What is eczema?
Eczema is a rash caused by inflammation of the skin. Eczema is also known as dermatitis – both words mean the same thing.
There are many types of eczema. The most common type is atopic dermatitis. Other types of eczema include seborrhoeic dermatitis, contact dermatitis, discoid eczema, and nodular prurigo. There are many others.
Eczema is a chronic skin condition that can be managed effectively with the right treatment and prevention strategies. If you or a loved one is experiencing symptoms of eczema, it’s important to consult a dermatologist for an accurate diagnosis and treatment plan. With proper care, people with eczema can lead healthy, active lives free from the discomfort and frustration of eczema flare-ups.
How do I know which type of eczema I have?
Your dermatologist will take a history and examine your skin. Based on this, it will be usually possible to identify which type of eczema you have. Sometimes it is not clear-cut, and there can be overlaps. Additional tests may also be required to help make a diagnosis such as:
- Blood tests
- A skin biopsy
- Allergy tests such as patch testing
Atopic dermatitis
Atopic dermatitis is a chronic skin condition that affects 1 in 5 children and 1 in 10 adults in the UK. Atopic dermatitis is characterized by red, itchy, and inflamed patches of skin. These may occur on the face and creases of the arms and legs. They can occur anywhere on the skin.
Eczema can be a frustrating and uncomfortable condition, and while it cannot be cured, it can be managed effectively with proper treatment. This article will discuss the causes, symptoms, and treatment options for eczema.
Seborrhoeic dermatitis
Seborrhoeic dermatitis can cause cradle cap, scaly scalps, flaking and itching on the face and central chest and back. Seborrhoeic dermatitis can affect other parts of the body too.
The exact cause of seborrheic dermatitis is not known, but it is thought to be related to the overgrowth of a yeast called Malassezia on the skin. Other factors that may contribute to the development of seborrheic dermatitis include stress, hormonal changes, weather changes, and certain medical conditions such as Parkinson’s disease and HIV.
What are the causes of eczema?
The exact cause of eczema is unknown, but it’s believed to be a combination of genetic and environmental factors. People with a family history of eczema, asthma, or allergies are more likely to develop the condition. Eczema can also be triggered by a variety of environmental factors, such as:
- Atopic eczema runs in families and is more common in those with hay fever and asthma
- Irritants: Certain chemicals, soaps, and detergents can irritate the skin and trigger eczema.
- Allergens: Allergens like pollen, dust mites, and animal dander can trigger eczema.
- Stress: Emotional stress can cause eczema to flare up.
- Temperature changes: Extreme heat or cold can trigger eczema.
- Hormonal changes: Hormonal changes during pregnancy or menstruation can cause eczema to flare up as can menopause and perimenopause.
What are the symptoms of Eczema?
The symptoms of eczema can vary from person to person, but common symptoms include:
- Red, inflamed skin: Eczema can cause red, inflamed patches of skin that may be itchy and painful.
- Dry, scaly skin: Eczema can cause the skin to become dry, scaly, and cracked.
- Itching: Eczema is often accompanied by intense itching, which can make the condition worse.
- Blistering: In severe cases, eczema can cause blisters to form on the skin.
- Darkening or lightening of the skin: Prolonged eczema can cause the skin to become darker or paler in colour.
Treatment Options for Eczema
There is no cure for eczema, but it can be managed effectively with the right treatment. A dermatologist can recommend a variety of treatment options based on the severity of the condition. Treatment is personalised to the individual, their age, lifestyle and the type of eczema they have.
- Moisturisers. Using moisturizers regularly can help keep the skin hydrated and prevent eczema flare-ups. Look for moisturizers that are fragrance-free and hypoallergenic.
- Topical Steroids: Topical steroids can help reduce inflammation and itching caused by eczema. These creams and ointments are available in different strengths and should be used as directed by a dermatologist. When used under supervision the risks of side effects and withdrawal flares are reduced significantly.
- Topical Calcineurin Inhibitors: These medications can also help reduce inflammation and itching caused by eczema. They are often prescribed for people with moderate to severe eczema.
- Anti Yeast medications may be suggested for seborrhoeic dermatitis.
- Oral Medications: In severe cases, a dermatologist may prescribe oral medications like oral steroids to help reduce inflammation and itching caused by eczema.
- Light Therapy: Light therapy involves exposing the skin to ultraviolet light to reduce inflammation and itching caused by eczema.
- Wet Wraps: Wet wraps involve applying a moisturizer to the skin and wrapping it in wet bandages. This can help reduce itching and inflammation caused by eczema.
- Antihistamines: Antihistamines can help relieve itching caused by eczema. They are available over-the-counter and by prescription.
- Immunosuppressant medications: These medications work by suppressing the immune system and reducing inflammation. They are often prescribed for people with severe eczema. Examples include Methotrexate and Ciclosporin.
- Biological therapies for atopic eczema. Antibodies given by injection can dampen specific parts of the immune system responsible for eczema and this can help dramatically control inflammation. In the UK, Dipulimab is licensed for atopic dermatitis. This injection is given every 2 weeks.
- JAK inhibitors for atopic eczema which also dampen a specific pathway of the immune system that causes inflammation have also been licensed in the UK for treating atopic eczema.
Preventing eczema
Preventing eczema flare-ups is an important part of managing the condition. Here are some tips to prevent eczema:
- Moisturise. Keeping the skin well-moisturised can help prevent eczema flare-ups. Use a fragrance-free, hypoallergenic moisturizer on a regular basis.
- Avoid Triggers. Avoiding triggers that can cause eczema flare-ups is key to preventing the condition. Common triggers include harsh chemicals, certain fabrics, extreme temperatures, dust, pets and stress.
- Use Gentle Soaps and Detergents. Using gentle soaps and detergents can help prevent eczema flare-ups. Look for products that are fragrance-free and hypoallergenic.
- Keep Skin Cool. Overheating can trigger eczema, so it’s important to keep the skin cool. Avoid hot showers or baths, and dress in lightweight, breathable clothing.
- Identify Food Triggers. Some people with eczema have food triggers that can cause flare-ups. Keeping a food diary and working with a dermatologist or allergist can help identify these triggers.
- Manage Stress. Stress can cause eczema to flare up, so managing stress is important. Practice stress-reducing activities like meditation, yoga, or deep breathing exercises.
- Avoid Scratching. Scratching can make eczema worse, so it’s important to avoid scratching the affected areas. Keep nails short and consider wearing gloves at night to prevent scratching.
- Get Enough Sleep. Lack of sleep can cause eczema flare-ups, so it’s important to get enough sleep each night. Aim for at least seven hours of sleep each night.
- Optimise hormones. Consider replacing oestrogen if you are perimenopausal or menopausal.
Tests for eczema
Patch Test
A patch test is another type of allergy testing that may be used in eczema. It involves applying a patch containing a small amount of allergen extract to the skin, usually on the back. It is typically used to test for contact allergens, such as metals, fragrances, cosmetics, hair dye, and preservatives.
The patch is left on for 48-72 hours, and the patient is instructed to avoid showering or bathing during this time.
If the patient is allergic to the allergen, a reaction will occur within 48-72 hours. The reaction may include redness, itching, or blistering of the skin.
You will be referred to a patch-testing specialist if this is required.
Avoiding identified allergens can help control eczema.
Blood Tests to identify allergies.
You may also require a blood test for allergy. A blood test, also known as a radioallergosorbent test (RAST), is a type of allergy testing that involves drawing blood from the patient and measuring the level of IgE antibodies in the blood. IgE antibodies are produced by the immune system in response to an allergen.
A high level of IgE antibodies in the blood may indicate an allergy to a specific allergen. Blood testing may be used to test for a wide range of allergens, including food allergens, pollen, and pet dander.
Elimination Diet
An elimination diet is a type of allergy testing that involves removing certain foods from the patient’s diet for a period of time and then reintroducing them one at a time to see if they cause a reaction. This type of testing is typically done in cases where food allergies are suspected.
Elimination diets are typically supervised by a dietitian, as they can be difficult to follow and may lead to nutritional deficiencies if not done correctly.
When should you see a Dermatologist for eczema?
A dermatologist is the ideal person to manage eczema, whether it is mild or severe. You should see a Dermatologist if
- You are unsure if you have eczema
- You are unable to control eczema with over-the-counter products or treatments from your GP
- Your eczema is causing impairment to your quality of life and interfering with work, school or relationships
- You are not sure what you should be using
- You would like to discuss alternative management for your eczema, or would like a second opinion
How to see a Dermatologist for eczema
If you or your child has eczema, and you would like diagnosis and treatment, then please see one of our Dermatologists, who will be happy to help. You can make an appointment here.
Additional reading
Further information on dermatitis can be found here:
