What is Eczema?

Eczema is an irritating and itchy skin condition characterised by a red rash, scaly patches of skin, cracked skin and inflammation.

Although it can occur at any age, eczema is a more common problem in early childhood and infancy. Research suggests that children who have at least one parent with atopic eczema (the most common type) or who have siblings who suffer from eczema are more likely to develop the condition. It is thought that atopic eczema affects around 1 in 5 children in the UK.

You may be at a greater risk of developing eczema if you suffer from allergies or other conditions such as asthma. Approximately 40% of infants and young children with moderate to severe atopic eczema also have some form of food allergy.

People who suffer from eczema struggle to retain moisture in their skin and this causes it to become extremely dry. This dry skin then reacts to certain triggers causing an eczema ‘flare up’. Keeping skin moisturised is key to controlling eczema symptoms.

What is eczema?

Eczema is a common condition of the skin that causes an itchy rash, irritation, scaly patches and blistering. Sometimes eczema can also result in the skin becoming infected.

It is thought to be caused by a mixture of the immune system becoming hypersensitive, exposure to environmental triggers and genetics.

If you are concerned that you may have eczema or any other skin condition you should make an appointment to see your GP. They may want to examine you and take a look at any problem areas of skin that you have, as well as discuss your family history of eczema, your general health and if you have any allergies.

Your doctor should be able to diagnose whether you have eczema or another skin condition, start you on a course of treatment and help you to identify whether there are any particular triggers that are making your eczema symptoms worse.

Some people who are affected by eczema will see their symptoms improve with time. Sometimes infants and children who suffered from eczema can seemingly ‘grow out’ of it; however, given the right triggers, symptoms can flare up again after a long time of staying dormant.

Eczema is not contagious, meaning that it cannot be passed from one person to another through contact.

What are the different types of eczema?

There are many different forms of eczema that affect different parts of the body, affect different demographics of the population and have symptoms that vary. Some are more common than others.

The six main types of eczema are:

• Atopic dermatitis – A long-term skin condition that causes dry, itchy and inflamed skin to develop on any area of the body (the most common form).
• Contact dermatitis – This occurs in a specific area when the skin reacts to an irritant, such as a chemical or cosmetic product.
• Dyshidrotic eczema – This affects the palms of the hands and soles of the feet and causes clear, painful blisters.
• Nummular eczema – This causes small, circular patches of irritated, crusty skin to develop often on the arms, back or back of the legs. It is more common amongst elderly people.
• Seborrheic dermatitis – It is not known what causes this skin condition that predominantly affects the face and head and causes yellow, oily, scaly patches of skin.
• Stasis/varicose dermatitis – This often occurs alongside problems with the circulation and affects the legs/lower legs.
• Atopic dermatitis (also called atopic eczema) is the most common form of eczema that people suffer from. It usually develops in very early life (often within the first 12 months) although it can show up for the first time in adulthood.

What causes eczema?

There can be many different causes of eczema. There is thought to be a genetic component to getting eczema; environmental and dietary factors can also contribute.

Sufferers who know what makes their eczema flare up, or get worse, may be able to avoid or limit contact with these things.

Common eczema triggers include dehydration, heavily scented toiletries and dairy products.

Some common irritants include:

• Certain wash powders or liquids, fabric conditioners or other laundry products.
• Household cleaners, disinfectants and chemicals.
• Washing-up liquid (especially if you allow prolonged contact with the skin and do not use suitable gloves).
• Perfumes and body sprays.
• Fabrics (especially man-made ones such as polyester).
• Metals (in particular nickel).

Environmental factors that can trigger eczema are:

• Weather extremities (very hot, cold, damp or humid conditions or sudden changes in temperature).
• Allergens such as dust mites, pet fur or pollen.

Dietary triggers are often composite factors, meaning they will make the symptoms worse, or more obvious, but may not be the sole cause. This means that eliminating them will not necessarily make the eczema go away completely.

Food and drink that can make symptoms worse include:

• Alcohol (as this dehydrates the body).
• Sugary foods (these cause a spike in insulin levels which can lead to inflammation).
• High fat or heavily processed food.
• Common allergens such as peanuts, soy, gluten and milk (especially in children).
• Dairy products.

If you think a food allergy may be contributing to your or your child’s eczema, it may help to keep a food diary. This can be the simplest way to identify certain food triggers. Your GP can advise you on whether they feel that allergy testing would be helpful.

What are the signs and symptoms of eczema?

Eczema symptoms can range from mild to severe. The most common symptoms cause the skin to become:

• Itchy.
• Red.
• Inflamed.
• Cracked or scaly.
• Sore.

Itchy skin often equals a lot of scratching which makes the condition worse. It is sometimes referred to as the itch/scratch cycle. This can cause secondary issues such as infection and scarring.

If you have signs of an infection, you should seek medical advice as soon as possible.

You may have developed an infection related to your eczema if:

• Your symptoms are becoming a lot worse.
• Fluid is oozing out from beneath the skin.
• The skin is extremely swollen, painful or hot to touch.
• You have a fever or feel generally unwell.
• Your rash has a yellow crust.

Eczema can affect the skin on any part of the body. Atopic eczema most commonly affects the skin in the body creases such as the elbows or behind the knees, or places where the skin appears thinner such as along the shins. The hands and fingers are also commonly affected, as well as the face or scalp in infants and young children.

Eczema can usually be managed and treated. There are some complications that are associated with having an irritating, lifelong condition like eczema such as the risk of infections, low self-esteem and self-confidence issues, as well as sleeping problems (usually caused by itching and skin aggravation).

Can eczema be prevented?

Eczema is often a long-term condition that people suffer from throughout their whole life. It can occur occasionally or more regularly and the signs and symptoms can change or lessen over time. People can sometimes go a long time without having any issues, then eczema symptoms can trigger unexpectedly.

Eczema can have a genetic component, meaning that the sufferer probably has a predisposition to the condition due to a family history. This can make it difficult to ‘prevent’ eczema from occurring.

If you are aware of certain triggers, such as a particular food, material or beauty product that affects your skin and makes eczema symptoms worse, you can avoid contact with the product.

Other sensible ways you can prevent eczema from getting worse include:

• Natural alternatives – Swap beauty products and toiletries containing chemical additives for more natural alternatives. Eczema sufferers may want to avoid products containing ingredients such as sodium lauryl sulphate (SLS), phthalates, lanolin, glycol and talc.

If you cannot cut out certain beauty products completely (such as by taking clearwater baths) look for products that are natural in origin, especially those certified as organic by the Soil Association as these are low in additives and chemicals. You can also try using a completely natural alternative as part of your self-care routine, such as coconut oil, Epsom salts or manuka honey.

• Hypoallergenic products – Always look for beauty products (creams, lotions, make-up, bath and body care items) that are labelled hypoallergenic. This means that these products are less allergenic than standard products and less likely to cause a reaction (although they still can).
• Anti-inflammatory diet – Eating foods that are high in sugar and refined carbs can elevate insulin levels and cause inflammation. Following an anti-inflammatory diet can help, as inflammation is a key factor in the triggering of eczema symptoms. Anti-inflammatory diets contain a lot of vegetables and fruit, omega 3, whole grains, good fats and pulses with little refined sugars or processed foods.
• Avoid excessive heat – Hot baths can trigger eczema symptoms so try to dial down the temperature of your baths or take showers. Wear loose-fitted cotton clothes in warm weather.
• Wear suitable PPE – When using cleaning products or chemicals at home or in the workplace, make sure that you avoid them having contact with your skin and always wear suitable gloves.
• Moisturise – Get into the habit of applying an emollient to your skin and keeping your skin moisturised, particular after washing your hands, bathing/showering or removing make-up.

Eczema can appear alongside other conditions or allergies, such as hay fever or asthma. It can also be triggered by tiredness and stress. Adopting a self-care routine, a healthy lifestyle, a balanced diet and staying hydrated can help to limit your eczema symptoms.

Can eczema be treated?

Although eczema cannot be cured, treatments for the condition are widely available.

These include:

• Over-the-counter (OTC) medicine, usually creams or lotions that are applied directly to the skin.
• Bandages or special suits that allow the skin to heal and moisture to be retained underneath.
• Prescribed medication (including corticosteroid creams or antihistamines).
• Natural remedies.

Over-the-counter emollient medicine includes different creams, lotions or ointments that help to moisturise the skin. An emollient is a treatment that when applied to the skin helps it to retain moisture.

Ointments are the most effective as they contain a high concentration of oil. Lotions contain the most water and a low concentration of oil. Creams fall somewhere in the middle. The type of emollient you need will depend on the severity of your symptoms; you may want to swap between them as your condition improves or deteriorates.

If you are an eczema sufferer you should make sure that you have an ample supply of your chosen emollient. You should also use it all the time (not only when your symptoms are flaring up).

To use an emollient:

1. Apply plentifully and as needed.

2. Smooth onto the skin in the same direction as your hair grows (avoid rubbing).

3. When applying after bathing or showering, pat the skin dry and apply it when your skin is still damp to maximise the amount of moisture your skin retains.

Topical corticosteroids can be prescribed by a doctor to apply when symptoms are too severe for OTC medication. When applied to the skin corticosteroid creams reduce inflammation. They are available in different strengths, depending on the severity of symptoms or the part of the body that is affected.

Corticosteroids can be:

• Very mild such as hydrocortisone.
• Medium such as betamethasone valerate.
• Strong such as a higher dose of betamethasone valerate or betamethasone dipropionate.
• Very strong such as clobetasol propionate or diflucortolone valerate.

Corticosteroids are not usually recommended for babies under one as they can cause thinning of the skin. Other side effects can include acne (especially when used on the face by adolescents), hair growth and changes in skin colour. The likelihood of experiencing side effects increases with prolonged use.

Other medicine a GP may prescribe for eczema includes antihistamines which can help to control the itching associated with having eczema by blocking the effects of a substance in the blood called histamine. Usually, histamine is released when your body thinks there is a problem and it makes blood vessels expand and causes the skin to swell.

Popular natural remedies to help alleviate eczema symptoms include oatmeal soaks, calendula cream, aloe vera gels and acupuncture.

The effects of eczema may come and go over time.

Try to build the management of your eczema symptoms into your regular routine to keep them under control:

• Avoid any known environmental or dietary triggers as far as possible.
• Do not scrub the skin too hard whilst washing or bathing.
• Try not to scratch your eczema rash to the point of bleeding.
• Use mild soaps and natural products where possible.
• Establish a personal hygiene and self-care routine.
• Use prescribed or OTC medications for eczema routinely and as directed.
• Stay hydrated and keep your skin well moisturised.