Share this information:
  • 1
  •  
  •  
  • 2
  •  
  •  
  •  
  •  
  •  
  •  
  •  
    3
    Shares

1 Star2 Stars3 Stars4 Stars5 Stars (2 votes, average: 5.00 out of 5)
Loading...

 

Ezcema and atopic dermatitis on grown ups and children

Eczema and atopic dermatitis

Written by Dr A Sahota, Department of Dermatology, Royal Free Hospital and Dr M Rustin, Department of Dermatology, Royal Free Hospital

What is eczema?

Eczema is the general term used to describe various itchy skin diseases. It is not a very precise term and the disease that most people call ‘eczema’ is known medically as ‘atopic dermatitis’. Dermatitis simply means inflammation of the skin.

Atopic dermatitis

Atopic dermatitis on a child. It looks like small dots.

What is atopic dermatitis?

Eczema

Variations of eczema

Atopic dermatitis is a very common skin problem. It affects approximately 20 per cent of children at some point but most of them grow out of it. But approximately 2 to 4 per cent of the adult population is affected. In the last 30 years, atopic dermatitis has become more common in the United States, South America and European countries.

Atopic dermatitis

Huge eczema on the neck

What causes atopic dermatitis?

What causes eczema

Atopic dermatitis is caused by a combination of genetic and environmental factors:

  • Genetic factors

Atopic dermatitis tends to run in families. A child with atopic dermatitis is likely to have another atopic condition, such as asthma or hay fever, or at least be related to someone with one.

Red dots behind the ear

Several genes have been linked to atopic dermatitis although the connection is not clear. It is likely that a complex combination of genes allows an environmental trigger to cause atopic dermatitis.

Eczema

Eczema on infants feet

  • Environmental
  • House dust mites.
  • Skin infections, such as the bacterium Staphylococcus aureus.
  • Stress.
  • Food, particularly cow’s milk, eggs or occasionally soy.
  • Hard water as you may need to use more soap, which irritates the skin.
  • Fewer childhood infections.

What are the symptoms of atopic dermatitis?

Dermatitis on a baby face

Sometimes eczema covers the whole face of a baby

Itching in association with either wet, weeping skin or dry, scaly red skin, which affects:

  • skin creases around the neck, in the elbows and knees, and on the wrist and ankles.
  • the face (especially around the eyes), the scalp, and in severe cases the whole body.

With an infection the skin can become sore and crusted. This may be a sign of infection either with bacteria (usually staphylococcus) or less commonly with the cold sore virus (herpes simplex).

How is atopic dermatitis diagnosed?

Eczema on fingers

Your doctor can usually diagnose eczema by simply looking at the affected area. He may also take a family history of atopic diseases such as asthma or hay fever. You may also need a blood test to help identify the trigger to the condition, eg dog or cat hair, dust, pollen or diet.

What else could it be?

Eczema

It may be allergic contact dermatitis, caused by an allergy to nickel, perfumes, or preservatives in creams and emollients. The disease can also be confused with scabies.

Atopic dermatitis

The typical example of atopic dermatitis on child’s face

Atopic dermatitis treatment and cure

There is no cure for this condition but several treatments can reduce its severity.

Emollients or moisturisers can help reduce redness and itchiness and also make other treatment, especially topical corticosteroids, more effective.

Big spots of eczema on the back

Topical corticosteroids (anti-inflammatory creams, ointments, gels or solutions) reduce the severity of the problem within a few days. Sometimes they are combined with antibacterial ingredients to treat infected skin. They are perfectly safe when used properly.

Eczema

Eczema can often occur under arms

Phototherapy is a form of treatment using artificial light. There are two types: ultraviolet B (UVB) and psoralen + ultraviolet A (PUVA). Both are done in hospital outpatient departments and need to be given two to three times each week for six weeks or more. Although highly effective, treatment must be limited as excess exposure to these lights can cause skin cancers.

Eczema

Eczema can be dry, and can also be wet

Corticosteroid tablets or injections can temporarily clear severe atopic dermatitis in a few days. However, patients suffer side effects if they use them for more than two weeks.

Atopic dermatitis on the infant

Sometimes eczema can grow on the whole baby’s body

Ciclosporin is an immunosuppressant (a medicine that suppresses the immune system) used in people with severe atopic dermatitis, and can control symptoms even several months after treatment has stopped. But it can also cause kidney damage.

Eczema

Dry eczema often occur on arms and legs

Azathioprine is another immunosuppressant effective in treating atopic dermatitis. However it can affect the bone marrow and the liver.

Eczema

Dry eczema on child’s legs

Mycophenolate mofetil is similar in its actions to azathioprine. It can also affect the bone marrow.

Chinese herbs can be beneficial for some patients, taken either as a tea or applied to the skin. They can also have side effects including liver and kidney damage. The herbs are usually not available on the NHS and can be expensive.

Eczema on hands

In the most tough cases the disease can cause necrosis

What other treatments are available?

Antibiotics are sometimes prescribed if the atopic dermatitis is infected. The commonest infection is a bacterium called Staphylococcus aureus, which causes a yellowish crust on the affected area. The antibiotic usually prescribed is flucloxacillin (or erythromycin if a person is allergic to penicillin).

Antiviral medicines may be needed if the atopic dermatitis becomes infected with the cold sore virus (herpes simplex). The doctor may prescribe aciclovir to be taken as a tablet or syrup. In severe cases, treatment should be given in hospital through a drip.

Dry eczema

Dry eczema on fingers

Antihistamines are useful for patients, particularly children, who cannot sleep because they feel so itchy. Only antihistamines that have a sedative side effect are effective. They are available as tablets and syrups.

Wet wraps are a type of fabric dressing that is soaked in warm water and then made into a suit to cover the whole body. A second dry layer is put on top of this. These need to be changed daily.

Bandages can also prevent sufferers from scratching their arms and legs.

Eczema treatment

Treatment of eczema can take a long time

Evening primrose oil has a mild anti-inflammatory effect and is sometimes recommended for children with mild skin condition. It is usually taken as capsules.

How can I help myself?

Creams for eczema

Take good care of your skin, moisturising it everyday. Cleanse your skin with a cream (eg aqueous cream) or an ointment (eg emulsifying ointment) rather than soap. Even ‘gentle’ or ‘hypoallergenic’ soaps dry the skin and this makes atopic dermatitis worse. Avoid scratching the itch, as this will make the skin darker, thicker and even itchier.

Eczemas

Multiple eczemas on the back

Reduce the number of dust mites:

  • cover the mattress with a plastic sheet, which is damp dusted weekly
  • vacuum carpets, beds and soft furnishing weekly
  • avoid putting clothing onto carpets
  • use a synthetic pillow instead of feather/down
  • regularly wash soft toys at 50ºC or higher
  • damp dust whole house weekly
  • replace carpets with hard flooring if possible.



  •  
    3
    Shares
  • 1
  •  
  •  
  • 2
  •  
  •  
  •  
  •  
  •  
  •  
  •  
  •