Eczema - Atopic

Eczema is a chronic skin condition that causes the skin to become itchy, reddened, dry and cracked. Atopic eczema is the most common form of eczema. Atopic refers to a lifelong tendency to allergic conditions such as asthma and hay fever.

Atopic eczema (atopic dermatitis) can affect people of all ages but is most commonly seen in children. In most cases children grow-out of Atopic eczema as they get older, however it is not possible to tell when or if this will happen in individual cases. Approximately fifty per cent of children will no longer be troubled by eczema by two years of age and eighty five per cent by five years of age.

Some people are only mildly affected and have small areas of dry skin, which are occasionally itchy. In more severe cases the skin may become cracked which causes soreness and bleeding skin.

CAUSE
The exact cause of eczema is not known. It is known that a history of eczema, asthma or hay fever in the family does increase a person's risk of developing one of these conditions.

TRIGGER FACTORS
If you and your GP are able to establish which factors trigger eczema flare-ups, you can try to avoid contact with them. It is important to be aware of the following 3 factors and remove them from your environment:

Heat: The skin of a person with eczema is very hot, and heat increases the itch. Avoid hot baths and long car trips. Dress in a couple of thin layers rather than a thick layer of clothing. A single layer can be removed in warm weather or if you are participating in physical activity. Avoid heavy bed-covers. Soft cotton or silk sheets and one thin cotton blanket are appropriate bed linen. Children with eczema are prone to frequent waking and scratching through the night. Wet dressings improve the sleep pattern of children with eczema, by keeping them cool and reducing the itch.

Dryness: The skin should be moisturised many times a day to help with this dryness. There are many things that can dry the skin like water, air-blowing heaters, cleaning agents, soap, swimming and dry winds. Your skin will be dryer in the winter as the humidity is lower and heaters are used more.

Irritation: Clothing can worsen eczema especially when it has a prickly feeling. Large fibres, especially seams, wool, stitching, tags, frills and lace edges will make you feel itchier. Small cotton or silk fibres are the fabrics of choice for clothing or bed linen.

SIGNS AND SYMPTOMS
Eczema is a red, hot, dry and itchy rash that can affect one or many areas on the face and body and it can be mild, moderate or severe.
Atopic eczema can cause your skin to become:
• Dry,
• Itchy,
• Red,
• Broken,
• Thickened and cracked.

During a flare-up, your skin may be extremely itchy, red, hot, dry and scaly, wet, weeping and swollen, and infected with bacteria (usually staphylococcus).

Children
When the rash begins in the first few months of life it normally affects the face. The cheeks and chin become red, dry, hot and itchy. This is made worse by dribbling, hands touching the face and mouth and saliva irritating the skin. At this age eczema may also affect the trunk and limbs, but less severely. As the child develops, the eczema is less likely to affect the face and more likely to be present on the limbs and trunk. The nappy area is not usually affected. When the child becomes school-aged the eczema tends to affect the hot areas of the body, such as the skin creases of the neck, elbows, knees and buttocks.

TREATMENT OPTIONS
As with all conditions your Doctor should be consulted for the diagnosis and treatment of this condition. People with severe eczema often find that it has a significant impact on their daily lives. Unfortunately there is no cure for eczema, although there are many ways to keep it under control. Atopic eczema can cause a child to scratch their skin because of the itch. These areas may become infected with bacteria and this can worsen the eczema. If there is an infection, your child may need a course of oral antibiotics. In some severe cases of Atopic eczema, your GP may refer you to a Dermatologist (a specialist in treating skin conditions) for assessment and treatment.

Emollients are substances that help to soften and smooth your skin in order to keep it supple and moist. They are also used instead of soap. This is one of the most important forms of Atopic eczema management. It is important to keep the skin moisturised to prevent dryness, cracking and further irritation. Your GP will recommend the most suitable types of emollient for your individual needs.

A topical corticosteroid (one that is applied directly to your skin) may be prescribed by your GP in more severe cases of Atopic eczema and for flare-ups of the condition. Corticosteroids work by quickly reducing inflammation. When used correctly, corticosteroids are safe and effective.

Antihistamines help to reduce the symptoms caused by allergies e.g. sneezing, watery eyes and itching. Antihistamines can either be sedating or non-sedating. Sedating anti-histamines can make people feel drowsy. They are normally prescribed during an eczema flare-up to help ease itchiness at night, helping you or your child to get a good night's sleep. Sedating antihistamines are prescribed on a short-term basis, usually for a maximum of two weeks at a time. Sedating antihistamines should NOT be given to children under two years of age.

Wet dressings are important for the effective management of eczema. Wet dressings are essential when your child is itchy and hot and if they are waking from the itch. Your child may need a wet dressing if they itch and scratch during the night, if there is blood in the sheets in the morning, and if the eczema is still present despite treatment with topical corticosteroids, moisturisers and bath oils.

DIET HINTS
If you or your child has Atopic eczema, it is advisable to consult your GP before making any significant dietary changes. Your GP may refer you to a Dietician for specialist advice. Some foods, such as milk, eggs and nuts, have been shown to trigger eczema symptoms. If you are breastfeeding a baby who has atopic eczema, it is advisable to seek medical advice before making any changes to your regular diet.

VITAMINS/MINERALS/HERBS
Always consult your Doctor before taking any vitamins, minerals or herbs for advice on any possible side effects and drug interactions.
• Supplementation with essential fatty acids can help to alleviate the symptoms of atopic eczema by relieving inflammation.
• The probiotic supplements Lactobacillus GG and Bifidus, taken by children and breastfeeding mothers, may help to reduce the severity of Atopic eczema

PHARMACIST'S ADVICE
Ask your MedAux Pharmacist for advice.
1. Avoid using soap where possible and use emollients to cleanse and combat dry skin. Ask your Pharmacist for advice.
2. Normal shampoos can be replaced with a soap-free cleanser.
3. Keep the skin cool and well moisturised to help reduce severity of symptoms.
4. A warm (not hot) bath containing lubricating oils may help to relieve dry skin.
5. Avoid bathing or showering in very hot water as heat can aggravate eczema.
6. Wet dressings can provide relief to itching, dry skin. Dip a non-irritating cloth into cold water, wring out excess fluid and apply to the itchy area for 15-20 minutes. The cloth may be rewetted as often as needed. Ask your Pharmacist to recommend a suitable cloth
7. Avoid irritants such as woollen clothing, chemicals, detergents, cosmetics etc. If the diet is inadequate, some dietary supplements might be considered. Ask your Pharmacist for advice on dosages and interactions.