What is Eczema?
Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition characterised by dry, itchy, and inflamed skin. It's a very common condition, especially in children, but it can affect people of all ages. Eczema is not contagious, meaning you can't catch it from someone else. While the exact cause of eczema is unknown, it's believed to be a combination of genetic and environmental factors.
Eczema is often used as an umbrella term for several types of dermatitis, including:
Atopic dermatitis: The most common form, often linked to allergies and asthma.
Contact dermatitis: Caused by direct contact with irritants or allergens.
Dyshidrotic eczema: Characterised by small blisters on the hands and feet.
Nummular eczema: Presents as coin-shaped patches of irritated skin.
Seborrheic dermatitis: Affects oily areas like the scalp and face, causing dandruff and inflammation.
Understanding the specific type of eczema you have is crucial for effective management. If you're unsure, it's always best to consult a healthcare professional.
Common Causes and Triggers
While the precise cause of eczema remains elusive, several factors are known to contribute to its development and trigger flare-ups. These can be broadly categorised as genetic predispositions, environmental factors, and immune system dysfunction.
Genetics: Eczema often runs in families. If you have a family history of eczema, asthma, or hay fever, you're more likely to develop eczema yourself. Specific genes involved in skin barrier function and immune regulation have been linked to eczema.
Environmental Factors: Exposure to certain environmental factors can trigger eczema flare-ups. Common triggers include:
Irritants: Soaps, detergents, shampoos, disinfectants, and certain fabrics (like wool or synthetic materials) can irritate the skin and trigger eczema.
Allergens: Pollen, dust mites, pet dander, mould, and certain foods can trigger allergic reactions that lead to eczema flare-ups. Food allergies are more common in children with eczema.
Climate: Extreme temperatures, both hot and cold, and low humidity can dry out the skin and exacerbate eczema symptoms. Sweat can also be a trigger for some people.
Infections: Bacterial, viral, or fungal infections can trigger or worsen eczema.
Stress: Psychological stress can weaken the immune system and trigger eczema flare-ups. Learn more about Rashy and our commitment to providing resources for managing skin conditions.
Immune System Dysfunction: In people with eczema, the immune system overreacts to triggers, leading to inflammation and skin damage. This overactive immune response disrupts the skin's natural barrier function, making it more susceptible to irritants and allergens.
Identifying your specific triggers is essential for managing eczema effectively. Keeping a diary of your activities, diet, and environmental exposures can help you pinpoint potential triggers.
Recognising the Symptoms of Eczema
The symptoms of eczema can vary from person to person and depend on the type and severity of the condition. However, some common symptoms include:
Dry, itchy skin: This is the hallmark symptom of eczema. The itching can be intense and persistent, leading to scratching, which can further damage the skin.
Red, inflamed skin: The affected areas of skin may appear red, swollen, and inflamed.
Rashes: Eczema rashes can appear anywhere on the body, but they are most common on the hands, feet, elbows, knees, face, and scalp. The appearance of the rash can vary depending on the type of eczema.
Small, raised bumps: These bumps may ooze fluid and crust over when scratched.
Thickened, leathery skin: Chronic scratching can lead to thickened, leathery skin, known as lichenification.
Scaly, flaky skin: The skin may become dry, scaly, and flaky.
Blisters: In some cases, small blisters may form on the skin, particularly in dyshidrotic eczema.
In infants, eczema often appears on the face, scalp, and extensor surfaces of the limbs (outer sides of elbows and knees). In older children and adults, it tends to affect the flexural surfaces (inner sides of elbows and knees), wrists, and ankles. It's important to note that eczema symptoms can come and go, with periods of flare-ups and remission.
Diagnosis and Medical Evaluation
If you suspect you have eczema, it's important to consult a doctor or dermatologist for diagnosis and treatment. A medical evaluation typically involves:
Medical History: The doctor will ask about your personal and family history of eczema, allergies, and asthma.
Physical Examination: The doctor will examine your skin to assess the type, location, and severity of your eczema.
Allergy Testing: Allergy testing, such as skin prick tests or blood tests, may be performed to identify potential allergens that are triggering your eczema. This can help determine if contact dermatitis is a factor. Our services can help you find qualified professionals.
Skin Biopsy: In rare cases, a skin biopsy may be necessary to rule out other skin conditions.
There is no specific test to diagnose eczema. The diagnosis is usually based on the doctor's clinical assessment of your symptoms and medical history. It's helpful to provide the doctor with a detailed account of your symptoms, triggers, and any treatments you've tried.
Treatment Options: Topical and Systemic
Eczema treatment aims to relieve symptoms, reduce inflammation, and prevent flare-ups. Treatment options can be broadly divided into topical and systemic therapies.
Topical Treatments: These are applied directly to the skin and are the mainstay of eczema treatment.
Emollients (Moisturisers): Emollients are essential for hydrating the skin and restoring its barrier function. They should be applied liberally and frequently, especially after bathing. Choose fragrance-free and hypoallergenic emollients.
Topical Corticosteroids: These medications reduce inflammation and itching. They are available in various strengths, and your doctor will prescribe the appropriate strength based on the severity of your eczema. Use topical corticosteroids as directed by your doctor, as overuse can lead to side effects.
Topical Calcineurin Inhibitors (TCIs): These medications, such as tacrolimus and pimecrolimus, also reduce inflammation but do not have the same side effects as topical corticosteroids. They are often used for long-term maintenance therapy.
Topical Phosphodiesterase-4 (PDE4) Inhibitors: Crisaborole is a non-steroidal topical medication that reduces inflammation by inhibiting PDE4. It is approved for use in children and adults.
Systemic Treatments: These medications are taken orally or by injection and are used for more severe cases of eczema.
Oral Corticosteroids: These medications can quickly reduce inflammation but are not recommended for long-term use due to potential side effects.
Immunosuppressants: Medications like cyclosporine, methotrexate, and azathioprine suppress the immune system and reduce inflammation. They are typically used for severe eczema that has not responded to other treatments.
Biologic Medications: Dupilumab is a biologic medication that targets specific proteins involved in the inflammatory process. It is administered by injection and is approved for use in adults and children with moderate to severe eczema.
Phototherapy: Exposure to ultraviolet (UV) light can help reduce inflammation and itching. Phototherapy is usually administered in a doctor's office or clinic.
Your doctor will work with you to develop a treatment plan that is tailored to your specific needs and the severity of your eczema. It's important to follow your doctor's instructions carefully and to report any side effects.
Lifestyle Management and Prevention
In addition to medical treatments, lifestyle management plays a crucial role in controlling eczema and preventing flare-ups.
Moisturise Regularly: Apply emollients liberally and frequently, especially after bathing. Choose fragrance-free and hypoallergenic products.
Avoid Triggers: Identify and avoid triggers that worsen your eczema, such as irritants, allergens, and stress.
Bathe Wisely: Take short, lukewarm baths or showers. Avoid hot water and harsh soaps. Pat your skin dry gently and apply emollient immediately after bathing.
Wear Soft, Loose-Fitting Clothing: Choose clothing made from soft, natural fibres like cotton. Avoid wool and synthetic materials that can irritate the skin.
Manage Stress: Practice stress-reducing techniques such as yoga, meditation, or deep breathing exercises.
Keep Your Nails Short: Short nails can help prevent skin damage from scratching.
Use a Humidifier: A humidifier can help keep the air moist, which can prevent dry skin.
Consider Wet Wrap Therapy: Wet wrap therapy involves applying a layer of wet bandages over moisturised skin to hydrate and soothe the skin. This can be particularly helpful for severe eczema flare-ups. Always consult with your doctor before starting wet wrap therapy.
Eczema can be a challenging condition to manage, but with the right treatment and lifestyle adjustments, you can control your symptoms and improve your quality of life. If you have any concerns or questions about eczema, don't hesitate to consult a healthcare professional. You can also check our frequently asked questions for more information.