Overview
Eczema, or atopic dermatitis, is a long-lasting condition in which the skin becomes dry, itchy and inflamed. The outer layer does not hold water well or keep irritants out, and the immune system reacts more strongly than it needs to.
It usually begins in babies and young children, but it can start at any age. It comes in flare-ups with quieter spells between, and it cannot be cured, though it can be controlled well.
Symptoms
The itch is the main symptom and it is often worse at night. Affected skin may be dry, cracked, scaly or thickened from rubbing, and darker, lighter, redder, purple or grey than the skin around it. Scratched areas may weep, blister or bleed.
In babies it often affects the face and scalp; in older children the creases of the elbows and knees; in teenagers and adults the hands, neck and eyelids.
When to see a doctor
See a doctor within a few days if the eczema is not settling with the usual creams, if the itch disturbs sleep, if patches are oozing or crusty, or if a new rash follows a change of cream, soap or detergent.
Causes
There is no single cause. Inherited differences in the proteins that build the skin barrier, together with an immune system that inflames easily, leave the skin dry and reactive. Something in the surroundings then sets off a flare.
Common triggers are soaps and detergents, wool and rough fabrics, heat, sweat, dust mites, pollen, pets, tobacco smoke, skin infections and stress. They differ from person to person.
Risk factors
- A parent, brother or sister with eczema
- A family history of asthma or hay fever
- Starting in infancy or early childhood
- Dry skin, and dry or dusty surroundings
- Frequent contact with soaps, detergents or water at work
Complications
Scratching broken skin lets bacteria in, so infected eczema is the commonest complication. The cold sore virus can also spread across eczema and cause a painful, rapidly spreading rash of blistered sores that needs urgent treatment.
Constant itch disturbs sleep and concentration, and skin rubbed for years grows thick and leathery.
Prevention
Eczema cannot be prevented, but flare-ups can be made fewer:
- Apply moisturiser at least twice a day, and again after washing
- Wash with a soap substitute rather than soap
- Keep baths short and lukewarm, and pat the skin dry
- Choose soft cotton clothes and rinse laundry well
- Keep nails short, and use mittens for a baby who scratches in sleep
Diagnosis
Eczema is usually diagnosed by looking at the skin and asking where the rash sits, how long it has been there, what makes it worse, and whether asthma or hay fever run in the family.
Tests are rarely needed. Allergy or blood tests are used when another cause is suspected, and a swab may be sent if the skin looks infected.
Treatment
Treatment has two parts: moisturisers every day to keep the skin barrier working, and something stronger to calm a flare-up.
For flares, doctors prescribe creams or ointments that reduce inflammation. Steroid creams are the usual first choice, matched in strength to the skin and the site, and non-steroid creams are used on delicate areas such as the face and eyelids. Dressings and wet wraps may be added.
Infected skin is treated with or antiviral medicines. Severe eczema may be referred for light treatment or for medicines that damp down the immune system, including newer injected medicines.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Eczema is catching, so the child should be kept away from others.”What is true?
Fact
Eczema is not contagious. It cannot be passed on by touching, sharing a bed or playing together. It runs in families that also have asthma or hay fever, which is inheritance, not infection.
Myth“Steroid creams are harmful and should be avoided as long as possible.”What is true?
Fact
Creams and ointments that carry a steroid are, along with moisturisers, the main treatment for a flare-up, and they are prescribed in a strength to suit the skin and the site. What doctors avoid is steroid tablets, because the eczema tends to rebound when they stop. Use the cream as the doctor directs rather than stopping it early or borrowing someone else's.
Myth“Moisturiser is only cosmetic. The medicine is what matters.”What is true?
Fact
Moisturisers, also called emollients, are treatment. They are applied at least twice a day, and used in place of soap, to hold water in the skin and keep the barrier working. Skin that is kept moisturised flares less often.
Myth“Eczema means a food allergy, so milk or eggs should be stopped at once.”What is true?
Fact
Food is a trigger for some people and not for most. Soaps, detergents, wool, dust mites, pets, pollen, heat, sweating and stress are commoner triggers. Cutting foods out of a child's diet should be discussed with a doctor first, because growing children need them.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Will my child grow out of eczema?
Many children improve a great deal as they grow, and some have almost no trouble by their teens. Others keep sensitive skin into adult life, often on the hands. Even when it continues, good daily skin care and prompt treatment of flares make a real difference to how much it affects everyday life.
Is it safe to use a steroid cream on my baby's face?
Only on a doctor's advice. Facial skin is thin, so a mild preparation is used, for a short course, and often a non-steroid anti-inflammatory cream is chosen instead. Never use a strong cream bought over the counter, or one prescribed for an adult's arms, on a baby's face.
Does bathing make eczema worse?
Bathing helps if it is done gently. Keep the water lukewarm and the bath short, use a soap substitute rather than soap, pat the skin dry instead of rubbing, and put on moisturiser straight afterwards while the skin is still slightly damp.
Can changing the diet clear eczema?
For a small number of people, usually young children, a particular food does set off flares, and a doctor can help identify it. For most, diet is not the driver, and removing foods without advice risks poor nutrition without helping the skin. Discuss any planned change with a doctor first.