Eczema

What is eczema?

The word eczema comes from the Greek and means 'to boil over'. Eczema or dermatitis are two medical terms used to describe numerous skin conditions. Like many allergic conditions the severity of the disease can vary. Although it can sometimes look very unpleasant eczema is not contagious.

What are the symptoms of eczema?

The main symptoms of eczema is skin that is dry, red and inflamed. The area of skin that is affected is often very itchy and in some cases small blisters may form, which can weep and become crusted. Eczema is usually found on the face, hands, the insides of the elbows and the backs of the knees, but it can cover most of the body.

What causes eczema?

The cause of eczema depends on what type you have, read below for more information on the different types. However, in adults, eczema can be triggered off by certain chemicals so care may need to be taken in some jobs. Areas of work with a high risk include: hairdressing, nursing, cleaning, engineering, animal handling or plastering.

Types of eczema

There are many different forms of eczema, which may look and appear very similar but have very different causes.

Two of the most common types of eczema are atopic eczema and contact dermatitis:

Atopic eczema

Atopic eczema also known as atopic dermatitis is probably the most common form of eczema and is believed to affect up to 1 in every 5 children. Atopic eczema is thought to be a hereditary condition which is usually linked to hay fever and asthma so you may also suffer from one of these at the same time.

Both adults and children can be affected by atopic eczema though children will often grow out of it by the time they reach their teens.

People who have atopic eczema are sensitive to things found in the environment, these are known as allergens and may include any of the following:

• House dust mites - they occur in all homes all over the world and are commonly found in mattresses, bedding, carpets and soft toys. They are completely harmless and many of us are totally unaware of their presence.
• Animals - e.g. cats or dogs.
• Grass, tree or weed pollens.
• Occasionally foods, such as milk, eggs, chocolate or nuts.

The main symptom of atopic eczema is the unbearable itchiness, if you constantly scratch you can cause your skin to split, leaving it prone to infection. Other symptoms include, dryness of the skin, redness and inflammation. Factors, such as stress and infections, like the common cold have been known to make the symptoms of atopic eczema worse. Atopic eczema is commonly seen in skin folds.

Contact dermatitis

Contact dermatitis develops when the skin has been in contact with something in the outside world. There are 2 types of contact dermatitis both with similar symptoms to atopic eczema, though it is usually the hands that are affected.

Allergic contact dermatitis

People are not born with allergic contact dermatitis but develop it over a period of time through repeated contact to an allergen. It is not known why some people develop an allergic reaction to a substance when to others it remains harmless.

Symptoms, when they appear, may include itching, redness, flaking and cracking of the skin. An example of allergic contact dermatitis is, a rash that appears on the wrist after wearing a watch that contains nickel. Nickel is the most common cause of allergic dermatitis in women.

Common allergens include:

• Nickel - e.g. spectacle frames, cheap jewellery or belt buckles.
• Wet cement.
• Rubber and latex e.g. condoms or rubber gloves.
• Cosmetics, hair dyes and perfumes.
• Plants and flowers- e.g. dahlias or chrysanthemums.

In order to prevent reactions occurring, you must try to avoid contact with any allergen that you know causes your eczema symptoms to flare up.

Irritant contact dermatitis.

This is a type of eczema, which is caused by frequent contact with everyday substances, such as soaps and detergents, causing an irritation and damage to the outer layer of skin. Adults are most commonly affected, especially on their hands.

Common irritants include:

• Paints
• Petrol
• Washing-up liquid, soaps and fabric conditioner.
• Shampoo
• Cleaning chemicals such as disinfectants and bleaches.

This form of eczema can be prevented, by trying to avoid the irritants that cause the problems and by keeping the skin moisturised.

Are there any complications with eczema?

The most important thing to do if you have eczema is to keep the skin moisturised to prevent it from drying out. If the skin is dry it becomes a good home for the bacteria Staphylococcus aureus. If the eczema becomes infected with Staphylococcus the skin may become very red, weep a lot and produce yellowish dry crusts. You may also notice blisters filled with a yellow pus. If this condition develops it will need to be treated with antibiotics, such as penicillin.

One of the most serious complications with atopic eczema is eczema herpeticum, this develops when eczema becomes infected with the herpes virus. Eczema herpeticum is a serious condition and medical help must be sought. The symptoms of eczema herpeticum may include a high temperature, an extensive rash with small skin blisters filled with yellow pus and you may generally feel unwell. The rash can cover the whole of the skin surface. Eczema herpeticum can occur when anyone with eczema, especially if it is sore and open has skin to skin contact with someone who has active facial (cold sores) or genital herpes. Eczema herpeticum is treated with oral anti-virus antibiotics. However, considering how common the herpes simplex virus and atopic eczema are, this condition is fortunately quite rare.

If at any time the skin is very sore, weepy or you develop small blisters with pus then the eczema may have become infected, you should visit your doctor for advice and treatment.

What tests will I have to diagnose eczema?

Eczema is usually diagnosed from the appearance of the skin alone. However, a test may be needed to decide what allergen is causing the skin problems. You can read more about the types of tests available in the section "How are allergies diagnosed?" on the allergies page.

What treatments are available?

There is no cure for eczema but there are many treatments available, which reduce the inflammation and ease the discomfort of itchy skin. However, even after treatment the skin will always be sensitive and will often need special care. Remember, as with all types of allergies the best treatment is to find out what causes the eczema and then avoid it! Treatments available to minimise your eczema symptoms may include any of the following:

Emollients

Emollients are moisturisers that provide the skin with a barrier, which softens and hydrates the skin. This barrier will prevent dryness and make the skin feel more comfortable. Emollients are available in many forms - ointments for very dry skin, creams and lotions for moderate eczema, gels for eczema that is under the hair and bath oils. As there is such a wide range of emollients available, it may be a case of trial and error before the most suitable one is found for you. Like all new products, it is advisable that you test a little on your skin first to ensure no irritation occurs. E45™ cream is probably one of the most popular emollients. Emollients should be used at least twice daily but you can use them as often as you need.

Topical steroids

When eczema flares up a steroid cream may be needed to reduce the inflammation. Topical steroids come in four different strengths: mild, moderate, potent and very potent. Your doctor will decide what treatment is needed for you. The cream is applied thinly to the affected area. Topical steroids should only be used as directed by your doctor or nurse. The mildest steroid is available over the counter at pharmacies and is called hydrocortisone, ask you pharmacist for advice.

Oral steroids

If eczema is severe a short course of oral steroids could be prescribed, this is usually in situations when topical steroids have failed to improve the eczema.

Other treatments

If other methods have failed and your eczema is severe your doctor may discuss the use of artificial light treatment (sunbeds) but only for older children and adults. Antihistamine tablets to reduce severe itching, stronger medication or wet wrapping are other treatments that your doctor may recommend. Wet wrapping consists of a type of bandaging that is applied to moisturised skin. The bandage is soaked in lukewarm water and then cut to size so that it covers the affected area. The bandage can be applied overnight to the limbs, trunk, neck and even face (holes are cut in the dressing for eyes, ears, nose and mouth). This treatment is highly successful for severe weepy eczema. Bandages can also prevent the sufferer from itching irritated skin.

You should remember what works well for one person might not work well for another. Eczema is a very individual condition.

To minimise the symptoms and avoid further attacks:

• Regularly dust and vacuum your house to reduce the population of house dust mites.
• Wash your child's soft toys frequently to kill dust mites.
• Avoid scratching yourself and keep your child's nails short to minimise skin damage.
• Keep to a strict skin care routine.
• Take lukewarm baths with emollients and don't stay in too long.
• Apply only advised or prescribed moisturisers instead of highly perfumed products.
• Wear cotton fabrics and avoid clothes made of wool and other rough fibres.
• Dry yourself thoroughly after washing by patting the skin, rather than rubbing. .
• Keep your skin moisturised with your chosen emollient.
• Use gloves when handling chemicals, solvents and detergents.
• Most importantly try to avoid the allergens that cause your skin to flare up.

Related topics