IOA :: Atopic eczema

Atopic eczema

Atopic eczema (or atopic dermatitis) is an inflammatory disease of the skin that is very common in children, but can also affect adults.

Atopic eczema is very often the first manifestation of allergy in life. The symptoms may appear in the first weeks or months of life, but the usual onset is around the age of 6 months when child is weaned.

In two out of three children with atopic eczema, it disappears or becomes very mild after the age of 6-10 years. In most children, food allergies to milk and eggs remit by the age of 6, although allergies to nuts and fish tend to persist.

A relationship was noticed between development of atopic eczema early in life and other allergic diseases (particularly asthma) in the following years. However, the relationship is complex. It appears that the risk of developing other allergic diseases later in life is higher in children who have persistent food allergy and develop allergy to inhaled allergens such as house dust mite, pollen or animal allergens.

Atopic eczema can present differently at different ages. Acute and chronic eczema can have a different appearance. Sometimes urticaria precedes acute eczema.

The most constant and important symptom of atopic eczema is itching. This symptom seems to be associated with a dry skin and it is considered that scratching it induces contributes to the other symptoms of acute eczema.

During eczema flare-ups, the skin is extremely itchy; becoming inflamed and red. Usually, small watery blisters develop on the affected areas. When scratched, the blisters break-open leaving the skin weepy and wet.

In areas of the skin which are chronically affected by eczema, the skin becomes thickened with skin marks more prominent in response to scratching.

Any part of the skin can be affected by eczema but some specific regions are typical at certain ages:

In infants, the face and the scalp are primarily affected, but the rest of the body can also be involved. Characteristically, the diaper (or nappy) area is spared.
In older children and adults, facial eczema often becomes restricted to areas around the eyes and mouth. Also, the skin folds of the arms and legs (such as the arm fold, around the wrists, behind the knees) become typical sites of eczema involvement.

Eczema has an unpredictable evolution with periods of flare-up and periods of remission.

External factors that irritate the skin can trigger the flare-ups or aggravate the course of the disease: heat or cold; soaps (particularly those that cause extensive skin drying); detergents, perspiration; chemical substances; and rough clothes that rub the skin (such as woollen clothes). Stress is also an important aggravating factor.

Treating eczema is not easy. The measures below can help you to control your eczema (they are additional measures to the treatment recommended by your doctor).

Remember that the treatment of eczema is long term and the results you hope for do not come overnight. Don’t get disappointed too easily and don’t change your doctor every few days!

Atopic eczema is not always atopic

Very often, children with atopic eczema are also allergic, particularly to food allergens, or have allergies running in their families. However, sometimes eczema can occur in the absence of allergy. There appears to be a lack of “cement” between the skin cells, allowing external substances to penetrate and irritate the skin in both types.

Atopic eczema can disappear, but dry skin is for ever!

Usually children with atopic eczema have dry skin which is more irritable and seems to be more itchy than a normally hydrated skin.

People who have suffered from eczema as children, continue to have dry and sensitive skin even when the eczema symptoms have completely remitted. Their skin will need special attention with regular moisturizers for the rest of their lives.

It’s not a bad child - it’s an itching child!

The itch in atopic dermatitis can be very severe and difficult to deal with. If your child is irritable and bad tempered it might be because his/her skin is itching too much. Also, itch is often aggravated during the night, keeping your child awake and preventing him/her having a calm, refreshing sleep. This will make your child tired, irritable and lead to poor concentration during the day.

So, before you lose your temper with your child, make sure that you have done everything you can to help him/her through his/her itchy problem.

Sometimes the eczema can return after years of complete remission of symptoms.

Every little helps

Moisturise your skin several times daily. Use a moisturiser specially developed for allergic skin or a non-perfumed moisturiser.

Avoid scratching your skin when itchy; tapping it is better. Also, wet dressings or a lukewarm shower may help.

Bathing

A 10 minute bath daily helps to hydrate your skin. Don’t make it longer or it will have the opposite effect!

You can add bath oil to the water.

Take lukewarm baths (hot water makes the eczema worse).

Avoid soap, use an alternative such as a water- based cream.

Dry the skin by pressing the towel gently against it, do not rub your skin.

Apply a moisturiser as soon as your skin is dry (ideally in the first 5 minutes after getting out of the bath).

Clothing

Don’t use clothes that make you sweat as perspiration irritates the skin.

Don’t wear woollen clothing directly on the skin as it is rough and irritates the skin.

Wear cotton underclothing (if possible with long sleeve and legs).

Wash new clothing before wearing it for the first time. It removes the irritant chemical substances which are used for treating the textile fibres (such as formaldehyde).

Use mild detergents, preferably in a liquid formulation without enzymes to wash your clothes.

Always give an extra rinse when you wash your clothes. Avoid fabric softeners.

Pyjamas containing silver can help to prevent skin infection which exacerbates eczema. These pyjamas are interwoven with threads of real silver, a substance which has been used since Egyptian times to fight infections.

Keep children’s nails short and consider using cotton mittens for babies who scratch at night.

Leisure and eczema

Swimming is a good sport (provided that you don’t stay in the water too long). Remember that chlorine in the water can irritate your skin. Therefore, wash thoroughly with mild soap and apply a moisturizer immediately after getting out of the swimming pool.

Sunbathing can be helpful. However, use high protection factor sunscreens to prevent sunburn. And don’t stay in the sun too long – it can accentuate the dryness of your skin and make you sweat.

Protect your skin from cold weather.

Try to reduce your stress. It can have miraculous effects!