return to top
Known Causes
The causes of eczema are many and varied, and depend on the particular
type of eczema that a person has. Atopic eczema is thought to be a
hereditary condition, being genetically linked. It is proposed that people
with atopic eczema are sensitive to allergens in the environment which are
harmless to others. In atopy there is an excessive reaction by the immune
system producing inflamed, irritated and sore skin. Associated atopic
conditions include asthma and hayfever. Other types of eczema are caused
by irritants such as chemicals and detergents, allergens such as nickel,
and yeast growths. In later years eczema can be caused by a blood
circulatory problems in the legs. The causes of certain types of eczema
remain to be explained, though links with environmental factors and stress
are being explored.
return to top
Types of
Eczema
There are several different types of eczema, many of which look
similar but have very different causes and treatments. The first step in
effective treatment of eczema is a correct diagnosis. It is very important
to see a general practitioner in the first instance, who may make a
referral to a specialist dermatologist for further diagnosis and
treatment.
Atopic eczema: - Atopic eczema is the
commonest form of eczema and is closely linked with asthma and hayfever.
It can affect both children and adults, usually running in families. One
of the most common symptoms of atopic eczema is its itchiness (or pruritis),
which can be almost unbearable. Other symptoms include overall dryness of
the skin, redness and inflammation. Constant scratching can also cause the
skin to split, leaving it prone to infection. In infected eczema the skin
may crack and weep (‘wet’ eczema). Treatments include emollients to
maintain skin hydration and steroids to reduce inflammation.
Allergic contact dermatitis: - Develops
when the body’s immune system reacts against a substance in contact with
the skin. The allergic reaction often develops over a period of time
through repeated contact with the substance. For example, an allergic
reaction may occur to nickel, which is often found in earrings, belt
buckles and jeans buttons. Reactions can also occur after contact with
other substances such as perfumes and rubber. In order to prevent repeated
reactions it is best to prevent contact with anything that you know causes
a rash.
Irritant contact dermatitis: - This is a
type of eczema caused by frequent contact with everyday substances, such
as detergents and chemicals, which are irritating to the skin. It most
commonly occurs on the hands of adults and can be prevented by avoiding
the irritants and keeping the skin moisturised.
Infantile seborrhoeic eczema: - A
common condition affecting babies under one year old, the exact cause of
which is unknown. Also referred to as cradle cap, it usually starts on the
scalp or the nappy area and quickly spreads. Although this type of eczema
looks unpleasant, it is not sore or itchy and does not cause the baby to
feel uncomfortable or unwell. Normally this type of eczema will clear in
just a few months, though the use of moisturising creams and bath oils can
help to speed this along.
Adult seborrhoeic eczema: -
Characteristically affects adults between the ages of 20 and 40. It is
usually seen on the scalp as mild dandruff, but can spread to the face,
ears and chest. The skin becomes red, inflamed and starts to flake. The
condition is believed to be caused by a yeast growth. If the condition
becomes infected, treatment with an anti-fungal cream may be necessary.
Varicose eczema: - Varicose eczema affects
the lower legs of those in their middle to late years, being caused by
poor circulation. Commonly the skin around the ankles is affected,
becoming speckled, itchy and inflamed. Treatment is with emollients and
steroid creams. If left untreated, the skin can break down, resulting in
an ulcer.
Discoid eczema: - Is usually found in
adults and appears suddenly as a few coin shaped areas of red skin,
normally on the trunk or lower legs. They become itchy and can weep fluid.
Usually discoid eczema is treated with emollients (and steroid creams if
necessary).
return to top
Conventional
Treatment
There is currently no cure for
eczema though research continues to shed new light on the condition.
However, there are many ways to minimise the discomfort and distress which
eczema can bring, the foundation of which is an effective skin care
routine. A wide range of treatments is available, either over the counter
at the pharmacy, or on prescription from a doctor. Many complementary
therapies are available, which some people find helpful. In addition,
there are ways of minimising environmental allergens commonly found in the
home.
There are a number of ways to manage
eczema, all of which begin with an effective skin care routine. Having
access to accurate information is important as this allows the person with
eczema, or their carer, to make informed choices when managing the
condition. The following are the more commonly used treatments. Further
information on any of these can be obtained through the National Eczema
Society.
Emollients: - Emollients are necessary to
reduce water loss from the skin, preventing the dryness normally
associated with eczema. By providing a seal or barrier, the skin is less
dry, itchy and more comfortable. Emollients are safe to use as often as is
necessary and are available in various forms: ointments for very dry skin,
creams and lotions for mild to moderate or ‘wet’ eczema and gels for
eczema under hair. Some are applied directly to the skin, whilst others
are used as soap substitutes or can be added to the bath. The range of
emollients available is enormous and it may be necessary to try several
before the most suitable one is found. Testing a small amount on the skin
first is advisable, as emollients contain substances to which some people
are sensitive.
Topical steroids: - When eczema is under
control only emollients need to be used. However in flare-ups, when the
skin becomes inflamed, a steroid cream may be needed. Steroids act by
reducing inflammation and are used in most types of eczema. Topical
steroids come in four different strengths, mild, moderately potent, potent
and very potent. The strength of steroid cream that a doctor prescribes
depends on the age of the patient, the severity of the condition and, the
size of the area and part of the body to be treated. Topical steroids are
applied thinly to the affected area, as directed by the prescribing
doctor. Your eczema should be reviewed regularly if topical steroids are
being applied. It is important to use only the steroid cream prescribed
for yourself and not to lend or borrow (what may be) an unsuitable cream
from someone else. Many people have concerns regarding the use of topical
steroids and their side-effects. As long as steroids are used
appropriately and as directed by your doctor, the likelihood of side
effects is very rare. Reported side-effects have been largely due to the
use of very potent steroid preparations over long periods of time.
Oral steroids: - are sometimes prescribed
in very severe cases and usually under the direction of a consultant
dermatologist, when topical steroids have been found to be ineffective.
These can have possible side-effects and the doctor should ensure close
monitoring when prescribed.
Other treatments: - that your doctor may
discuss are anti-histamines to reduce inflammation and wet wrap bandaging
to soothe dry itchy skin. Ultra Violet light treatment and stronger
medication may be considered for very severe eczema.
return to top
