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What is Eczema?
Eczema is a term used to describe itchy, red inflammation of the skin with oozing of fluid and crusting, which doctors also describe as atopic dermatitis. People who have eczema usually have a family history of asthma, hay fever and atopic dermatitis (eczema). Some people who have eczema also have asthma or hay fever.
What Does Eczema Look Like?
Babies with eczema may have dry skin from early infancy. Dryness is a very common feature of skin with eczema. Over the next few months redness, oozing and crusting and signs of scratching develop followed by thickening, and sometimes cracking, of the skin. Babies often have involvement of the face but older children often have involvement of the elbow and knee folds, wrists and ankles, and it may even be generalised.
  
What Causes Eczema?
Eczema is an inherited disease in which part of the immune system is over active. People with eczema can be shown to have multiple allergies on skin and prick testing, particularly to house dust mite, pollens and certain foods. These allergies are also commonly seen with asthma and hay fever but their exact role, if any, in producing eczema is not yet known. Similarly the role of dietary allergies is doubtful but certain foods may aggravate eczema in younger children. Eczema is not infectious and cannot be spread to other people.
What Things make Eczema Worse?
This will vary from person to person but frequent causes of worsening of eczema include woolen or fibrous clothing next to the skin, overheating, excessive drying out of the skin, dry heating and, if you are allergic to them, excessive exposure to house dust mite and exposure to the fur of cats and dogs. Possibly it will flare if you are stressed or exposed to cigarette smoke. Secondary infection with staph bacteria or herpes virus also worsens eczema as does rubbing and scratching.
What Simple Treatments are Helpful?
Avoidance of known precipitating factors e.g.: house dust mite. The regular use of a moisturising preparation, which should also be applied after a bath or a shower, is a must. Try to pick one that feels comfortable or soothing and is not too expensive. The use of a mild soap for washing of soiled areas and use of a bath oil is frequently recommended.
Common treatments prescribed by your doctor may include corticosteroid (cortisone) cream which helps reduce inflammation and break the itch/scratch cycle. Your doctor may also prescribe tar based creams and special types of “prescription only” moisturisers. A new type of non-steroid cream called Pimecrolimus also acts to reduce inflammation and itching but without some of the side-effects of corticosteroid creams.
Aare Steroid Creams Dangerous?
If used properly as prescribed by your doctor, no. Mild steroid creams like 1% hydrocortisone can be used anywhere on the skin without risk of side effects. More potent steroid creams should be used sparingly or not at all on the face or in folds where moisture tends to increase the effects of the steroid. Sometimes exceptions need to be made so always follow the instructions of your doctor.
What about Alternative Therapies?
Many alternative health practitioners offer therapy for eczema. There is limited research indicating whether these treatments are helpful and which treatments are reasonable to try. Many of these treatments are totally unproven. Some of the herbal creams could cause allergic skin rashes and the safety of some preparations is questionable. Solarium treatments are also not shown to significantly help eczema.
What Complications are There?
Firstly the eczema may become so extensive so that it cannot be controlled by just applying creams. Other treatments may need to be used, including tablets and ultraviolet light therapy (phototherapy) might need to be considered. Sometimes creams need to be used under wet dressings. Secondly the eczema may become infected with either staph or herpes virus, and both of these can be effectively treated.
What if These Treatments Fail?
In severe cases a number of treatments with increased risk of side effects including phototherapy, Cyclosporin, Azathioprine or oral steroids can be used. These would only be used for limited periods. Sometimes hospitalisation is needed to carry out the wet dressings intensively, have light therapy, or initiate one of the tablets mentioned.
What is the Long Term Outlook?
About 65% of children who develop eczema will have no rash by the time they become teenagers. There may be, however, persisting sensitivity of the skin to irritants. A small number of people whose eczema clears in childhood may get a further outbreak of eczema when they are adults.
What is Available for the Future?
New creams and ointments as well as tablets are being discovered all the time. As eczema is a genetic disorder, it is always possible that some day a type of gene therapy may be effective.
The photographs on this page have been reproduced with the permission of the Department of Dermatology, St Vincent's Hospital Melbourne. |
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