Eczema

Atopic eczema (also known as dermatitis) is the most common form of eczema and often occurs in people who have allergies such as hay fever. Atopic eczema is common and usually starts in babies aged around 3–6 months (60% of children with eczema develop it before their first birthday). 20% of children aged 3–11 years have eczema but around half of all cases are greatly improved by the time a child reaches 11 years, and around two-thirds improve by the age of 161. Atopic eczema persists into adulthood in 1–5% of people.

A number of factors appear to play a part in the development of eczema. These include abnormalities in the inflammatory and allergy responses, and defects in the oily (lipid) skin barrier. This can lead to increased water loss and a tendency towards dry skin, and can make the skin more susceptible to irritation and infection, resulting in rashes and inflammation. Eczema symptoms usually have certain triggers such as soap, detergents, changing temperatures, dust, animal dander, pollens and moulds. Genetic factors (which generic factors?) are amongst those that may cause eczema.

Symptoms vary from person to person and can affect any part of the body. In babies, atopic eczema occurs usually on the face with small patches over the body. In children, atopic eczema is seen in body creases, such as the backs of knees or insides of elbows. In adults, the face is most commonly affected2. If not controlled, the skin can become ‘angry looking’, dry, red and itchy, and eczema ‘flare’ causes the skin to be red and sore. The itching leads to scratching that can lead to worsening symptoms, bleeding and skin infection. Sleep is often disturbed due to the itching and overheating.

Studies have shown that atopic eczema can have a greater impact on quality of life of children than illnesses such as epilepsy and diabetes3.

Atopic eczema can be inherited and tends to run in families but atopic eczema cannot be caught from another person; it is NOT contagious.

Eczema can also occur on the hands. Sometimes it is caused by irritant substances and contact allergies or even just excess washing. People who have had atopic eczema as a child are more likely to develop allergic hand eczema. Chronic hand eczema can sometimes cause uncomfortable blistering (also known as pompholyx or dyshidrotic eczema), and it can be difficult to cope with everyday activities when hands are sore.

It is important to avoid scratching affected skin as this increases the likelihood of infection and skin damage. Treatment strategies usually focus on avoiding trigger factors and keeping skin well hydrated with emollients and moisturisers.

In the UK if your skin is sore and inflamed, your GP may prescribe topical corticosteroids, which may be mild (hydrocortisone), moderate (clobetasone butyrate) or even stronger (for example, mometasone). These treatments can be helpful when used over a short period of time for rapidly dealing with flares or when used occasionally for preventing flare ups. There may occasionally be side effects with topical corticosteroids such as stinging, thinning of the skin, changes in skin colour, acne or hair growth but these usually stop once the treatment stops.

 

Pharmaceutical (i.e. non-surgical) atopic eczema treatments that may be recommended by a pharmacist or prescribed by a GP in the UK are described in the table below.

 

Atopic eczema treatment options
 
   
Self care techniques   Pros   Cons  
Try to reduce scratching and avoid triggers, such as soaps, detergents, or woollen clothing  
  • Reducing scratching will reduce the risk of infection and help avoid skin damage
  • Avoiding triggers can prevent a flare-up of symptoms
 
  • May need to keep a diary to work out what your triggers are
  • Not possible to avoid all triggers – for example, it is very difficult to remove dust mites from your home
  • Self care techniques alone may not be effective in controlling eczema
 
Emollients (moisturisers)      
Creams, lotions and oils that reduce the loss of water from the skin  
  • An important background treatment for all types of eczema
  • Provide a protective barrier to keep moisture in your skin and irritants out
  • Large number of products to choose from
  • Soap substitutes and bath additives available
  • Can be bought over the counter from your pharmacy
 
  • Should be used at least twice a day if possible, or more often if you have very dry skin
  • Some ointments and oils can be greasy
  • Some products can irritate your skin
  • Some products are highly flammable and should not be used near a naked flame
  • Emollients added to the bath can make it very slippery
  • Emollients alone do not control eczema – inflamed, itchy skin needs an anti-inflammatory treatment such as a topical corticosteroid
 
Steroid creams and ointments      
Creams and ointments containing steroid medication, which reduce inflammation  
  • The most effective treatment for eczema flare-ups – can reduce inflammation within a few days
  • Usually only need to be used once a day
  • Safe if appropriate strengths are used in the right place for the right amount of time
  • Can be used between flare-ups to control eczema in the most severe cases
  • Different formulations, such as creams or ointments, are available at different strengths for different parts of the body
 
  • Can cause mild burning or stinging for less than a minute after they are applied
  • In rare cases, may cause thinning of the skin, changes in skin colour, acne, and increased hair growth if the wrong preparation is used in the wrong place for too long (for example, a very strong preparation used on the face for several months)
Antihistamines      
Medicine that can help reduce itching  
  • Can be used to relieve itching during flare-ups
  • Sedating antihistamines, which make you drowsy, can be used to relieve itching at night
  • Non-sedating antihistamines may help relieve long-term itching
 
  • Will not reduce skin dryness
  • Drowsiness caused by sedating antihistamines may affect your ability to drive and will be worse after alcohol, and may affect schoolwork in children
  • Sedating antihistamines don't cause drowsiness in everyone
  • Non-sedating antihistamines can still cause drowsiness in some people
 
Bandaging      
Medicated dressings or wet wraps applied to the skin that are sometimes either used over emollients or with topical corticosteroids  
  • Can help prevent scratching, allow the skin to heal, and stop the skin becoming  
  • Time taken to apply bandages daily can be inconvenient
  • Easy to remove or get underneath if child is determined to scratch
  • Should not be used over infected eczema as it could encourage spread of infection
 
Steroid tablets      
Tablets containing steroids, which reduce inflammation  
  • Rarely used nowadays, but can be effective in bringing particularly severe flare-ups under control if used for a short period (usually only five to seven days at a time)  
  • Unlikely to be prescribed frequently or for longer periods without referral to a specialist
  • If taken for a long time or taken often, they can affect the growth rate of children or cause other serious side effects, such as high blood pressure, brittle bones, or diabetes
 
Specialist treatments      
Calcineurin inhibitor cream or ointment      
Cream or ointment that reduces inflammation  
  • May be effective for moderate to severe eczema, or eczema that does not respond to other treatments
  • Does not thin your skin
  • Useful for people with eczema who cannot use topical steroids
  • Useful for facial eczema – for example, around the eyelids, where topical steroids cannot be used for long periods
 
  • Only available from a dermatologist, or from your GP if they have expertise in this area
  • Long-term safety is still being evaluated
  • Side effects can include a burning or tingling sensation, itching and swelling
  • If you drink alcohol, this may cause facial flushing and skin irritation
 
Phototherapy      
Exposing the eczema to artificial ultraviolet light  
  • May be effective for severe eczema or eczema that does not respond to other treatments
  • Can prevent scratching and help stop the skin drying out
 
  • Only available from a dermatologist at a regulated phototherapy unit  
Immunosuppressant medication      
Medicines that suppress your immune system, such as cyclosporine, azathioprine and methotrexate  
  • May be effective for severe eczema, or eczema that does not respond to other treatments  
  • Only available from a dermatologist
  • Not all immunosuppressants are licensed for atopic eczema, which means the medicine may not have undergone clinical trials to see if it is effective and safe in the treatment of this condition
  • Side effects can include nausea, muscle pain, and an increased risk of infections
 
Alitretinoin capsules      
Capsules to reduce irritation and itchiness  
  • May be effective for severe long-term eczema on the hands in adults, which has not responded to other treatments  
  • Only available from a dermatologist
  • Only available for people over 18
  • Can cause birth defects, so women must avoid pregnancy, ideally by using two methods of contraception, and must have pregnancy tests throughout treatment
  • Side effects can include headaches, a dry mouth, and flushing
  • More serious potential side effects include sight problems and suicidal thoughts
 

http://www.nhs.uk/Conditions/Eczema-(atopic)/Pages/Treatmentoptions.aspx

 

Unlike emollients and moisturisers, SEQuaderma Red Dry Itchy Skin improves the skin barrier, helps normalise skin function and, importantly, is very effective at hydrating the skin layers with pure water. In a clinical study, it was shown that just 3 weeks’ use improved the symptoms and appearance of eczema. Unlike many drugs, SEQuaderma can be used long term for symptom management. Also, by improving hydration and skin function, SEQuaderma can help prevent flare-ups, and potentially reduce reliance on prescription medications (e.g. topical steroids and antibiotics) that can be associated with side effects. Please check our life changing stories.

1 http://patient.info/health/Atopic-Eczema [Accessed 10 June 2015].

2http://www.nhs.uk/Conditions/Eczema-(atopic)/Pages/Symptoms.aspx [Accessed 10 June 2015].

3 Beattie PE, Lewis-Jones MS. A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases. Br J Dermatol 2006;155:145–151.