Eczema – facts and myths

Eczema is a relatively common but complex condition which requires patient education in order to treat symptoms and improve quality of life
An estimated one in 10 people suffer from eczema. Eczema affects around one in eight children and one family in four. The peak age for developing first symptoms is between six months and two years

Eczema is most common in babies between the ages of two to 18 months who are not being breast fed.

Half of affected children improve by school age, and a further quarter improve by their teens.

Atopic eczema is usually hereditary, although external factors can make symptoms worse. Many people with an increased tendency towards atopic eczema also have an increased risk of other allergic conditions such as asthma and hayfever.

Stress seems to affect many diseases, especially those linked with immune function, like eczema.

The itch caused by eczema can cause extreme distress. This is made worse by sleep deprivation. Visible eczema can affect sufferers self confidence.

There are some types of eczema that affect adults and are rare in children. These include nummular or discoid eczema that is most common in middle-aged or elderly adults, most of whom have no previous history of skin problems. This takes the form of circular, itchy scaly patches on the body that look very similar to ringworm. Pompholyx most commonly appears for the first time in people in their 20s and 30s and affects the palms and the soles of the feet in which fluid accumulates forming small blisters. In people who have atopic eczema that continues into adult life, symptoms are usually worse around skin flexures such as the neck, elbow, wrist, ankle or knee.

Research suggests that a type of skin bacteria, Staphylococcus aureus, commonly colonises eczema skin lesions although this may not be clinically obvious. It is associated with 90% of dry, scaly eczema patches and can be isolated from apparently normal skin in 85% of sufferers. In contrast, S. aureus is usually only found on the skin of 5% of people without eczema as it is usually confined to skin folds (eg groin, under breasts, armpits). It is a myth that eczema is infectious.

Eczema can be related to work. Some cases of eczema are due to an allergy to particular substances encountered through the work place. It can be difficult to establish what you are allergic to, although skin patch testing may help. This type of eczema is usually referred to as contact dermatitis. Adults who suffered from atopic eczema as a child often find that localised recurrences appear in adult life, usually through excessive exposure to water or chemicals.

Treatment options

When the skin is dry and itchy, the mainstay of treatment is with emollients to soothe and moisturise the skin. They work by either preventing water loss from the surface layer of skin or by improving water binding in the skin or both.

• Bath emollients help to soothe, rehydrate and soften the skin.
• Emollient creams are vital and considerably more effective than everyday cosmetic creams. They are particularly suitable for localised areas. Aqueous cream is used as a soap substitute by simply applying to the skin, massaging in lightly then rinsing off.
• Antibacterial bath emollients contain an additional antiseptic agent to reduce the number of bacteria found on the skin surface; this is particularly important in atopic cases which are linked with bacterial colonisation. Antibacterial bath emollients help combat eczema flare-ups.
• Antihistamines help to reduce itching and swelling in some cases of allergic eczema; they are best taken by mouth as topical application may trigger sensitisation. Some may also cause drowsiness but this can help promote sleep.
• Mild steroid creams (eg. 1% hydrocortisone), damp down inflammation and improve symptoms. They are not suitable for use in children under 10 or in pregnancy and must not be applied to sensitive areas of the body.

Prescription only treatments include steroids, topical antibiotic creams, oral antibiotics, potassium permanganate and alternative medicine.

Dr Tango is a  Consultant Physician with facts and Figures Email- caremed001@gmail.com Blackberry Pin - 74282d21