Eczema describes an itchy, inflamed skin rash. The term eczema comes from a Greek word meaning 'to boil over'. This condition may also be called dermatitis.
Eczema Tips
Eczema Overview
Eczema is a chronic, itchy inflammation of the skin, usually starting in early childhood. Eczema causes the skin to become dry, red and thicker in some places. There are many different types of eczema, the most common being ‘atopic dermatitis.’ Eczema is occasionally described as "the itch that rashes".
Eczema is a common condition affecting 10-20% of school children and around 5% of adults in the UK.
Eczema Symptoms
Eczema may vary in appearance from individual to individual. Typical features include itchy, red skin that may be dry thickened and cracked. Periodic flare ups, followed by a period of no symptoms, up to several years at a time, are common.
Eczema Causes
Though the tendency to develop eczema generally has a genetic component, certain foods (such as dairy products, eggs and yeast) and skin irritants (pet hair, detergents, wool) can act as triggers, particularly in children.
Eczema is divided into a number of types according to the main cause, even though the symptoms may be similar (see below). Atopic eczema is the most common type of eczema and is linked with hay-fever and asthma.
Eczema Treatment
There are a number of treatments for both children and adults that can relieve the symptoms of eczema. The right treatment may depend on the cause, and it is often necessary to try several treatments before finding one that is successful.
Although there isn't a cure for eczema, there are a number of things you can do to manage it. The goal of eczema treatment is to heal the skin, keep it in good condition and manage the symptoms when they appear.
Although eczema can look unpleasant, it’s important to remember that it is not contagious.
Types of eczema
There are five main types of Eczema:
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Atopic eczema: this is the most common type of eczema. Atopic eczema sufferers may also develop asthma or hay fever or have relatives who have these conditions.
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Discoid eczema: this appears as small round circles or patches on the skin and is most common around middle age.
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Allergic contact eczema: the skin becomes sensitised to something over a period of time and an allergic reaction occurs on re-exposure.
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Irritant contact eczema: occurs when the skin comes in contact with something that strips away its natural oils and makes the skin red, dry, cracked and itchy.
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Seborrhoeic eczema: is also very common and usually shows up in areas rich in sebaceous (grease) glands, like the forehead, scalp and side of the nose.
Many children outgrow eczema around the age of seven, although they may remain susceptible to it when the body is put under stress. They can also pass the tendency onto their children.
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Eczema Causes and Triggers
While the exact cause of eczema remains unclear, it is believed to result from a hyperactive response of our immune system to an irritant. It often occurs together with allergies and frequently runs in families. A family history of hay fever or asthma is frequently elicited.
Individuals with a genetic tendency to develop allergies who are additionally exposed to environmental triggers like, pollen, moulds and fungi, mites, and animal dander may develop eczema. Exposure to coarse material like wool, various cosmetics, extremes of temperature and certain foods may precipitate or worsen the condition in others.
Eliminating exposure to triggers plays an important part in managing te symptoms.
Eczema Triggers:
The following are all common eczema triggers:
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Climate changes, especiallyif exposed to cold winds or excessive heat
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Water, especially hard water
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Soaps, detergents, cleaners, bubble baths, cosmetics, perfume
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Pollen, pet hair, animal dander, dust
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Stress and anxiety
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Synthetic or wool fibres
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Certain chemicals, cids, alkalis, oxidising or reducing agents, oil, solvents
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Sweating
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Colds, flu or infections of any kind
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Eczema Symptoms
Eczema symptoms are characterised by a dry, red, scaly rash, which is extremely itchy. Eczema commonly affects the face, neck hands and in creases of the limbs.
The rash usually starts off as minute pearly blisters beneath the skins surface. When it's severe the rash may weep and can cause sleeplessness due to the intense itching.
Main eczema symptoms
You may notice some or all of the following symptoms:
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Itching: Itching is usually the primary symptom and is often worse at night. Being a common feature of many conditions, itching alone doesn’t mean that you have eczema. The itching is usually accompanied by the other symptoms. .
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Discoloured skin with reddish to brown-gray patches: When the skin is inflamed there is an increased blood flow to the area resulting in a red appearance. The redness may also be due to a bacterial infection.
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Thickened, leathery cracked skin: The area affected by eczema is often thicker than non affected skin. This is usually due to a protective response as a result of repeated scratching.
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'Bubled up' skin: Tissue fluids can ooze between the cells and gather into collections or blisters. Depending on the nature of the eczema, and whether infection is present, there can also be large blisters filled with fluid or pus. Protein in this fluid crusts over when scratched
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Raw, sensitive, infected skin, due to persistent scratching
Any part of the body may be affected by eczema symtpoms. The forehead, cheeks, forearms, legs, scalp, and neck are typically affected in infants. In children and adults, eczema classically occurs on the face, neck, and the insides of the elbows, knees, and ankles.
The skin around your eyes, including your eyelids may also be involved. Scratching can cause redness and swelling around the eyes, and in disease of some duration, patchy loss of eyebrow hair and eyelashes may result.
When to see your doctor
Talk to your doctor if you develop an unexplained rash, have a family history of eczema or asthma, or have some of the symptoms associated with eczema. It is essential that you seek medical help if:
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Your discomfort levels are high, distracting you from your everyday routine and causing loss of sleep
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Over-the-counter hydrocortisone creams prove unsuccessful in treating the condition, in which case your doctor might want to try something stronger.
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Yellowish to light brown crust or pus-filled blisters form over existing patches of eczema. This could be the result of a bacterial infection that should be treated with an antibiotic.
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Having eczema puts you at increased risk of contracting the viral disorder. Be aware of this in case you are in the company of someone with cold sores, genital herpes or any other viral skin disease.
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The presence of many small, fluid-filled blisters may indicate eczema herpeticum, a rare but potentially serious complication caused by the herpes simplex virus.
Eczema Diagnosis
This is made on the basis of your symptoms and clinical signs of the disease. Pertinent features include: Itching, this is generally severe
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Dry skin
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Skin inflammation
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Secondary infection of the skin
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Frequent flare-ups of eczema activity
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Family history of eczema, hay fever or asthma
Patch or skin-testing may be required to identify various allergens. Blood tests like RAST and ELISA are occasionally used to identify various triggers, especially if a patient has a skin condition or is on medication like antihistamines. The latter may interfere with a skin test, but these in general do not interfere with allergy blood tests.
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Eczema Treatment
Although there is no cure for eczema there are many treatments that can help relieve the symptoms. There are also a number of things you can do at home to help keep your eczema under control.
Medical Treatments for eczema
Good, sensible skin care is an important part of managing eczema. In many instances this can be enough to manage milder cases of eczema.
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First line eczema treatments: Doctors will usually start patients on the mot simple treatments. For example they may suggest a room-temperature bath which will help remove crusted skin. Apply a good moisturizer immediately afterwards, this will help to retain the skins natural moisture.
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Corticosteroid creams: Corticosteroid creams and ointments have been the mainstay of eczema treatment for many years. There are OTC creams available for milder cases. If your eczema is more severe your doctor may suggest a prescription only cream. In the most severe cases and usually only when other treatments have failed your doctor may prescribe oral corticosteroids.
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Immunomodulators: Newer drugs called topical immunomodulators are available to help treat eczema. These medicines help control inflammation and reduce immune system reactions when applied to the skin. Talk to your doctor about whether these may be right for you.
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Oral antihistamines: Oral antihistamines will sometimes help to relieve eczema symtpoms and can be usefull at nightime. They can cause drowsiness and may help you to sleep despite the eczema itching
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Other Treatments: In the most extreme instances of eczema, your doctor or dermatolgist may suggest ultraviolet light therapy. There are also drugs that supress the immune system and may be tried for adults. Your doctor would be the best person to talk to if other more traditional forms of treatment have not helped.
Supplement treatments for eczema
Research suggests that people who have eczema don’t process essential fatty acids from food normally, leading to low levels of a fatty acid called gamma-linoleic acid (GLS). This helps your immune system work properly, so taking a supplement could help reduce the skin inflammation associated with eczema. It can take around three months for GLA to have an effect on the body once you start taking supplements.
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Evening primrose oil, starflower oil and blackcurrant seed oil all contain GLA. A number of studies have found that taking these supplements cold not only reduce the number of eczema flare-ups but also how severe they are and the length of time they last. An analysis of nine scientific trials found that GLA was also helpful in reducing itching.
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Fish Oils may also help eczema. Fish oils reduce levels of leukotriene B4, a compound that has been linked to eczema.
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B Vitamins may play a supportive role in managing eczema. Deficiencies in some B vitamins, especially biotin and inositol, have been linked to skin disorders, while other B vitamins are needed to mainitain healthy skin and good circulation.
Herbal treatments for eczema
Many herbs have traditionally been used to help relieve the symptoms of eczema.
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Liquorice root contains a substance called glycyrrhizinic acid, which is believed to help reduce the symptoms of eczema. It can be taken internally or applied directly to the skin.
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Living with Eczema
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People with eczema should avoid contact with soap, detergents and other irritants. This means wearing rubber gloves for household and wet work, or cotton gloves when cleaning
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They should avoid jobs or occupations that expose their skin to irritants, such as hairdressing, catering, mechanical engineering and perhaps nursing, especially if eczema affects the hands
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Reduce the population of house dust mites in the home by regular dusting and vacuuming of carpets. Dust mite bed covers have benefitted some eczema patients, and frequent airing and changing of bed linen will help.
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Bed clothes should be washed at 50 degrees C or more to kill dust mites
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Old mattresses are more likely to harbour dust mites, as can old furry toys. Shaking soft toys vigorously and placing them in a plastic bag in the freezer for a few hours helps.
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Some atopic eczema sufferers are sensitive to cat or dog fur and it makes sense to avoid these pets if a family member suffers from atopic eczema.
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The use of make-up can irritate facial skin in a person with eczema and should be used sparingly and with care.
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It is best to keep central heating turned down as low as possible as this can dry out the skin.
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Cotton clothe are less irritating on eczema affected skin than wool or polyester.
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Bathing and showering are fine provided that a soap substitute such as an aqueous cream is used or a bath oil is added.
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Bubble bath should be avoided as it is a detergent.
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The moisturizer that a person uses should be applied straight after a bath or shower, once the skin has been patted dry.
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Holidays in a warm climate can be beneficial as the skin receives more sunlight.
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Although sunlight is usually helpful, atopic eczema may make the skin more sensitive and cotton clothes and sunblock are advised to avoid burning.
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People with eczema can go swimming. Putting on an emollient or skin barrier before and after the swim reduces any irritation.
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Avoid physical and mental stress.
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Eating right, light activity, and adequate sleep will help you stay healthy, which can help prevent flares.
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Eczema Research
Omega-3 Fatty Acids - A Ray Of Hope Against Eczema
According to a report published in a recent issue of the British Journal of Dermatology, daily supplementation of docohexaenoic acid (DHA), an omega-3 fatty acid, may improve the symptoms of eczema, also called atopic dermatitis.
Researchers at Charite-Universitatsmedizin Berlin conducted a clinical trial, which showed that an 8-week course of the supplement, with 5.4 g of the omega-3 PUFA DHA administered every day, led to an improvement of the clinical symptoms of eczema.
Dietary sources of omega-3 fatty acids include oily fish such as salmon and sardines, linseed oil, kiwifruit oil, flaxseeds, butternuts, and walnuts. Omega-3 fatty acids, especially DHA and eicosapentaenoic acid (EPA) are considered super nutrients. They aid cognitive functions and may help protect against heart disease. This new study indicates that omega-3 PUFA may help alleviate atopic eczema as well.
Fifty-three people, with an average age of 26.6 years and who had been diagnosed with atopic eczema, were randomly assigned to two groups. One received a daily supplement of 5.4 g of DHA. The other, the control group, received saturated fatty acids with an equal calorific value. Those in the first group who received DHA exhibited a significant clinical improvement in the symptoms of eczema, which was not exhibited by members of the control group. This pointed to the anti-inflammatory properties of fatty acids.
These findings need to be confirmed in larger studies, though, before skin specialists can start prescribing a daily supplementation of DHA for eczema treatment and management.
Source: British Journal of Dermatology Volume 158, Issue 4, Page 786-792 "Docosahexaenoic acid (DHA) supplementation in atopic eczema: a randomized, double-blind, controlled trial" Authors: C. Koch, S. Dölle, M. Metzger, C. Rasche, H. Jungclas, R. Rühl, H. Renz, M. Worm
Childhood Eczema Linked to Asthma in Middle Age
Childhood eczema, an allergic skin condition, increases the likelihood of childhood asthma as well as the persistence of asthma in later life, reports a 37-year long study published in the August issue of the Journal of Allergy and Clinical Immunology.
The Tasmanian Longitudinal Health Study (TAHS) is an ongoing study that began in 1968. 8583 seven-year-old school children were enrolled for this study. They were surveyed again in 1974, 1979-81, 1991-93, and most recently in 2003-05. About 81% of those still alive and traceable responded to the latest survey.
769 of the seven-year-olds in 1968 had childhood eczema. These children showed an increased incidence of asthma in preadolescence, adolescence, and adulthood. Over time, the incidence of asthma as teenagers almost doubled in those with childhood eczema compared to those who did not have eczema. 63% of the participants were more likely to develop asthma as adults.
The researchers suggest that the link between eczema and asthma may be due to genetic and environmental factors. Eczema could also be contributing to asthma directly. One possible way could be the migration of certain immune system cells from the skin of the eczema patient to tissues in the patient’s airways. These cells are primed for an allergic response and could increase the likelihood of inflammation in the airway in response to an inhaled allergen later in life. If there is actually a cause-effect relationship between eczema and asthma, an aggressive treatment of childhood eczema could reduce the chances of asthma in later life.
Sources:
(1) http://www.medscape.com/viewarticle/579141
(2) http://www.jacionline.org/article/S0091-6749(08)00954-8/abstract
(3) http://www.nlm.nih.gov/medlineplus/news/fullstory_68194.html
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