Eczema

Eczema is a chronic inflammatory skin condition. Eczema often presents as dry, itchy and reddened skin.

The reason why certain people develop eczema is largely unknown. It is common for people with eczema to also have other allergies (ASCIA 2019; Health Direct 2017). This suggests that genetic factors increase the likelihood of a person developing eczema (ASCIA 2019).

What Is Eczema?

In the case of eczema, a person’s skin is not retaining moisture well. This makes the skin prone to dryness, as well as making it more open to allergens and irritants. If a person then scratches the skin the skin 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 2019).

Eczema has certain triggers such as environmental irritants, certain fabrics, heat and, in some cases, particular foods, and these triggers should be avoided (Better Health Channel 2018).

People who have eczema often find that there are periods during which it is more manageable and times when it’s less - the less manageable periods are known as flare-ups (NHS 2016).

Managing eczema usually involves both general skin care strategies as well as prescription treatments. While eczema is manageable, the effect of this condition on people should not be underestimated. Eczema can have a profound effect on everyday life, particularly on physical and mental health. It is worth noting that eczema is not contagious (Better Health Channel 2018).

Why Does Eczema Occur?

The exact cause of eczema is not known, but thought to be a combination of triggers and genetic factors. People who have eczema have an over-reactive immune system, that produces inflammation when triggered by a substance inside or outside of the body (National Eczema Association n.d.). 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 2018).

It is widely speculated that eczema is not affected or aggravated by diet in most cases. 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 2018).

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, a percentage as high as 30% of infants with eczema, who have a family history of allergies, will develop a food allergy. Up to 40% will develop asthma and/or allergic rhinitis (hay fever) (Ascia 2019).

Eczema Throughout Life

Types of eczema are generally divided by stage of life. There are three main stages: Infantile eczema, childhood eczema and adult eczema. This article will provide a broad overview of eczema and offer suggestions for management of the condition (ASCIA 2019).

Symptoms of Eczema

• Dry skin;
• Itchiness;
• Red, scaly and inflamed skin;
• Weeping on the affected area;
• Lesions; and
• Changes in colour of skin, such as skin appearing lighter (hypopigmentation) or darker (hyperpigmentation).

(Better Health Channel 2018; Healthy WA n.d.)

Managing Eczema

Good Hygiene

Eczema is particularly vulnerable to infection. This means a person with eczema is at a higher risk of complications such as impetigo, cold sores, and warts (ASCIA 2019; Better Health Channel 2018). The bacterium Staphylococcus aureus may cause a secondary infection of impetigo, and possibly contribute to symptoms of eczema (Better Health Channel 2018).

Suggestions for washing:

• 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.

(Better Health Channel 2018; ASCIA 2019)

Reducing Irritants

• Avoid overheating 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, moisturise well after if swimming occurs.

(Better Health Channel 2018; ASCIA 2019)

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 2018)

General Tips for Eczema Management

• Control the urge to itch.
• Keep fingernails short so if a person does scratch they will cause less aggravation.
• Use cold compresses and wet wraps to control the itch. Non-drowsy antihistamines may also reduce symptoms.
• Moisturising 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 appears.
• In some cases, people with eczema need to treat infections as they occur, while others may require long term prevention strategies.

(Better Health Channel 2018; ASCIA 2019; Healthdirect 2017)

Conclusion

While eczema is a condition with no cure, it is mostly manageable. Many people find that it improves naturally with age (Healthy WA n.d.). It is 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.

Additional Resources

• Australasian Society of Clinical Immunology and Treatment: https://www.allergy.org.au/patients/skin-allergy/eczema

References

• Australasian Society of Clinical Immunology and Allergy (ASCIA) 2019, Eczema (Atopic Dermatitis), ASCIA, viewed 6 November 2019, https://www.allergy.org.au/patients/skin-allergy/eczema
• Better Health Channel 2018, Eczema (atopic dermatitis), Better Health Channel, viewed 6 November, https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/eczema-atopic-dermatitis
• Healthdirect 2017, Eczema, Healthdirect, viewed 6 November 2019, https://www.healthdirect.gov.au/eczema
• Healthy WA n.d., Eczema (atopic dermatitis), Healthy WA, viewed 6 November 2019, https://healthywa.wa.gov.au/Articles/A_E/Eczema-atopic-dermatitis
• National Eczema Association, Eczema Causes and Triggers, National Eczema Association, viewed 6 November 2019, https://nationaleczema.org/eczema/causes-and-triggers-of-eczema/
• National Health Service (NHS), Overview Atopic Eczema, NHS, viewed 6 November 2019 https://www.nhs.uk/conditions/atopic-eczema/

(Answers: c, b, c)