itch is only mild. However, sometimes it can increase in intensity resulting in extremely inflamed skin.
Some eczema patients find that the itch gets so bad that they scratch it until it bleeds. This is called the “itch-scratch cycle” and can make your eczema worse. Over time your skin may also get rough and thickened.
As a skin disease, eczema can improve or get worse over days, weeks or moths. If eczema gets worse, it’s called an eczema flare – this can happen without a single factor being responsible for it.
Eczema and its symptoms are different for everyone. Your eczema may not look the same on you as it does on your child or another adult. Eczema can also appear in different areas of your body at different times.
Symptoms of eczema can include:
You may only have a few of these eczema symptoms or all of them. It’s important to note that the only way to know if you have eczema is to visit your doctor or dermatologist so they can look at your skin and ask about your symptoms.
You can contact us here for a skin consultation.
If you have eczema it means that when your skin barrier is damaged, the moisture evaporates resulting in your skin being more susceptible to allergens and irritants. This irritation can trigger your skin to release certain chemicals that make the skin itchy. If you scratch the skin, more chemicals are released which results in the skin feeling even itchier. This is known as the “scratch and itch” cycle and can be very distressing.
Known triggers and aggravating factors for eczema include:
These eczema triggers may be relevant for some people but it’s not routinely recommended that everyone avoid all these potential triggers. You should discuss these potential triggers with your doctor or dermatologist.
If you have skin that’s affected by eczema it can be more vulnerable to infections including warts, cold sores and impetigo. Good hygiene suggestions include:
Beauty products can be used if you have eczema. We suggest you keep in mind the following:
Some eczema patients can have an allergic reaction to environmental triggers. It can be helpful for some people to have allergy testing (for example, prick testing for common environmental allergens such as house-dust mites, moulds and grass pollens). If you suspect you may have this allergy, ask your doctor or dermatologist for more information.
The best way to cope with temperature changes if you have eczema
If you have eczema, abrupt temperature changes and humidity changes can sometimes irritate your skin. For example, going in and out of air-conditioned buildings on hot days or heated buildings on cold days. Some patients report that physical activity or exercise that makes you sweat heavily can also trigger the itch of eczema.
We suggest that you:
The following tips have helped our patients cope with eczema:
It is very important to seek professional medical advice before using any medication: whether over the counter or prescription to determine its side effects.
Eczema treatments include:
Eczema responds well to anti-inflammatory creams. Topical steroids (corticosteroids) come in various strengths and are available by prescription from your doctor. It is recommended that you use the lowest strength topical steroid cream that works adequately. Using high-strength topical steroids for extended periods, especially on delicate areas like the face, can cause side effects, which include thinning of the skin. After bathing, make sure your skin is thoroughly dry before applying the cream.
Pimecrolimus cream is a non-steroid anti-inflammatory cream that can help reduce flare-ups of eczema if applied at the first signs of eczema.
Coal tar can be applied to the affected areas to reduce the itch from eczema. Only use it under supervision of a doctor who is experienced in managing eczema. Coal tar has a strong smell and usually stains any fabric it touches. It can also irritate some people’s skin.
Ultraviolet radiation therapy (phototherapy) for eczema can help reduce the symptoms of chronic eczema. Exposure under medical supervision can be carefully monitored with the use of specially designed ‘cabinets’. The patient stands naked in the cabinet as the fluorescent tubes emit ultraviolet radiation.
People with stubborn eczema may need up to 30 sessions. The risks of unsupervised ultraviolet radiation therapy can be the same as for sunbathing – faster ageing of the skin and greater risk of skin cancer.
Most people affected by eczema can manage the condition using ointments and creams. While oral medications can help people whose eczema is resistant to treatment, their side effects can include high blood pressure, increased susceptibility to all types of infections, and mood and behavioural changes.
Because of these risks, and the need for close and regular monitoring, oral anti-inflammatory treatment is only considered in severe cases of eczema that are difficult to control with other therapies.
There is growing evidence that allergens introduced into the body through the skin can lead to the later development of food allergy, asthma and hay fever. Aggressively treating eczema in children and taking steps to restore normal skin barrier function might lower the future risk of these conditions.
As skin with eczema skin is often broken, it places the sufferer at risk of contracting skin infections. At the first sign of any infection, professional medical advice should be sought.
Eczema sufferers are also at risk of developing herpes simplex type 1 (cold sores) which can spread over a large area of the skin. Because herpes simplex can spread over wide areas, it’s important to see you doctor for prompt treatment.
Warts (small, raised lumps) can be caused by viral infections. They can take up to 12 months to clear themselves up.
People with eczema are also at risk of contracting a widespread skin infection known as impetigo (school sores). Treatments for this include antibiotic tablets and antiseptic creams.
To avoid any complications associated with vaccination, the disease should be discussed with a medical professional. Normal childhood immunizations generally pose no risk to the eczema sufferer.
Eczema can be treated but not cured. To book a consultation with our specialist dermatologists and eczema experts, contact us.