Eczema/dermatitis a troublesome condition
Eczema or dermatitis is an inflammatory condition of the skin. Patients present with red, itchy skin which may also blister. A good understanding of the triggers and irritants which cause eczema is essential in order to avoid exacerbations of this troublesome condition.
There are 2 main types of dermatitis/eczema:
- Atopic eczema: Caused by a problem from 'within' the body, this is a condition one is born with.
- Contact dermatitis: This is caused by a substance from outside the body that on contact causes patches of inflammation of the skin.
Although patients with atopic eczema may have no obvious triggers, many exacerbations may be made worse by irritants to the skin:
- Soaps and detergents tend to make the skin dry and consequently more likely to become irritated. Alternatively, emollients, which are soap substitutes and which moisturise the skin, may be used. It is important to protect skin with cotton lined rubber gloves when using detergents. Clothes should be rinsed well after washing and use of non-biological detergents is recommended.
- Perfumes, preservatives and alcohols contained in toiletries and make-up can irritate the skin. Wool can also cause skin irritation and cotton clothing is preferable. Heat aggravates eczema so loose clothing and avoidance of extreme temperatures may help prevent exacerbations.
- Scratching aggravates an itch, creating an 'itch-scratch' cycle. It is important to keep fingernails short and consider wearing cotton gloves at night. Anti-scratch mittens can be helpful for babies.
- The most common foods which occasionally trigger eczema include cow's milk, eggs, soya, wheat, fish, and nuts. Symptoms such as itching, redness, swelling and inflammation around the mouth as well as the development of a rash (urticaria) may develop within two hours of eating the offending food. Other symptoms may occur such as abdominal pain, vomiting, wheezing, itchy eyes and sneezing. Delayed reactions which produce similar symptoms may develop within 6-24 hours after eating trigger foods. However, it is important to note that less than 1 in 10 children with atopic eczema have food sensitivity. If you suspect a food is making eczema symptoms worse, then see your GP. You may be asked to keep a diary for 4-6 weeks in order to identify possible trigger foods. An exclusion and challenge test may help to confirm the diagnosis.
- Pollens, pets, moulds, pregnancy and hormone changes may also trigger symptoms.
- Topical steroids, which reduce inflammation, are used when one or more patches of eczema flare up. There are different formulations available depending on the condition of the skin. Topical steroids should be used until the flare-up has completely cleared, and then stopped, usually after 7-14 days. If there is no improvement after 3-7 days a stronger topical steroid may be prescribed. Emollients and topical steroids should be applied at least 15 minutes apart in order to allow full absorption of one product before application of the next.
- Immunomodulators are licensed for use in people aged two years and over who have eczema which is not controlled with usual treatments.
- Antihistamines can help relieve itch.
- Tar shampoo may be of benefit for patients who have large amounts of scale.
Should you notice areas of weeping, blisters, infected skin lumps, crusts or rapidly worsening eczema you should contact your GP immediately as these can be signs of infected eczema which requires immediate treatment with an antibiotic.
Further information is available from the Irish Eczema Society's website; www.eczemaireland.org.