Scratch that itch – Diagnosing and managing eczema

mother applying antiallergic cream at baby neck with skin rash and allergy with red spot cause by mosquito bite

Eczema is a general term for a red, scaly and often itchy skin rash. In severe cases the skin can ‘weep’, with small fluid-filled sacs and crusts forming, whilst other sufferers may have dry, cracked skin that has thickened over time. Eczema can be a real nuisance, affecting everyone from babies right through to their mums – and beyond.

Here Dr Nilesh Morar, a Consultant Dermatologist at Bupa Cromwell Hospital, explains the various types of eczema you can get and looks at how the condition can be managed, whatever your age or skin type.

The first thing a doctor will do when assessing eczema is to establish if it has been caused by internal factors such as diet, genetic factors or by an external trigger such as a reaction to a product that has been applied to the skin.

‘Atopic’ eczema is the most common form linked to internal factors, affecting up to 20% of children. It often begins in the first few months of life in the folds of the skin and face, although any part of the skin can be affected. Atopic eczema may be associated with asthma and hay fever. It is caused by genetic defects in the skin barrier function, which leads to greater loss of water through the skin, and hence dry skin that can then become inflamed.
Babies can also get ‘cradle cap’ soon after birth, which is the same form of eczema that presents in adults as dandruff or scaling around the eyebrows. This usually clears up after six months of age.

Children under two can also have eczema triggered by food allergies (which can be diagnosed by blood and skin prick tests), but in most children the eczema improves over time. Some adults get eczema that appears as itchy blisters on the palms of the hands and soles of the feet (especially in hot, humid countries), or as round itchy areas on the upper or lower limbs.

Eczema can also occur due to varicose veins on the shins, and older people may develop it due to having less fat in the skin barrier. Eczemas caused by external factors are either due to a contact dermatitis (a reaction to something external applied on the skin to which one
becomes allergic), or to an irritant contact dermatitis. The latter happens when harsh chemicals like acids are applied to the skin.

So how do you best manage eczema?

Looking after your skin barrier is crucial:

• MOISTURISE twice-daily (at least!) with an eczema specific moisturiser
• REPLACE soap with a less drying equivalent
• PAMPER yourself with daily baths using essential oils and lukewarm water
• TREAT infections as soon as possible
•  HOOVER carpets (to lose the dust mites!) and wash bed sheets regularly

Other treatments include:
•  STEROID creams to ease active eczema until it settles
• NON-STEROID anti-inflammatory creams to help prevent flare-ups
• BLOOD TESTS, skin swabs and patch tests
•  ULTRAVIOLET light for severe eczema
• TABLETS for severe eczema

Eczema is extremely common and can be effectively treated and managed, so if you areconcerned about yourself or your child, a GP will be able to set you on the right track.

If you would like to see a Consultant Dermatologist at Bupa Cromwell Hospital, please call 020 7460 5700 or email appointments.team@cromwellhospital.com
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