What is eczema?
Atopic dermatitis (commonly known as eczema) is an inherited, chronic inflammatory skin condition that effects one in three Australians at some time during their lives. Patches of skin become red, scaly and itchy. Sometimes, tiny blisters containing clear fluid can form and the affected areas of skin can weep. Weeping is a sign that the dermatitis has become infected, usually with the bacterium Staphylococcus aureus (‘golden staph’), however eczema is not contagious. People who have eczema have a different genetic makeup, meaning their body does not make as much of the oils and fats that are needed to protect the skin from moisture escaping and things that irritate the skin from entering.
Atopic dermatitis usually occurs in people who have an 'atopic tendency'. This means they may develop any or all of three closely linked conditions; atopic dermatitis, asthma and hay fever (allergic rhinitis). Often these conditions run within families with a parent, child or sibling also affected. A family history of asthma, eczema or hay fever is particularly useful in diagnosing atopic dermatitis in infants.
Although eczema affects all ages, it usually appears in early childhood (in babies between two-to-six months of age) and disappears around six years of age. In fact, more than half of all eczema sufferers show signs within their first 12 months of life and 20 per cent of people develop eczema before the age of five.
Most children grow out of the condition, but a small percentage may experience severe eczema into adulthood. The condition can not only affect the individual sufferer, but also their family and friends. Adult onset eczema is often very difficult to treat and may be caused by other factors such as medications.
In people with eczema the skin does not retain moisture very well, which causes it to dry out easily. This makes the skin more open to allergens and irritants. These can trigger the skin to release chemicals that make the skin itchy. Scratching itchy skin causes more chemicals to be released, making the skin feel itchier. This scratch and itch cycle can cause discomfort, disrupt sleep and affect quality of life. It is therefore important to keep skin that is prone to eczema well hydrated, by moisturising the skin every day.
Triggers
Allergens
Allergens are substances that trigger an allergic reaction, which may include sneezing, itching, watery eyes, and a stuffed or runny nose. Allergens may include dust mites, mould, grasses, plant pollens, pets.
Dust mites are one of the most common triggers. They are small, microscopic organisms which are typically found indoors (mattresses, pillows, carpet) and are typically in areas of high humidty.
Stress
While stress does not physically trigger eczema, it can worsen the itch-scratch cycle. The body releases a hormone called cortisol when it is under stress. In large doses, such as dealing with chronic and ongoing stress, cortisol increases inflammation throughout the body. This can then lead to skin inflammation and an eczema trigger or flare up. Stress can also cause habit scratching. It is thought that scratching can make the itch worse, which makes you want to scratch more. this is called the itch-scratch cycle.
Family History
A family history of eczema, asthma or hay fever (the strongest predictor). If both parents have eczema, there is an 80% chance that their children may also develop eczema
Irritants
Irritants are things that can make eczema worse. This might include soaps, bubble bath, shampoos, air conditioning, fragrances, perfumes or woollen/synthetic fabrics. These irritants can damage the protective barrier function of the skin. Once the protective barrier is lost, eczema frequently develops.
Change in weather/temperature
The change in weather can often lead to the drying out of skin, thus leading to itching. Having hot, frequent showers is also a trigger for eczema as heat can aggravate the itch and make eczema suffers more likely to scratch.
Treatment
1. Moisturise
There are multiple ways to treat and control your eczema flare ups. Using moisturisers and cortisone based ointments can help ease the symptoms, however it is also important to avoid skin irritants as well such as soap, hot water and synthetic fabrics.
Using a moisturiser (emollient) is the key to keeping your skin hydrated and less prone to flare ups. Emollients soothe and relieve the itching, producing an oily layer over the skin surface which traps water beneath it. This prevents the penetration of irritants, allergens and bacteria thereby reducing or preventing the development of eczema
Develop a good skincare routine, ensuring you are moisturising within 3 minutes of getting out of the shower to trap in the moisture. Note: Avoid having a hot shower, and opt for a lukewarm shower, towel drying, rather than rubbing at your skin. To get the most out of using emollients, apply gentle in the direction of the hair growth, as rubbing up and down may trigger itching and block hair follicles. By creating a solid skincare routine it will help to soothe, moisturise and protect the skin. Even when your eczema appears to have disappeared, continue to use in order to prevent flareups.
2. Avoid Over Heating
Where possible, avoid over heating your skin, as abrupt temperature and humidity changes can irritate the skin. For example, going in and out of air conditioned buildings on hot days or heated buildings on cold days can dry out and irritate your eczema prone skin. On warm days, limit hard physical activity or exercise that makes you sweat heavily as this can also trigger itching. Other quick tips include wearing several layers of clothing that you can remove, as required, instead of one heavy layer, don't overheat your house and avoid too many blankets on your bed.
3. Medications
There are multiple medications you may be prescribed by your doctor. Please note it is important to seek professional medical advice before using any medication - whether over the counter or prescription to determine its side-effects. Anti histamines may be prescribed to help reduce the itch and if choosing a sedating antihistamine it may induce sleep. However please note - antihistamines are not recommended, and should not be used in young children. Doctors may also prescribe topical corticosteroids to actively treat redness and inflammation. Ensure that adequate amounts are used. As a guide, one fingertip unit (FTU) is the amount of ointment from the first bend in the finger to the fingertip, which will cover an area equal to two adult hands. Steroid Creams come in different strengths, and the strength of the steroid that a Doctor prescribes depends on the age of the patient, the severity of the condition and where it is being applied on the body. As long as the steroids are used as directed by your Doctor, for a short period of time, the likelihood of side effects is very rare.
References
https://healthywa.wa.gov.au/Articles/A_E/Eczema-atopic-dermatitis
https://www.aaaai.org/conditions-and-treatments/library/allergy-library/eczema-atopic-dermatitis
https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/eczema-atopic-dermatitis
https://www.allergy.org.au/patients/skin-allergy/eczema
https://dermnetnz.org/topics/atopic-dermatitis/
https://www.eczema.org.au/eczema-facts/
https://allergyfacts.org.au/allergy-anaphylaxis/eczema-atopic-dermatitis/management
