Atopic Dermatitis / Eczema – Allergy UK

Symptoms

Eczema, also known as atopic eczema or atopic dermatitis, is a skin condition causing inflammation and intense irritation. Eczema symptoms tend to be caused by dry skin. The skin becomes hot, itchy and inflamed; it may also be red and appear irritated. Atopy, or being atopic, means having a genetic tendency for your immune system to make increased levels of IgE antibodies to certain allergens. An atopic individual is likely to have more than one allergic condition during their lifetime, such as eczema, asthma, hay fever or food allergy.

In young children, patches of dry, scaly skin, or (less commonly) wet, weepy skin, can appear anywhere on the body. In older children, the eczema usually appears on wrists, ankles, elbows, knees and face, including the eyelids. In adults, it may localise, affecting the face, hands, neck and scalp although it can affect any part of the body.

Skin that is affected by eczema gets sore and broken when it is scratched, it can look wet and may bleed. Scratching is hard to avoid since the main distressing symptom of eczema is unbearable itching but once the skin gets broken and cracked, infections can set in, causing even more discomfort. Those with severe eczema often feel cold when others are hot. This is because the skin is the largest organ of the body and one of its roles is helping to regulate body temperature. Conversely, being hot in bed causes severe irritation.

This skin condition can affect any age range and it is thought to be caused by a defect in the skin barrier that makes it more susceptible to inflammation and allows allergens and bacteria to make contact with the immune system.

Eczema can affect ones quality of life significantly and may also affect sleep patterns. Whilst this can make you irritable and frustrated, good management can help alleviate these problems. This skin condition is well understood and dermatologists (skin doctors) have developed effective skin treatment regimens to control and manage the symptoms. It can take some time to find the most suitable therapy for each individual, often causing embarrassment and daily frustration with the symptoms in the meantime. Many people do not understand that eczema is neither infectious nor contagious.

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Generally, GPs can diagnose eczema and differentiate whether you have eczema or another skin condition. Seasons of the year (for example, in winter), or even emotional responses (such as stress), may cause eczema to worsen. However, a large number of eczema sufferers are not able to link a cause to their symptoms. It is essential that any known triggers are avoided and sometimes keeping a trigger symptom diary at home may help you to realise what might be causing flares. Important things to consider include bubble baths, shampoos, make-up products, chemicals such as cleaning products and occupational irritants such as hairdressing products or heavy oils and lubricants used in the motor industry or allergens, such as latex gloves, leather, cement or certain plants.

If further investigation is needed, or the skins condition is not improving with barrier protection and prescribed treatment, your GP may make a referral to see a dermatologist to pinpoint the exact cause of the condition. Allergy patch tests can identify substances causing contact allergy. Allergy tests (either skin prick testing or a specific IgE blood test) may help to identify airborne or food allergens involved in flares, as many people with atopic dermatitis/eczema may also have asthma, allergic rhinitis/hay fever. Allergens that trigger these may also trigger symptoms in eczema, such as house dust mite, animal dander, mould spores, pollen or foods. You may need to be referred to an allergy clinic for skin prick or specific IgE blood tests.

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No. Children are born with the tendency to have eczema and many things can make their eczema worse. These are known as triggers for the eczema. Foods can be triggers for eczema especially in infants but the foods are not the primary cause of the eczema. If a food is found to make eczema worse, excluding that food may significantly improve symptoms but not cure the condition. A food that is not eaten often but causes symptoms may be easier to identify than one that is eaten daily, such as milk/dairy products, wheat or soya.

Some patients with the IgE-associated variety of AEDS suffer from worsening of their skin symptoms after contact with certain airborne allergens, such as house dust mite, pollens, or animal hairs, and improve after appropriate allergen avoidance strategies are introduced.

Emollient lotions and creams are prescribed for eczema and dry skin, and are, in their simplest form, mixtures of oil and water. Some emollients may also contain slight amounts of antibacterial chemicals (to avoid infection in broken skin), or steroids (to reduce inflammation).

Emollient products range in their consistency, from being runny lotions to thick creams, and while they can be a very cooling and soothing treatment for eczema, the stickiness of the thicker products can sometimes make them a source of annoyance. It is important to find a product that is suitable for you.

Dry skin is more susceptible to eczema, and once the skin barrier is broken, it is open to potential infection and further irritation from allergens and other chemical irritants. Scratching also causes the body to release histamine, which further aggravates the symptoms. Emollients work to reduce eczema symptoms by creating a protective barrier on the top layer of the skin, moisturising it and reducing water loss. The oil also provides lubrication so that the dry skin, which is often itchy and rough, will not be as easily irritated.

Although emollients do not stop the underlying cause of eczema, they calm and soothe the skin, and give it time to repair itself. For emollients to work effectively, they need to be used as part of a regular treatment regimen. This means that they should be applied at set times of day, and should be used whether they appear to be needed or not.

Eczema can flare up at any time, in some instances due to infection, hormonal changes, stress or allergens, but also for no obvious reason. Even when emollients are used, there may be times when eczema seems to get worse. However, regular treatment can help to minimise the number and severity of flare ups.

Emollients should be continued, even when all traces of eczema have vanished. By keeping the skin moisturised, it will be better hydrated and with less chance of the skin barrier being broken, the risk of allergens and other irritants causing eczema is reduced.

Emollients are available as lotions, creams, ointments, shower and bath products and soap substitutes. These products should be used every day as emollients support the skins barrier function by helping it to retain water and form a protective layer against allergens or bacteria. They can also help to relieve the itchy symptoms typical of eczema.

Water can have a drying effect on skin and so emollients are also available as bath products, which help to hydrate and protect the skin while soaking in the water, although it is no longer advised to soak for more than 15 minutes. In addition, soap can also make eczema worse because it dries the skin further. Soap substitute emollients can also be prescribed, which can be rubbed on and rinsed off skin just like liquid soap.

You may find that you are prescribed several creams if your eczema symptoms vary and different creams may be more suitable for different times. For example, you may prefer to use a less oily cream during the day and use a thicker cream or ointment treatment at night. Ointment also have the advantage of needing less or no preservatives, to which a few people can eventually react.

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It is sometimes necessary to apply topical corticosteroids (e.g. hydrocortisone), as these reduce inflammation in the skin.

Many people worry when steroids are mentioned as a treatment option because of stories they may have heard in the media, particularly related to anabolic steroid abuse in sports. These, however, are not the same steroids that are used as medical treatments and, when used as directed by a physician, steroids have an important role to play in treating a range of ailments, including eczema.

Topical steroids are safe to use but it is important to always follow the instructions provided, making sure you understand which areas you apply the cream to and exactly how much. If you have any questions, then ask your doctor or nurse for further advice and information.

Steroid creams only need to be applied to the inflamed areas of skin. One fingertip of cream (where the cream is squeezed along the fingertip as far as the first joint) is usually enough to cover an area of skin twice the size of an adults hand. Fingertip units are used as a guide for the amounts needed for different parts of the body.

Sometimes emollients and other creams (i.e. steroids and antibiotics) are needed in combination. It is important to leave an adequate gap between applying the different creams to allow one cream to be absorbed before applying another, ideally at least 10 minutes. If creams are applied too soon after each other they may be diluted so healing and control of the symptoms can take longer. Steroid creams, when used for a long time at a high dose, can cause skin to be thinned. This will not happen when steroid creams are prescribed at the appropriate strength, with less potent steroids being prescribed on the face than on the body. It is also important to use steroid creams as early into flares as possible, as this will avoid the need for higher strength preparations, required when the eczema is severe. Doctors are also increasingly using steroid creams proactively for only a couple of days a week (weekend therapy), even when the eczema is well controlled, to prevent future flares, as this has been shown to reduce the amount of steroids needed in the long-term.

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Sometimes, special pyjama-like garments (known as wet wraps) that are used for children, may also help certain areas of your body that have not responded to the usual topical application of emollients and steroids. Wet wraps can also be useful if you suffer from itch at night and cannot sleep, allowing you to have a better quality of sleep during times when the eczema is particularly bad. There are various ways of applying these garments and your nurse or doctor will be able to demonstrate the best way of application.

It important to follow the advice of your treating practitioner for the length of time of wet wrap treatment, and it is important to have your skin re-assessed when the treatment comes to an end.

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Calcineurin inhibitors are an alternative to steroid creams. There are two different preparations, Tacrolimus (0.03% and 0.1%) and 1% Pimecrolimus (also known as Protopic and Elidel), licensed for use in children over the age of two. Like steroid creams, they reduce the skin inflammation and can lessen itching.

These creams are suitable for use on almost every part of the body, as they do not thin the skin and are often used when steroids have proved unsuccessful, or are not suitable, for example, on sensitive skin around the eyes. Emollients should continue to be used as well as these creams.

A common side effect of these creams is a short-lived burning sensation on application, which is harmless and generally settles down after a few applications. These drugs are thought to be safe and effective in the short-term but their safety for long-term use has yet to be proven.

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There are many other types of dermatitis/eczema, which are non-atopic, i.e. not triggered by allergens or related to allergy, such as seborrhoeic; pompholyx; irritant contact; gravitational/asteototic; discoid/nummular. Information on these is available from http://www.eczema.org

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Atopic Dermatitis / Eczema - Allergy UK