Eczema

What is eczema?
Eczema is a chronic skin condition, which affects about 1 person in 12 at some time in their lives. Eczema (dermatitis) is mostly an inherited skin condition, but can sometimes be caused by environmental allergens or irritants. Eczema is an inflammation of the skin which may cause dryness, flakiness, heat and, probably most importantly, itching.

Dermatitis is a term which is sometimes connected, in people's minds, with exposure to chemicals. It really only means inflammation of the skin, and could be used interchangeably with eczema, as it often is by doctors.

Eczema can be caused by a number of different factors, and may result in just a small patch of skin being affected, but can affect skin anywhere on the body.

Causes
The causes of eczema often has a strong genetic component, and there is often a family history of atopy. The condition may also be aggravated by house dust mite, cat and dog dander, or grass pollen, and other closely associated familial, allergic conditions such as asthma or hayfever. In adults it is also thought to have an emotional component as it often appears in times of stress. Thyroid function tests should be checked in chronic cases as this is one of its causes. It can also be aggravated by anxiety and chemicals.

The other possible causes include:

Infantile eczema which often affects young babies. This may lead to a patch below their chins, which gets wettest from dribbling, and may be associated with cradle cap.
Contact with substances which irritate the skin chemically. This is caused by direct contact between the skin and the substance, which might be such things as detergents, soaps, diesel or engine oils, strong chemicals, cleaners etc.
Contact with substances which the body has become allergic to. Commonly this involves nickel, rubbers etc. If a woman was sensitive to nickel in the past it would cause a reaction where the bra hooks and suspenders came near her skin, as these typically contained nickel. Plastics have helped to overcome this risk, but jewelry and watches are still a common cause. Suddenly people need to spend a bit more on their presents to you!

Symptoms
The typical eczema rash usually starts as a raised and reddened scaly patch, quickly developing into weeping, pus-filled sores which may then crust over. If left untreated, the skin often becomes dry, cracked and itchy, and thicker in appearance due to the reaction to persistent scratching. In children between the ages of two and ten, the rash appears mainly in the folds and creases of skin including the backs of knees and behind the ears. In infants under two years old, the rash is most likely to appear on the face, elbows or knees.

The itch is intense, and makes you want to scratch. You should avoid this if you possibly can, as scratching only makes the symptoms worse. People say that if you have to do anything, gentle rubbing, with the flat of your hands is better than scratching.

Diagnosis
The doctor will usually come to the diagnosis from examining your child. If in doubt, or if he or she feels that you need further tests, then you may be referred to a skin specialist (dermatologist).

Further tests may include blood tests, patch tests (where little patches of different substances are stuck to your skin for a few days, to see if you react to any of them) and other allergy tests.

Treatment
There is essentially no cure for eczema. It involves a sensitivity of the skin that you are likely to have to some degree from now on. There are, however, a number of approaches which help to minimise your symptoms. The treatment for chronic eczema usually involves the use of corticosteroid creams, moisturisers and oils. The strength of the steroid creams will vary depending upon the severity of the condition. Long-term use of steroid creams is to be avoided as much as possible as it can result in thinning of the skin. Avoidance of irritants or anything which aggravates the skin should be observed. With age, eczema often improves and can even disappear altogether. Some moisturisers contain antiseptics which are good for controlling the bacteria in the skin which affects the eczema:

• Avoid spraying strong irritants like perfumes on the skin
• Avoid balm creams containing lanolin as some can cause an allergy
• Avoid chemicals like detergents and sudden changes in temperature of tap water
• Look for trigger factors, particularly allergens from animal furs, soaps, deodorants etc.