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Eczema - causes, symptoms, treatment

 
Eczema (atopic dermatitis) is a common form of dermatitis (skin inflammation) that causes the skin to become itchy, red, swollen and painful.  Symptoms can vary from a mild rash that disappears quite quickly to a more severe condition that’s present for a long time.   The main goal of treatment is to eliminate itching which, in left untreated, can provoke or worsen the other symptoms. 
 
Eczema is particularly common among young New Zealanders, occurring in 15% of children and 9% of adolescents.  The prevalence of eczema is higher among young New Zealanders of Maori and Pacific Island ethnicity.

General information

Eczema generally occurs in babies and children, although it can occur at any time of life.  Eczema usually develops in the first year of life.  Most children have a substantial improvement in their eczema by their mid-teens but, in some, severe eczema persists into adulthood.

Eczema usually starts on the face followed by the hands and feet.  Older children tend to be affected in the elbow and knee creases, neck, wrists, ankles and feet.  The hands and feet tend to be the most commonly affected areas in adults. Eczema is not a contagious condition.

Eczema tends to develop in people with allergies such as asthma and hay fever and often runs in families.

Causes

Healthy skin acts as a barrier to retain moisture and to protect the body from environmental challenges.  Any factor that disrupts the ability of the skin to act as an effective barrier can lead to the loss of moisture, causing dryness and the entry of allergens, irritants and bacteria, which can result in inflammation and infection.
 

Potential causes of eczema are:

  • Factors that cause the skin to become dry, which in turn affects the skin's barrier function
  • Genetic mutations that affect the skin's barrier function
  • Immune system dysfunction causing an unwanted inflammatory response in the skin.

Certain substances or conditions called trigger factors can cause eczema to flare (ie: become worse). These trigger factors can be: 

  • Irritants such as soaps and detergents, wool, skin infections, dry skin, low humidity, heat, sweating or emotional stress.
  • Allergens such as dust mites, pollen, moulds or foods.
Consultation with your doctor may be helpful in identifying the triggers.

Signs and symptoms

The classic symptoms of eczema are:  

  • Itching.  This is the worst aspect because it can be upsetting for the child.  It also makes the child scratch causing further rawness of the skin and possible infections to develop.
  • Redness caused by extra blood flowing through the blood vessels in the skin in the affected area.
  • A grainy appearance to the skin, caused by tiny fluid filled blisters just under the skin called “vesicles.”
  • Weeping when the blisters burst, either by themselves or because of scratching, and the fluid oozes on to the surface of the skin.
  • Crusts or scabs that form when the fluid dries.
  • Children with eczema often have dry, scaly skin.  This may be the result of the disease or it may also be the natural skin type of the family.  Dry skin can be a predisposing factor to developing eczema.
  • Pale patches of skin may appear because eczema can disturb the production of pigment which controls skin colour. The effect does fade and disappear.
  • Lichenification - a leathery, thicker skin area in response to scratching.  

Treatment

The main goal of treatment is to eliminate the itching which provokes or worsens the other symptoms and causes the most discomfort.  In some very mild cases eczema can be managed by:  

  • Avoiding likely sources of irritation (triggers)
  • Using emollients such as special bath oils and moisturisers.
It is necessary to work with the child's doctor in order to develop a treatment plan that works best for each child.  Treatment may need to be reassessed, especially if the condition worsens or fails to respond to treatment.  In some cases the doctor will refer the child to a skin specialist (dermatologist).
 
Corticosteroids, such as hydrocortisone, reduce the inflammation in response to an allergic reaction.  There are different strengths of corticosteroid creams and ointments available on prescription.  Care needs to be taken, especially if applying a very strong corticosteroid as it can cause the skin to become thin.  These creams should not be put on liberally but instead only the thinnest smear should be applied to the rash.  The best time to do this is after a bath, as the skin is more absorbent. 

Discuss with a doctor or pharmacist the correct use and application of the corticosteroid cream or ointment prescribed.  Establish when it is appropriate to use and when to stop using it, or when to use a weaker corticosteroid.  It is not advisable to use a corticosteroid on the face unless prescribed by a doctor. Occasionally, corticosteroid medication may need to be given orally.

Pimecrolimus cream (Elidel) is a topical, steroid-free, anti-inflammatory medication used to treat eczema, amongst other inflammatory skin conditions. It is available on prescription and can be applied to affected skin on the face, head and around the eyes where corticosteroid creams are not recommended.
 
Special diets that exclude certain foods (elimination diets) have been effective in treating eczema in some children. However, not all children respond to diet therapy.  Talk to your doctor, allergy specialist or dietitian about this.

Antihistamines may help the itching.  The drowsiness they cause can also be useful at night to conquer sleeplessness caused by the irritation. 

In some cases, medications to suppress the immune system may be needed to treat the condition.
 
In severe cases, phototherapy or ultraviolet (UV) treatment may be suggested.  This involves controlled exposure to UV-A and/or UV-B for a few minutes, two to three times each week.  A course of treatment may continue for several months.
 
Skin that is broken and damaged is more likely to be infected by bacteria or yeasts.  One common type of bacterium (staphylococcus aureus) produces yellow crusts or pus filled spots.
Should bacterial infection occur, this can be treated with a course of antibiotics.  Antibiotics can be taken orally in the form of syrup, capsules or tablets. 

Preventative measures

 The following may help alleviate the symptoms and prevent future outbreaks of eczema:  

  • Use pure cotton or cotton mixtures instead of wool or synthetics
  • Do not use soap.  Instead add bath oils to bath water and use emulsifying ointment or a water dispersible cream instead of soap
  • Avoid enzyme detergents and fabric softeners when washing clothes as these can irritate the skin
  • Avoid foods that are known to provoke allergic reactions such as peanuts, eggs, seafood, milk, soy and chocolate
  • Direct use of antiseptics and solvents should also be avoided
  • Environmental factors, such as heat, sunlight and cold can irritate the condition.  If this is the case, protect the child from them or avoid them as much as possible
  • Use a humidifier in winter and summer
  • Moisturise the skin.  Washing with water alone rapidly results in drying, but adding oil to water will moisturise dry, eczema-prone skin effectively.  Discuss with the doctor or a pharmacist what is available. It may take some time and experimentation to find the best product for the child
  • Bandages can be used to stop scratching at night.  Cotton mittens can be especially helpful
  • Fingernails should be kept short to decrease the damage caused by scratching.

Further information and support

Allergy New Zealand can assist with further information, support and resources. Their contact details are:

Allergy New Zealand
Freephone: 0800 34 0800
Website: www.allergy.org.nz  

References

Allergy New Zealand (2010). Eczema (Web Page). Auckland: Allergy New Zealand. http://www.allergy.org.nz/A-Z+Allergies/Eczema.html [Accessed: 07/07/17]
Clayton, T., et al. Time trends, ethnicity and risk factors for eczema in New Zealand children: ISAAC Phase Three. Asia Pac Allergy. 2013 Jul;3(3):161-78.
NHS Choices (2015). Atopic eczema (Web Page). Redditch: National Health Service (NHS)
England. http://www.nhs.uk/Conditions/Eczema-(atopic)/Pages/Introduction.aspx [Accessed: 07/07/17]
Kim, B.S. (2017). Atopic dermatitis (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/1049085-overview [Accessed: 07/07/17]
Schwartz, R.A. (2017). Pediatric atopic dermatitis (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/911574-overview#a4 [Accessed: 07/07/17]


Last reviewed – July 2017
 
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