What is eczema and what are the treatment options?

Eczema and dermatitis mean the same thing, namely inflammation of the skin. There are lots of different type of eczema, the most common is atopic eczema which tends to start in childhood and can run in the family (and is linked to the tendency to have asthma and hay fever).

You can also develop contact eczema (due to allergy to something you are coming into contact with), varicose eczema (on the lower legs associated with varicose veins), seborrheic eczema (which affects the scalp and face, due to sensitivity to one of our skin flora yeast). Pompholyx eczema is a blistering type of inflammation on the hands and feet which is often worse in hot weather.

Eczema can develop on any part of our skin. In babies it often starts on the face and then spreads elsewhere, infants can commonly have eczema in their skin creases (such as behind their knees, on their neck) and in adults the pattern can be more common on the face (often around the eyes) and hands.

Atopic eczema is hereditary — it runs in the family and is a genetic tendency that is linked to having asthma and hay fever (what we call atopic conditions). So, if you have eczema, you may also develop asthma and/or hay fever.

Eczema in children is very common, almost a ¼ of children will develop some eczema, but for most of them it settles before adulthood. Eczema can result from occupational exposure to irritants such as doing lots of ‘wet work’ (healthcare workers, those looking after young children, chefs, hairdressers etc) – water can actually dry the skin out and hand washing/hand sanitizing in the pandemic has caused an increase in irritant hand eczema.

Contact allergic eczema is caused by someone becoming allergic to something they are coming into contact with, such as perfumes, chemicals in body products, metals, hair dyes etc. Eczema is not contagious so you cannot give it to anyone, and they can’t give it to you.

The inflammation in the skin causes the skin to turn over too quickly so the skin becomes thickened and raised from the normal skin surface. Because the skin is thickened, it is less elastic and can split and crack. Eczema can make the skin red and itchy in appearance and eczema can ‘knock the normal skin pigment around’ making the skin look lighter or darker than the normal skin.

Eczema inflammation reduces the barrier function of the skin which can allow bacteria (staph aureus and strep) and viruses (such as herpes simplex virus – eczema herpeticum, and molluscum) to colonise the eczema leading to more inflammation. The reduced barrier function can also lead to loss of water from the skin surface causing the skin to dry out.

Eczema can also leave you vulnerable to becoming allergic to things in the outside world (such as animal dander, house dust mite, pollens, chemicals) as small proteins can pass through the reduced skin barrier and trigger allergic immune responses internally.

Often no investigations are required, eczema is a clinical diagnosis. Occasionally a skin biopsy can be taken if the diagnosis is unclear.

Blood tests can show a raised eosinophil count (a type of white cell raised in numbers in allergic conditions), and you may also have a raised Immunoglobulin E (another marker of allergy). You can have blood tests (specific IgE RAST) to look for specific allergies to food, animal dander, pollens etc) and you may offered skin prick testing (which is thought to be a more accurate way of detecting these allergies than blood tests (small amounts of potential allergens are pricked into your skin, and reactions can be seen within minutes).

You may also be offered patch testing which looks for possible allergies to substances that you are in contact with (such as metals, perfumes, preservatives, hair dye etc). In this test, patches containing small amounts of these substances are put on your back for a few days (as these reactions are often delayed for a few days), and then the specialist sees what you may have reacted to.

Change in the weather/seasons can cause a flare of eczema, some eczema is worse in the winter and some worse in the summer. Stress can make any skin condition worse, including eczema. Sweat is an irritant and can cause eczema to flare up. Harsh soaps, hand sanitizer and detergents can irritate the skin, and make eczema worse. Wool should be avoided close to the skin as this can lead to increased irritation and itching; natural cotton is usually best. Smoking, alcohol and having any kind of underlying illness can make eczema worse.

Ensuring you get plenty of good quality sleep, trying to reduce stress if possible, using emollient washes instead of harsh soaps, regularly using moisturiser on your skin to keep it well conditioned. There is no direct link between eczema and diet except if you have a known food allergy when you should try to avoid those allergenic foods if possible. A healthy diet is always best for a healthy body and skin, so eating lots of fruit and vegetables is a great basis for a healthy diet.

The key to treating eczema is to switch off the inflammation and avoid anything that is known to make it worse (identified allergies, irritant detergents, wool clothing etc). Doctors and other healthcare workers may give you prescription topical creams/ointments to apply to the active areas of eczema and these are designed to switch off the inflammation and damp eczema down. These creams are not a cure for the eczema, but they can usually control it very well if you are given the right strength of cream and you know how to use it. Creams may be steroids or non-steroids. Different strengths of creams are used at different body sites. Regular moisturising can help to keep your skin in a good condition and make it feel more comfortable and less dry.

If your eczema is becoming infected sometimes you may be given antiseptic washes or even antibiotics to help clear the bacteria or antiviral medication to clear viruses. Occasionally for more severe or extensive eczema you may be offered phototherapy (light treatment) or tablets treatments (such as short courses of oral steroids, or longer courses of methotrexate). Newer biological treatments are also now available in some dermatology clinics for patients with eczema not responding to conventional treatments, these are usually regular injections that help to switch off the inflammation more effectively.