Eczema – the painful cycle of inflammation

Eczema cannot be cured. It can be treated and managed; key to this is caring for skin and managing the cycle of inflammation. Ensure that you discuss treatment with a medical professional; it’s also a good idea to ask what they can prescribe (as this may be free or discounted) as this often includes soap replacements and moisturisers as well as treatment creams.

Moisturise

It’s important to keep skin supple and moisturised. It’s a good idea to bathe every day (as the water will help to hydrate skin) and avoid soaps and other products that will have a drying effect. I’ve heard some people find goats milk soap to be gentler than normal soap and some emollient lotions can be used as soap replacements (though you may find they do better in a shower than a bath as I’ve found they can be kind of gluggy in bath water).

It’s a good idea to moisturise every day even when eczema isn’t flared up. Be careful when selecting moisturisers as general ones often contain alcohol that can still have a drying effect. It’s a good idea to discuss options with your doctor or pharmacist, and to look for ones endorsed by an eczema association.

Also, try different ones. You might find that some work better for you than others or that you prefer the smell or texture of some over others. I have a sorbitol/glycerin cream from the doctor which is ‘fragrance free’ but which I personally think smells so bad, v.s. one from Curash which I don’t think smells at all.

First: Emollients

Emollients are basically moisturisers that are essential for increasing skin hydration and mimicking the barrier effect of the surface lipids the skin is lacking.

These should be used at least once a day at a different time to when corticosteroids are applied (as they will dilute these and prevent them from being as effective). It’s most effective to apply emollients after a warm bath or shower while skin is still damp.

Types of Emollients

From most effective to least effective.

• Ointment – This provides a ‘lock-in’ protective layer. It can leave a greasy film so is often preferred at night (over day).
• Cream –  Thinner and easier to apply. It is less effective than ointment and will need to be applied more often.
• Lotion – Has a runny consistency and is less effective again than cream.

Generally, the rougher and drier the skin is, the thicker the emollient that is required. So a lotion may be suitable when when skin is good but cream, and then ointment, as it gets worse.

Emollients are important as part of a daily routine and will help to soothe skin during a flare-up. They will not treat the inflammation and it is important that a treatment cream is also used.

Second: Corticosteroids

Topical corticosteroids (like hydrocortisone) actually treat the inflammation and help to reduce itchiness. They help to reduce blood flow in the skin and suppress over-active infection-fighting white blood cells. They imitate the effects of cortisol hormones produced naturally in the adrenal glands.

Doctors may prescribe different strength corticosteroid creams for different parts of the body (i.e. a weaker one for the face, and a stronger one for feet or hands where skin is thicker).

Additional treatments

Depending on the severity of symptoms, doctors may also discuss additional treatment options such as wet wrap, or oral anti-histamines.

There is little research supporting the effectiveness of using oral antihistamines to treat eczema but they can provide relief; for instance, night time ones can temporarily ease inflammation and also cause drowsiness.  Not only is scratching bad for the skin but chronic sleeplessness (due to lying in bed scratching) can cause a raft of flow-on troubles, especially for young children, so a night anti-histamine is something to consider discussing with your doctor.

Key source: “Eczema: The Essential Guide” by Sharon Dempsey

Eczema – Coming from Greek phrase “to bubble” or “to boil over”.

Eczema, also called ‘atopic dermatitis’, is a chronic skin condition characterised by inflamed, dry, and itchy skin which can have periods of acute flare ups. It’s one of three diseases that form the Atopic Triad; eczema, asthma, and allergic rhinitis are linked diseases which some people are genetically predisposed to develop. Eczema is not an allergy, however, it’s common for children that develop eczema to also have food allergies.

NOTE: Eczema is not a contagious disease. It’s not something that can be caught from touching, playing with, or bathing with someone that has eczema.

Eczema – Cause factors

Eczema can be maddening for those that suffer from it. Skin starts off becoming swollen, red, and bumpy. The skin becomes itchy, often intensely so, and sufferers can rub the skin raw simply because the pain is easier to tolerate than the itch. The skin can also feel hot and painful. Little water blisters can appear that will burst and weep easily if scratched. It’s important not to scratch as this will damage the skin further (easier said than done, especially for young kids!).

Skin will bleed easily because of the inflammation and scratching damages the skin cells resulting in additional blood and immune cells rushing to the area.

It’s also common for areas of skin where eczema frequently flares up to become rough, scaly, chapped, and cracked. This is because dead skin cells are shed and replaced at a faster rate than healthy skin; these dead cells often sit on the skin. These areas of skin also lose moisture more easily and as it escapes the skin dries out and cracks form.

It’s important to discuss treatment options with a medical professional; eczema requires on-going management and care for the skin.

Eczema – painful inflammation cycle

Key source: “Eczema: The Essential Guide” by Sharon Dempsey

Atopic Triad

‘Atopic’ refers to diseases that are hereditary and therefore tend to run in families; they also often occur together. It’s common for someone to have eczema, a form of allergic rhinitis (like hayfever), and asthma (though they may have these at different times of their lives); someone that is ‘atopic’ (or a family that is ‘atopic’) are also more likely to have food allergies. It’s possible to have mild cases of these diseases (like eczema) and not be atopic; it requires a doctor’s diagnosis and the demonstration of allergic antibodies.

It’s worth researching ‘atopy’ when it’s diagnosed by a doctor because it helps to have an awareness that your toddler that has eczema has a higher chance of developing asthma later in childhood (see ‘The Atopic March’).  It also means that if one parent has hayfever and another has a mild food allergy, children have a greater chance of being ‘atopic’ although they may exhibit this differently than either of their parents.

If you have suspicions of a food allergy, allergic rhinitis encompasses more than just hay fever in response to pollen. In general terms it means that an allergen has caused the inside of the nose to swell and become inflamed. This can cause cold-like symptoms, such as sneezing, itchiness, and a blocked or runny nose. Ongoing inflammation in the sinuses can also result in ‘allergy shiners‘ (like a continually bruised look beneath the eyes even if sleep hasn’t been disrupted). The problem is that under 5’s do get a let of colds and it can be hard to distinguish between an actual cold and a warning sign that there is an underlying allergy. If there’s a family history of atopic illnesses or your child has been diagnosed with other atopic illnesses (like eczema) then it’s worth reading up on the most common food allergies and discussing these with your doctor. For most children, a food allergy will result in them creating IgE antibodies which can be screened for with skin or blood testing.

Key source: “Eczema: The Essential Guide” by Sharon Dempsey