Eczema, also called dermatitis, is a common skin condition marked by itchy and inflamed patches of skin.
Eczema sufferers tend to have skin that doesn’t “keep in” moisture very well, so it becomes dry, red, irritated all increasing the intense desire to scratch. However scratching only worsens the condition and the endless cycle is highly frustrating and can impact sleep and productivity during the day.
There are different types of eczema.
Atopic eczema is commonly seen in babies and young children, appearing on the faces of infants. But atopic eczema can affect individuals at all stages of life all the way up to adulthood.
It tends to flare up and then subside, and often goes hand in hand with asthma or hay fever.
Symptoms of eczema include:
- Itchy, dry, rough, flaky, inflamed, and irritated skin – this can, in some cases, flare up and then subside to then return later.
- Intense itching – the individual will typically have a strong urge to scratch their skin, including overnight.
- Pink to red patches on the skin – as the skin becomes more inflamed this will cause it to change colour.
- Small, raised bumps, which may leak fluid and crust over when scratched.
- Patches of dried yellowish pus – this can signal that there is an infection. Infection is usually painful, rather than itchy.
- Thickened, cracked, scaly skin
- Atopic eczema can occur anywhere but usually crops up on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of the elbows and knees, and in infants, the face and scalp.
- Atopic eczema develops in people who have a genetic predisposition.
- Essentially, atopic eczema is caused by the following:
- Inability for the skin to act as a barrier
- Abnormal behaviour of the immune system (defence cells) in the skin
- Changes to the microbiome – the natural bacteria that live on the skin
- Environmental factors also contribute to the development or flares of atopic eczema. These include:
- Soaps and detergents – these remove natural oils from the skin and cause drying
- Friction (eg rough, scratchy materials)
- Sweat (can be due to synthetic fabrics that do not breathe – e.g. nylon or polyester)
- Sudden drop in humidity
- Stress – this can cause the eczema to become worse
- Food allergies – more likely in babies and young children
- Contact with an allergen – e.g. animal fur, house dust mite, grasses or pollens
- Swimming pools – chlorine and salt can both cause dryness
- Repeated “wet-dry” cycle – e.g. repetitive hand-washing or taking multiple showers on the same day
- Eczema tends to run in families and often accompanies other allergic conditions including asthma and hay fever. Many people with eczema already have hay fever, dust mite allergy or food allergy and 30% of infants with eczema, who have a family history of allergy will develop a food allergy, while up to 40% develop asthma and/or allergic rhinitis according to the Australasian Society of Clinical Immunology and Allergy.
The best prevention is to keep your skin care routine simple.
- Avoid triggers where possible.
- Apply moisturiser all over the body once to twice per day.
- Use a soap-free wash in the shower or a bath oil in the bath.
- Limit bathing to a maximum of once per day and keep them short
(<5 minutes) where possible.
- Apply creams or ointments as prescribed by your doctor, as soon as eczema is present.
- Under-treatment of eczema can mean the eczema persists longer .
- Topical corticosteroids or topical calcineurin inhibitors treat redness and inflammation. Ensure that adequate amounts are used. As a guide, one fingertip unit (FTU) is the amount of ointment from the first bend in the finger to the fingertip, which will cover an area equal to two adult hands.
- After your shower/bath, do not rub dry with a towel, pat instead. After your shower/bath, seal in the hydration with moisturiser within three minutes.
- If applying moisturiser before a topical steroid, wait 15 – 30minutes between applications. Otherwise, apply the moisturiser over the top of the steroid (not underneath it).
- If prescribed, use immune-modulating treatments for severe eczema.