Eczema

Atopic eczema is an inflammation of the skin, which tends to flare up from time to time. It usually starts in early childhood.

The severity can range from mild to severe. There is no cure but treatment can usually control or ease symptoms. Moisturisers (emollients) and steroid creams or ointments are the common treatments. About 2 in 3 children with atopic eczema grow out of it by their mid-teens.

What is atopic eczema?

Eczema is sometimes called dermatitis which means inflammation of the skin.

There are different types of eczema. The most common type is atopic eczema. In this type of eczema there is a typical pattern of skin inflammation which causes the symptoms.

The word atopic describes people with certain allergic tendencies. However, atopic eczema is not just a simple allergic condition. People with atopic eczema have an increased chance of developing other atopic conditions, such as asthma and hay fever.

What are the symptoms of atopic eczema?

Patch of atopic eczema
The skin usually feels dry.
Some areas of the skin become red and inflamed. The most common areas affected are next to skin creases, such as the front of the elbows and wrists, backs of knees and around the neck. However, any areas of skin may be affected. The face is commonly affected in babies with atopic eczema.
Inflamed skin is itchy. If you scratch a lot it may cause patches of skin to become thickened.
Sometimes the inflamed areas of skin become blistered and weepy.
Sometimes inflamed areas of skin become infected.
Typically, inflamed areas of skin tend to flare up from time to time and then tend to settle down. The severity and duration of flare-ups varies from person to person and from time to time in the same person.

In mild cases, a flare-up may cause just one or two small, mild patches of inflammation. Often these are behind the knees, or in front of elbows or wrists. Flare-ups may occur only now and then.

In severe cases, the flare-ups can last several weeks or more and cover many areas of skin. This can cause great distress. Many people with atopic eczema are somewhere in between these extremes.

Who has atopic eczema?

Most cases first develop in children under the age of five years. It is unusual to develop atopic eczema for the first time after the age of 20.

At the moment, about 1 in 5 schoolchildren have some degree of atopic eczema. However, statistics show that it is becoming more common year on year. In about 2 in 3 cases, by the mid-teenage years, the flare-ups of eczema have either gone completely, or are much less of a problem. However, there is no way of predicting which children will still be affected as adults.

Between 1-5 in 20 adults have atopic eczema.

What causes atopic eczema?

The cause is not known. The oily (lipid) barrier of the skin tends to be reduced in people with atopic eczema. This leads to an increase in water loss and a tendency towards dry skin.

Also, some cells of the immune system release chemicals under the skin surface, which can cause some inflammation. But it is not known why these things occur. Inherited (genetic) factors play a part. Atopic eczema occurs in about 8 in 10 children where both parents have the condition and in about 6 in 10 children where one parent has the condition. The precise genetic cause is not clear (which genes are responsible, what effects they have on the skin, etc). However, recent research suggests that in some people genetic changes hamper the production of a chemical (filaggrin) involved in the defence barrier of the skin.

As mentioned previously, atopic eczema is becoming more common. There is no proven single cause for this but factors which may play a part include:

Changes in climate
Pollution
Allergies to house dust mite or pollens
Diet
Infections
Other early-life factors.

There may be a combination of factors in someone who is genetically prone to eczema, which causes the drying effect of the skin and the immune system to react and cause inflammation in the skin.

What is the usual treatment for atopic eczema?

The usual treatment consists of three parts:

Avoiding irritants to the skin and other causes (triggers) wherever possible.
Moisturisers (emollients) - used every day to help prevent inflammation developing.
Steroid creams and ointments (topical steroids) - mainly used when inflammation flares up.

Treatment part 1 - avoid irritants and triggers where possible

Many people with atopic eczema have flare-ups from time to time for no apparent reason. However, some flare-ups may be caused (triggered) or made worse by irritants to the skin, or by other factors. It is commonly advised to:

Avoid soaps, bubble baths, etc, when you wash. They can dry out the skin and make it more prone to irritation. Instead, use a soap substitute plus a bath/shower moisturiser (emollient) - see below.
Biological washing powders and fabric conditioners can also sometimes cause problems.

Try as much as possible not to scratch. To help with this, keep nails short and use anti-scratch mittens in babies. If you need to relieve an itch, rub with fingers rather than scratch with nails.

Wear cotton clothes next to skin rather than irritating fabrics such as wool. However, it is probably the smoothness of the material rather than the type of the material which helps. Some smooth man-made fabrics are probably just as good as cotton.void getting too hot or too cold as extremes of temperature can irritate the skin.
After you wash clothes with detergent, rinse them well. Some biological detergents are said by some people to be irritating. But there is little proof that commonly used detergents that are used in the normal way make atopic eczema worse.