Atopic dermatitis, more commonly known as eczema, is a chronic inflammatory skin condition. It often presents as dry, itchy and reddened skin (Better Health Channel 2020).
The exact cause of eczema is largely unknown. However, it appears that those with a family history of allergy are more likely to develop eczema (ASCIA 2022).
What Is Eczema?
Eczema causes a person’s skin to not retain moisture well. Therefore, the skin is prone to dryness and is more open to allergens and irritants. If the person then scratches their skin, it can become even itchier. This is called the ‘itch-scratch cycle’. It can cause discomfort and may disrupt sleep and impact quality of life (ASCIA 2022).
People who have eczema often find that there are periods during which it’s more manageable and times when it’s less - the less manageable periods are known as flare-ups (NHS 2019).
Flare-ups can be triggered by environmental irritants, certain fabrics, heat and, in some cases, particular foods (Better Health Channel 2020).
Managing eczema usually involves general skin care strategies as well as prescription treatments. While eczema is manageable, the effects of this condition on people should not be underestimated. Eczema can have a profound impact on everyday life, particularly on physical and mental health. It’s worth noting that eczema is not contagious (Better Health Channel 2020).
Why Does Eczema Occur?
The exact cause of eczema is not known, but it’s thought to be a combination of environmental triggers and genetic factors. People who have eczema have an overactive immune system that produces inflammation when triggered by a substance inside or outside of the body (National Eczema Association 2022). A person is more likely to develop eczema if they have a family history of eczema or allergic conditions, such as allergic rhinitis (hay fever) or asthma (Better Health Channel 2020).
It’s speculated that in most cases, eczema is not affected or aggravated by diet. Advise patients to consult a doctor or dietitian for proper allergy testing and dietary advice if they think a certain food is to blame (Better Health Channel 2020).
Eczema Facts
A vast number of people who have eczema have co-occurring allergies. These often include hay fever, asthma, food allergies or dust mite allergies.
According to studies, up to 30% of infants with eczema who have a family history of allergies will develop a food allergy. Up to 40% will develop hay fever and/or asthma (ASCIA 2022).
Eczema Throughout Life
Types of eczema are generally divided by stage of life (note, however, that eczema can affect people of any age). There are three main stages:
Infantile eczema affects about 20% of children under the age of two, usually within the first six months of life. It usually improves between the ages of two and five.
Childhood eczema occurs between the ages of two and four, or can follow infantile eczema. It commonly causes rashes in the elbow creases, behind the knees, across the ankles, and sometimes on the face, ears and neck.
Adult eczema is similar to childhood eczema. It often improves in midlife and is uncommon in older adults.
(ASCIA 2022)
Symptoms of Eczema
Dry skin
Itchiness
Red, scaly and inflamed skin
Weeping on the affected area
Lesions
Changes in the colour of skin, such as skin appearing lighter (hypopigmentation) or darker (hyperpigmentation).
(Better Health Channel 2020; Healthy WA 2014)
Managing Eczema
Good Hygiene
People with eczema are particularly vulnerable to infection from pathogens such as Staphylococcus aureus and herpes simplex, leading to skin conditions such as impetigo, cold sores and warts (ASCIA 2022; Better Health Channel 2020).
Suggestions for washing are:
Take lukewarm showers or baths, avoiding very hot water
Use soap-free washing products designed for people with eczema or sensitive skin
Bath oils may help to moisturise the skin while bathing
Pat dry skin after bathing, rather than rubbing or wiping dry.
(ASCIA 2022; Better Health Channel 2020)
Reduce Irritants
Avoid overheating the skin. Wear layers of clothes that can be removed as opposed to one very heavy layer
Avoid overly heated rooms
Avoid perfumed products, make-up and fragranced skin lotions
Opt for soft, smooth materials next to the skin. For example, wear 100% cotton rather than scratchy materials like wool, polyester or acrylic. A cotton/synthetic mix may be appropriate. Avoid frequent exposure to water, soap, grease or chemicals, as these may damage the skin’s protective barrier
Wear protective gloves when handling any chemical or detergent. Avoid swimming in chlorinated pools or moisturise well afterwards.
(ASCIA 2022; Better Health Channel 2020)
Avoid Drastic Changes in Temperature
During winter, try not to overheat the house. Dress warmly when outdoors and remove layers when in a heated environment
During summer, don’t over-cool the house. Air conditioners can dry out the air and irritate the skin
Avoid intense physical activity in very hot weather. For example, exercise either first thing in the morning or in the evening when the sun is lower.
(Better Health Channel 2020)
General Tips for Eczema Management
Control the urge to itch
Keep fingernails short so if a person does scratch, it will cause less aggravation
Use cold compresses and wet wraps to control the itch. Non-drowsy antihistamines may also reduce symptoms
Moisturise very regularly
Emollients (moisturising treatments) should be used frequently. Creams, ointments and topical corticosteroids prescribed by a healthcare professional to reduce symptoms during flare-ups may also help
Responding to Infections:
Antibiotics may be recommended if recurrent infection occurs
In some cases, people with eczema need to treat infections as they occur, while others may require long term prevention strategies.
(Better Health Channel 2020; ASCIA 2022; Healthdirect 2022)
Conclusion
While eczema is a condition with no cure, it is mostly manageable. Many people find that it improves naturally with age (Healthy WA 2014). It’s important to know and respond to triggers of eczema - a general practitioner or specialist can help patients to devise a plan catered to their eczema.