Atopic Eczema

atopic eczema

Eczema is inflammation of the skin. There are different types of eczema. The most common type is atopic eczema. The word atopic describes people with certain allergic tendencies.

What are the symptoms of atopic eczema?

  • The skin usually feels dry.
  • Some areas of the skin become red and inflamed. The most common areas affected are next to skin creases, such as the front of the elbows and wrists, backs of knees, and around the neck. Inflamed skin is itchy. If you scratch a lot it may cause patches of skin to become thickened.
  • Sometimes the inflamed areas of skin become blistered.
  • Sometimes inflamed areas of skin become infected.
  • Typically, inflamed areas of skin tend to flare up from time to time, and then tend to settle down.

Who has atopic eczema?

Most cases first develop in children under the age of five years. It is unusual to first develop atopic eczema after the age of 20.

What causes atopic eczema?

The cause is not known. The lipid (oily) barrier of the skin tends to be reduced in people with atopic eczema. This leads to an increase in water loss and a tendency towards dry skin. Also, some cells of the immune system release chemicals under the skin surface, which can cause some inflammation.

What is the usual treatment for atopic eczema?

The usual treatment consists of three parts:

  • Avoiding irritants to the skin and other triggers wherever possible.
  • Emollients (moisturizers) - used every day to help prevent inflammation developing.
  • Topical steroids (steroid creams and ointments) - mainly used when inflammation flares up.

Treatment part 1 - avoid irritants and triggers where possible

Avoid soaps, bubble baths, etc, when you wash. Instead, use a soap substitute plus a bath/shower emollient (see below).
House dust mite may be a trigger in some cases
Food allergy may be a trigger in some cases
Other triggers
Stress and habit scratching, pollens, moulds, dander from pets, pregnancy, and hormonal changes before a period in women.

Treatment part 2 - emollients (moisturizers)

People with atopic eczema have a tendency for their skin to become dry. Dry skin tends to flare up and become inflamed into patches of eczema. Emollients are lotions, creams, ointments and bath/shower additives which prevent the skin from becoming dry. They oil the skin, keep it supple and moist, and help to protect the skin from irritants. As a rule, thicker, greasy ointments work better and for longer than thinner creams, but they are messier to use. Use an emollient ointment at bedtime.

Treatment part 3 - topical steroids (steroid creams and ointments)

Topical steroids work by reducing inflammation in the skin. The greater the strength (potency), the more effect it has on reducing inflammation, but the greater the risk of side-effects with continued use.

As a rule, a course of topical steroid is used when one or more patches of eczema flare up. You should use topical steroids until the flare-up has completely gone, and then stop it. In many cases, a course of treatment for 7-14 days is enough to clear a flare-up of eczema. Short bursts of high-strength steroid as an alternative
For adults, a short course (usually three days) of a strong topical steroid may be an option to treat a mild-to-moderate flare-up of eczema. A strong topical steroid often works quicker than a mild one. Using emollients and topical steroids together.

Most people with eczema will be prescribed emollients to use every day and a topical steroid to use when flares up develop. When using the two treatments, apply the emollient first. Wait 10-15 minutes after applying an emollient before applying a topical steroid. That is, the emollient should be allowed to absorb before a topical steroid is applied.

Infected eczema patches

Characteristics of infected eczema include weeping blisters, infected skin lumps (pustules), crusts, failure to respond to normal treatment, and rapidly worsening eczema. If the infection becomes more severe, you may also develop a fever (temperature) and generally feel unwell. If infected eczema develops then a course of an antibiotic tablet will usually clear the infection. Once the infection is cleared, it is best to throw away all your usual creams, ointments and lotions and get fresh new supplies.

Other treatments

Tacrolimus ointment and pimecrolimus cream are treatments introduced in 2002. They work by suppressing some cells involved in causing inflammation. (They are called topical immunomodulators.) They are not steroids. They seem to work well to reduce the skin inflammation of atopic eczema. Tar shampoos are useful to lift scale from affected scalps.
Antihistamine tablets are sometimes tried to help ease itch. They do not have a great effect on reducing itch, but some types of antihistamines can make you drowsy.

How can atopic eczema be prevented?

It may be worthwhile breast-feeding a newborn baby for three months or more if several members of the family suffer from allergies such as eczema, hay fever or asthma.

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