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Eczema

Published by Bupa's health information team, May 2009.

This factsheet is for people, or parents of children, who have atopic eczema, or who would like information about it.

Eczema, also known as dermatitis, describes a group of skin conditions where the skin is irritated or inflamed. There are many different types of eczema - the most common is atopic eczema (also called endogenous eczema).

• About eczema
• Symptoms of eczema
• Causes of eczema
• Diagnosis of eczema
• Treatment of eczema
• Living with eczema
• Questions and answers
• Related topics
• Further information
• Sources

About eczema

Up to one in five children get atopic eczema in the UK, but most grow out of it by their teens. About one in 10 adults suffer from atopic eczema.

There are various types of eczema, with slightly different causes and symptoms. This factsheet will focus on atopic eczema but the other types are also described.

Atopic eczema

Atopic eczema is usually inherited and affects parts of the body where the skin creases, such as the backs of the knees and the front of the elbows, as well as the chest, face and neck.

Allergic contact eczema

Allergic contact eczema develops when substances cause an allergic reaction. The rash usually starts at the site of contact with the substance, but can spread to other areas.

Irritant contact eczema

Irritant contact eczema is similar to allergic contact eczema and is caused by frequent contact with everyday substances such as detergents or cleaning products.

Seborrhoeic eczema

Seborrhoeic eczema is caused by Malassezia yeast, which normally lives on the skin, although the exact mechanism is unknown. The greasy rash usually starts on the scalp as mild dandruff (sometimes called cradle cap in babies). The dandruff can get worse, causing redness and irritation on other areas of the body. Seborrhoeic eczema is common in babies under one, although about one in 20 adults aged from 18 to 40 also have it. It's less common in old age.

Varicose eczema

Varicose eczema is found in older people. It occurs on the lower legs and is associated with poor circulation and high blood pressure.

Discoid eczema

Discoid eczema can occur in adults at any age, but is more common in later life. It's often caused by dry skin becoming infected. It appears as disc-shaped patches of red, dry and itchy skin on any part of the body, particularly the lower legs.

Symptoms of eczema

The symptoms of eczema vary depending on the type and severity. Symptoms of atopic eczema can include:

• red, inflamed skin
• dry, cracked skin
• itchy skin
• small water blisters on the skin, particularly on the hands and feet - or the skin can become wet and weepy if it's infected
• thickened areas of skin (lichenification) in places that are scratched frequently

Scratching the affected area damages the skin, causing it to bleed which can lead to infection.

Causes of eczema

You can't catch eczema. It doesn't spread from one person to another.

The exact cause of atopic eczema isn't fully understood at present. However, you can have a genetic, or inherited, tendency to develop the condition. Atopy means a family tendency to develop a variety of allergic conditions, including asthma, hay fever and eczema.

Sometimes, the symptoms 'flare up' for no obvious reason. But you may notice certain triggers that set off your, or your child's, eczema including:

• chemicals, detergents, soap or shampoo
• irritants such as pollen, house-dust mites, moulds or pet dander (tiny flakes of skin)
• being "run down", for example if you're unwell
• changes in hormone levels - the menstrual cycle and pregnancy can make eczema worse
• stress
• high or low temperature or humidity - this leads to seasonal variation in eczema severity but sweating can also make eczema worse
• rough or irritable fibres, such as wool

Diagnosis of eczema

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. He or she may rub a sterile cotton bud on the skin to check for infections.

You will normally be treated by your GP but he or she may refer you to a dermatologist, a doctor specialising in skin conditions.

Treatment of eczema

As atopic eczema can't be cured, treatments aim to control the symptoms.

Medicines

There are a number of treatments available from your GP or from pharmacies to treat eczema. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Emollients

Emollients are moisturisers which soothe and add water to (hydrate) the skin. They reduce dryness and the frequency of flare-ups. Emollients are the most common treatment and should be used every day even if you don't have eczema symptoms. Examples include aqueous cream and emulsifying ointment. You can apply emollients directly to your skin as lotions, oils or washes. You may have to try different emollients before you find the best one for you.

Mild steroid creams

Mild steroids, such as hydrocortisone (eg Dioderm and Efcortelan), can calm flare-ups of eczema by suppressing your body's inflammatory response. You should continue to use emollients at the same time as steroid creams.

Prescription medicines

If emollients and mild steroids don't treat your condition, there are a range of other treatment options that your doctor can prescribe.

• Stronger steroid creams, such as betamethasone (eg Betnovate) are available on prescription. You should apply them thinly and use the mildest cream that works because of side-effects. If you use a strong steroid for too long, or on delicate skin, it can thin your skin. This can make your skin more fragile leading to blemishes, wrinkles or visible small blood vessels. Always follow your GP's instructions about using steroid creams.
• Oral steroids, such as prednisolone, are available as tablets to treat severe eczema. They are used for the shortest period of time possible.
• Immunosuppressant tablets, such as ciclosporin (eg Neoral or Sardimun), can be prescribed for severe eczema. They can have significant side-effects so you shouldn't take them for long periods - ask your doctor for more information.
• Topical immunosuppressants are creams or ointments that you apply to your skin to reduce inflammation. They may be prescribed if other treatments haven't worked or you can't use them due to side-effects. Examples include tacrolimus (Protopic) and pimecrolimus (Elidel). These are new treatments that don't contain steroids so they may have fewer side-effects. However, their long-term safety has not been evaluated.
• Antibiotics, such as flucloxacillin or erythromycin, will be prescribed if your skin becomes infected.
• Antihistamine tablets that cause drowsiness can help you to sleep but they don't ease itching.

Complementary therapies

Some people find that complementary treatments, such as herbal creams and homeopathy, are helpful. However, there is no firm scientific evidence for this.

Herbal medicines may also help, but the active ingredients are poorly understood. Information about the quality and safety of the preparations is hard to obtain and side-effects, such as liver damage, have been reported.

Hospital treatment

If your eczema is severe you may need hospital treatment. This will remove you from the environment that may be triggering your symptoms and the hospital staff will ensure that you're using your treatments correctly.

If your skin is severely infected with a herpes simplex infection (eczema herpeticum), you will be given antiviral treatment in hospital.

For some people with eczema, ultraviolet light treatment is helpful. This is usually given in hospital by a dermatologist.

Living with eczema

Medicines are only part of the treatment for eczema. Eczema also needs to be managed by dealing with the things that make it worse.

Identifying and staying away from the things that trigger your, or your child's, eczema are an essential part of your overall treatment plan.

If your, or your child's, eczema is triggered by certain foods you should ask your GP for advice on how to deal with this. Keeping a diary to record anything that triggers eczema can help you to discover a pattern. Excluding foods may not have any effect and can lead to a deficiency of essential nutrients, calcium or protein. It should only be considered for children under the supervision of a GP or dietitian.

With good management and appropriate treatment, most people are able to control their atopic eczema.

Related topics

• Seborrhoeic dermatitis

Further information

• National Eczema Society
  0800 089 1122
  www.eczema.org
• British Association of Dermatologists
  020 7383 0266
  www.bad.org.uk

Sources

• Eczema. Skin care campaign. www.skincarecampaign.org, accessed 7 December 2007
• Eczema - atopic. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 7 December 2007
• Frequency of application of topical corticosteroids for atopic eczema. National Institute for Health and Clinical Excellence (NICE), 2004, Technology Appraisal 81. www.nice.org.uk
• Seborrhoeic dermatitis. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 7 December 2007
• Diagnosis and causes. Eczema. www.dermatology.co.uk, accessed 7 December 2007
• Atopic eczema. British Association of Dermatologists. www.bad.org.uk, aaccessed 7 December 2007
• 13.5 Preparations for eczema and psoriasis. British National Formulary. www.bnf.org.uk, accessed 7 December 2007
• Tacrolimus and pimecrolimus for atopic eczema. National Institute for Health and Clinical Excellence (NICE), 2004, Technology Appraisal 82. www.nice.org.uk
• Chinese herbs for eczema. Bandolier. www.jr2.ox.ac.uk, accessed 7 December 2007

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: May 2009