Eczema & Dermatitis

Eczema is a form of dermatitis, or inflammation of the upper layers of the skin. The term eczema is broadly applied to a range of persistent skin conditions. These include dryness and recurring skin rashes which are characterized by one or more of these symptoms: redness, swelling, itching and dryness, crusting, flaking, blistering, cracking, oozing, or bleeding.


Atopic eczema is believed to have a hereditary component, and often runs in families whose members also have hay fever and asthma. Itchy rash is particularly noticeable on face and scalp, neck, inside of elbows, behind knees, and buttocks. It is very common in developed countries, and rising. Click this link for much more information - Atopic Eczema.


Contact dermatitis is of two types: allergic (resulting from a delayed reaction to some allergen, such as poison ivy or nickel), and irritant (resulting from direct reaction to a solvent, such as sodium lauryl sulfate, for example). Some substances act both as allergen and irritant (wet cement, for example).Click this link for much more information - Contact dermatitis.

About three quarters of cases of contact dermatitis are of the irritant type, which is the most common occupational skin disease. Contact eczema is curable provided the offending substance can be avoided, and its traces removed from one's environment. Atopic eczema is not curable and sufferers will have flare-ups with varying degrees of frequency.

Treatment

Dermatitis is often treated by corticosteroid ointments, creams or lotions. They are highly effective in controlling or suppressing symptoms (redness and itching) in most cases.

For mild-moderate eczema a weak steroid may be used like hydrocortisone 1% cream which can be used for adults and children over 10 years, whilst more severe cases require a higher-potency steroid e.g. eumovate cream for adults and children over 12 years.
Side effects:
Prolonged use of topical corticosteroids is thought to increase the risk of possible side effects, the most common of which is the skin becoming thin and fragile (atrophy). Because of this, it should not be used on the face or other delicate skin unless advised by a doctor and should not be used for more than 7 days unless advised by a doctor.

Anti-itch drugs, like antihistamines, may reduce the itch during a flare up of eczema, and the reduced scratching in turn reduces damage and irritation to the skin (the Itch cycle).

Moisturizing
Eczema can be made worse by dryness of the skin. Moisturizing is one of the most important self-care treatments for sufferers of eczema. Keeping the affected area moistened can promote skin healing and relief of symptoms.

Soaps and harsh detergents should not be used on affected skin because they can strip natural skin oils and lead to excessive dryness. Instead, the use of moisturizing body wash, or an emollient like aqueous cream, will maintain natural skin oils and may reduce some of the need to moisturize the skin. Another option is to try bathing using colloidal oatmeal bath treatments like Aveeno.

In addition to avoiding soap, other products that may dry the skin such as powders or perfume should also be avoided.

Moistening agents are called 'emollients'. In general, it is best to match thicker ointments to the driest, flakiest skin. Light emollients like aqueous cream may not have any effect on severely dry skin. Some common emollients for the relief of eczema include Oilatum, Balneum, Diprobase, bath oils and aqueous cream. Epaderm ointment and Eucerin lotion or cream may also be helpful with itching. Lotions or creams may be applied directly to the skin after bathing to lock in moisture. Moisturizing gloves (gloves which keep emollients in contact with skin on the hands) can be worn while sleeping. Generally, twice-daily applications of emollients work best. While creams are easy to apply, they are quickly absorbed into the skin, and therefore need frequent reapplication. Ointments, with less water content, stay on the skin for longer and need fewer applications, but they can be greasy and inconvenient and can stain clothing.

The first and primary recommendation is that people suffering from eczema shouldn't use detergents of any kind on their skin unless absolutely necessary. Eczema sufferers can reduce itching by using cleansers only when water is not sufficient to remove dirt from skin.

Detergents, often made from petrochemicals, increase the permeability of skin membranes in a way that soaps and water alone do not. Sodium lauryl sulfate, the most common household detergent, has been shown to amplify the allergenicity of other substances ("increase antigen penetration").

Options in choosing a soap generally include:

Avoid harsh detergents or drying soaps:

Choose a soap that has an oil or fat base; a "superfatted" goat milk soap is best .
Use an unscented soap .
Patch test your soap choice, by using it only on a small area until you are sure of its results.

Use a non-soap based cleanser like aqueous cream
Use plain yogurt instead of soap
Instructions for using soap:

Use soap sparingly:

Avoid using washcloths, sponges, or loofahs, or anything that will abrade the skin.

Use soap only on areas where it is necessary
Soap up only at the very end of your bath
Use a fragrance-free barrier-type moisturizer such as petroleum jelly before drying off
Use care when selecting lotion, soap, or perfumes to avoid suspected allergens; ask your pharmacist or doctor for recommendations
Never rub your skin dry, or else your skin's oil/moisture will be on the towel and not your body; pat dry instead.

Summary:

Avoid soaps. Use Aqueous Cream as a soap substitute. Moisturise skin twice daily with a suitable moisturiser. Treat flare-ups (redness and itching) with hydrocortisone cream or Eumovate Cream. Consult your doctor periodically.

For your safety:

If your symptoms persist or are not controlled by over the counter medication then consult your pharmacist or doctor.

For much more information click Eczema or go to NHSDirect at www.nhs.uk

This page was last updated: Monday 25 September, 2017