What is eczema?

Eczema refers to a chronic inflammatory skin condition, characterized by dry skin, with patches
that are red and intensely itchy.

Eczema can occur anywhere on the skin and is commonly found on the bends of the arms,
backs of the knees.

The term 'eczema' is used in two different ways.

It can be used widely to describe any rash-like skin conditions.
It is usually used specifically to refer to the most common type of these skin
conditions: atopic dermatitis.

What causes eczema?

The specific cause of eczema remains unknown, but it is believed to develop due
to a combination of hereditary and environmental factors.

Children are more likely to develop eczema if a parent has had it or another atopic
disease. If both parents have an atopic disease, the chances increase further.

Environmental factors are also known to bring out the symptoms of eczema.45
These include:
 Irritants: soaps, detergents, shampoos, disinfectants, juices from fresh fruits, meats
or vegetables
 Allergens: dust mites, pets, pollens, mold, dandruff
 Microbes: bacteria such as Staphylococcus aureus, viruses, certain fungi
 Hot and cold temperatures: hot weather, high and low humidity, perspiration from
exercise
 Foods: dairy products, eggs, nuts and seeds, soy products, wheat
 Stress: it is not a cause of eczema but can make symptoms worse
 Hormones: women can experience worsening of eczema symptoms at times when
their hormone levels are changing, for example during pregnancy and at certain
points in their menstrual cycle.
Types of eczema
Atopic eczema
Atopic eczema is the most common form of eczema and is closely linked with asthma and
hayfever.

It can affect both children and adults, usually running in families.

One of the most common symptoms is itching (pruritus).

Other symptoms include dryness of the skin, redness and inflammation.

Constant scratching can also cause the skin to split, leaving it prone to infection.

Allergic contact dermatitis (ACD)

ACD develops when the body’s immune system reacts against a substance after contact with the
skin.

The allergic reaction often develops over a period of time through repeated contact with the
substance.

For example, an allergic reaction may occur to nickel, which is often found in earrings, belt
buckles and jean buttons.

Irritant contact dermatitis

This is a type of eczema caused by detergents and chemicals, which are irritating to the skin.

It most commonly occurs on the hands of adults and can be prevented by avoiding the irritants
and keeping the skin moisturized.

Infantile seborrheic eczema

A condition that affects babies under one year old.

Although this type of eczema looks unpleasant, it is not sore or itchy and does not cause the
baby to feel uncomfortable or unwell.

Normally this type of eczema will clear in just a few months, though the use of moisturising
creams and bath oils can help to speed this along.

Adult seborrheic eczema

Characteristically affects adults between the ages of 20 and 40.

It is usually seen on the scalp as mild dandruff, but can spread to the face, ears and chest.
The skin becomes red, inflamed and starts to flake.

The condition is believed to be caused by a yeast growth.

If the condition becomes infected, treatment with an anti-fungal cream may be necessary.

Varicose eczema
Affects the lower legs of those in their middle to late years, being caused by poor circulation.

Treatment is with emollients and steroid creams.

Discoid eczema
Is usually found in adults and appears suddenly as a few coin shaped areas of red skin, normally
on the trunk or lower legs.

They become itchy and can weep fluid.

Complications of Eczema
Skin Infections
Scratching that is associated with eczema can break the skin causing open sores which can then
become infected.

Eczema Herpeticum
Skin that becomes inflected with the herpes simplex virus (the virus that causes cold sores) is
called eczema herpeticum.

The symptoms may include painful pus or fluid filled blisters or sores, which may be
accompanied by fever, tiredness, and swollen glands.

Caution should be taken around anyone with a cold sore; kissing and skin-to-skin contact should
be avoided.

Neurodermatitis
Long term itching and scratching of the skin can lead to an increased sensation of itch.

These areas of the skin that are frequently scratched become thick and leathery in appearance,
and the patches can be red and darker than the rest of the skin.
 Symptoms of eczema

Infants:
 Rashes commonly appear on scalp and cheeks

 Rashes can cause extreme itchiness, which may lead to trouble sleeping.

Children, from 2 years old to puberty:

 Rashes commonly appear behind the creases of elbows or knees

 Also common on neck, wrists, ankles, crease between buttock and legs.

 Rashes can become bumpy, like goosebumps

 Rashes can lighten or darken in color

Adults:
 Rashes commonly appear in creases of elbows or knees or nape of neck

 Rashes can be especially prominent on neck, face and around the eyes

Impaired Skin Barrier Function

Our skin is the barrier to the outside world, is somewhat waterproof, and keeps our internal
organs and systems safe from the elements and from bacteria invading our bodies.

Atopic dermatitis patients have impaired barrier function.

This means that the skin barrier is broken down, loses moisture, and can allow bacteria to grow
and enter the body (causing bacterial infections on the skin).

Prevention is the Best Medicine

One of the frustrating parts of eczema is that flare-ups can still occur even when you are
diligently avoiding triggers and taking care of your skin. Keeping your skin moist is your first line
of defence against eczema.
The Role of Food Allergies
It is important to note that food allergies do not cause eczema, however foods can trigger a flare-
up. It is not recommended to withhold foods, or entire food groups, for long periods of time
without consulting your doctor or your allergist to confirm that there is in fact an allergy to that
food.

Allergy skin testing can help to provide clues about environmental and food allergies, however
patients with atopic dermatitis have high false positive rates, as the simple act of scratching the
skin during testing can cause inflammation which may then be misinterpreted as an allergic
reaction. Antihistamine use can also impact the accuracy of allergy testing. Speak with your
allergist about your eczema, and your medical treatments prior to testing.

Is there a cure for eczema?

Atopic eczema is a chronic, recurring condition with "flares" (active or new patches of eczema –
which look red, scaly, and/or bumpy) and remissions (when eczema is not as active). Some
people always seem to have some active areas. There are no definite cures for eczema although
patients can achieve excellent control and live quite comfortably. Most children will grow out of
their eczema, and flares will gradually reduce over time. We recommend following our Triangle of
Control (LINK) and Regimen (LINK) to ease your eczema symptoms and prevent future
flares. This is the first line of defence!

Tests and diagnosis of eczema

Skin allergy testing is often carried out when investigating potential eczema cases.
Diagnosis is based primarily on the patient's symptoms, but medical history is also
important.

A doctor will often ask about a patient's family history, other atopic diseases such as
asthma and hay fever, possible exposure to irritants, whether any foods are related
to flare-ups, sleep disturbances, past treatment for skin symptoms and the use of
steroids or other medications.

They may also attempt to rule out other conditions that can cause skin irritations.
This can involve the following tests:

 Patch testing: substances are placed onto the surface of the skin to test for skin
allergies
 Skin prick testing: a needle containing a small amount of a suspected allergen
pricks the skin to test for allergies that do not necessarily occur on the skin, such as
pollen or food
 Supervised food challenges: foods are eliminated and then introduced into the diet
to determine whether a food allergy is present.

Treatment
Eczema can be well-managed by following all three steps below, and keeping up with skin care,
even when the eczema seems to be in control.

3 Steps to Eczema Management:

1. Bathing and moisturizing to repair skin barrier

2. Prescription treatments to reduce inflammation and bacteria

3. Trigger avoidance to reduce flare ups

Bathing and Moisturizing

Bathing allows moisture to enter the skin. Coating the skin after every bath or shower, with an
emollient (moisturizer) helps to seal that moisture in the skin. This is necessary in patients with
eczema as their natural skin barrier, which would normally trap moisture in the skin, doesn’t work
well. This leaves the skin dry, rough and sensitive to irritants. It is a common myth that drinking
an adequate amount of water during the day will hydrate the skin. It is in fact the bathing and
moisturizing technique that hydrates the skin. Decades ago, doctors often recommended that
eczema sufferers limit baths and showers; however, experts now recommend bathing as an
important part of controlling eczema.

After bathing, gently pat the skin dry, and then immediately apply your moisturizer to skin that is
still damp. Apply prescription products, as recommended by your physician. Apply a moisturizer
several times throughout the day. Moist skin will reduce itchiness, which in turn helps to control
the disease, as flares occur or increase in response to itching. Frequent bathing (even 2 to 3
times daily) followed by a moisturizer should be your first defence in managing eczema and
flares!

Showering
Many adults prefer showering over taking a bath, for reasons of preference. Showering is fine for
people with eczema, as long as the water is not too hot. Use a gentle cleanser and/or shower oil.
After your shower, gently pat the skin dry (avoid rubbing the skin). While leaving the skin still
slightly damp, immediately apply your moisturizer (and/or prescription products as indicated by
your doctor).

The Bathing & Moisturizing Regimen

The bathing regimen should be followed diligently during a flare-up, and after a flare-up as
preventative and moisturizing maintenance. Bathing can be cut back to once per day when the
skin is smooth, soft, and properly moisturized. You should continue to moisturize the skin several
times daily, even when the skin is healthy.

Bathing – Step by Step

Follow these bathing steps to hydrate the skin, at least once a day, and up to three times a day
when the skin is flared.

What you will need:

 A bathtub or bathing basin for babies or toddlers

 An emulsifying oil (optional)

 a gentle cleanser

 a moisturizer

 prescription treatments, e.g. topical corticosteroids, etc, if necessary

 a timer, watch or clock

 a soft natural fibre towel (wash these regularly in hot water, as bacteria from eczema can
spread through towels and bedding)

Steps to Bathing the Eczema Sufferer:

1. Fill the bath with lukewarm water (add some emulsifying oil if you choose). The skin will
absorb some of the water (and oil if you add it).

2. Immerse the patient in the water, trying to cover as much of the body as possible. Do not
immerse the head in water. If eczema is on the face, or areas of the body not soaking in the
water, gently apply a soft wash cloth soaked in the water/oil mixture to those areas. Soak for
at least 5 minutes but not longer than 20 minutes.

3. Use a gentle cleanser on areas of the body that need additional cleaning.

4. Take care when handling babies and toddlers, as they will be slippery.

5. Gently dry off excess water with a soft towel, or briefly air dry if the air is warm. You may
leave the skin slightly damp.

6. Next, apply your medications, exactly as prescribed by your doctor. If your medicated
treatment contains a corticosteroid (e.g. Hydrocortisone, Fucidin® H), you would typically
apply now to the still damp skin. For the non-cortisone based prescriptions, such as Elidel®
or Protopic® ensure the skin is completely dry before applying.

7. When applying prescription products, carefully avoid the healthy skin.

8. Apply your moisturizer to the remaining patches of healthy skin. The entire body can and
should be moisturized between bathing with your regular, non-prescription moisturizer. If
most of the skin is covered in eczema, use your prescription products after the bath, and
then apply a coat of moisturizer to the whole body at least 30 minutes after the prescription
products.

Treatments for eczema

There is no overall cure for eczema.

Treatment for the condition aims to heal the affected skin and prevent flaring of the
symptoms.

Doctors will suggest a plan of treatment based around a patient's age, symptoms
and current state of health.

There are numerous things that people with eczema can do to support skin
health and alleviate symptoms, such as:7
 Regular warm baths can help alleviate eczema symptoms.

 Taking regular warm baths

 Applying moisturizer within 3 min of bathing to "lock in" moisture

 Moisturizing every day

 Wearing cotton and soft fabrics, avoiding rough, scratchy fibers and tight-fitting
clothing

 Using mild soap or a non-soap cleanser when washing

 Air drying or gently patting skin dry with a towel, rather than rubbing skin dry after
bathing

 Avoiding rapid changes of temperature and activities that make you sweat (where
possible)

 Learning individual eczema triggers and avoiding them

 Using a humidifier in dry or cold weather

 Keeping fingernails short to prevent scratching from breaking skin.