Eczema, Adult and Paediatric
Eczema is also known as atopic eczema and atopic dermatitis. It is a chronic skin condition that results in dry skin, itching and irritated skin lesions. It usually appears before the age of 5 but can start at any age. People with eczema have a higher chance of having other atopic disorders such as asthma and hayfever.
The exact causes of eczema are not fully known but we know that the strongest risk factor is a family history of eczema or other atopy. Certain environmental factors will also increase the risk.
Eczema skin is usually dry, itchy, sometimes with red patches or thickened areas of skin from persistent scratching. Flares can be triggered by many factors, for example certain foods, changes in temperature and humidity, infections, stress and contact allergies.
The diagnosis of eczema is reached by establishing a history of the onset of skin symptoms, location of involved skin (often at skin creases), triggers, times and frequency of flares, susceptibility to skin infections and a family history of atopy. History-taking is followed by examination of the skin. Rarely are other investigations required. However, in some cases other diagnoses need to be ruled out.
Treatment of eczema is different for each individual. Central to enabling good eczema management is providing appropriate education about the condition and good communication with the family doctor or dermatologist. Education will explain what treatments are used when, what quantity is used, how to manage a flare of eczema and importantly, how to recognise when a doctor should be consulted, for example when bacterial or viral infections occur on the skin.
Central to preventing flares of eczema is the regular use of emollients to help the protective barrier of the skin and to aid the repair of this barrier when the skin is dry and itchy. Avoiding use of soap or perfumed bath or shower products is advised. Maintaining short nails in infants and children affected is important. Applying emollients after bathing particularly helps to hydrate the skin. Emollients should also be applied 2 to 3 times per day. Emollients come in creams, ointments and lotions. Ointments are lipid-rich and are beneficial for dry, thickened areas. Creams have a lower lipid content and work well on large areas of mild eczema. Lotions have a high water content, this works well on moist or oozing areas of inflammed skin.
Next step is the use of topical steroids. This treatment is also applied to the skin to manage acute flares and in some people, regular use is advised to maintain the health of the skin. The amount of steroid ointment or cream is measured in FTU or finger tip units- see www.irishskin.ie for more information on this. The relevant strength of the steroid prescribed depends on the severity of the eczema, the age of the individual and whether they have other medical conditions. When the appropriate steroid ointment or cream is used, this is a safe and highly effective treatment for eczema.
Other treatments include wet wraps, anti-inflammatory topical agents, phototherapy and in severe cases oral medicines prescribed by dermatologists.