Eczema

There are a number of different types of eczema but by far the most common is known as atopic eczema, considered to be one of three ‘atopic’ disorders, along with asthma and hay fever. ‘Atopic' people are often hypersensitive to certain allergens, and people with a family history of asthma and allergies often develop eczema. Other types include allergic contact dermatitis. This is a reaction to a substance that the skin comes directly in contact with and is commonly caused by nickel, rubber, perfumes, paints, dyes, soaps and detergents. Infantile seborrheic eczema is also known as cradle-cap; this scaly skin condition commonly affects babies on the scalp or diaper area - it is not sore or itchy and generally clears up without intervention.
Adult seborrheic eczema can be due to an over-reaction to the natural yeasts in the skin, or may be hormone-related (it is often worse cyclically in women). It is usually found on the nose and eye-brows, scalp, chest and back. Photodermatitis typically causes a pattern of heat-rash and itchy spots, caused by sensitivity to sunlight.
Eczema can be graded from very mild, with red dots or a rash, to severe, where the skin becomes swollen, blistered or cracked and very sore. Areas of eczema can become infected, with weeping or crusting over the top, soreness and failure to respond to eczema treatment. If you think this is a mild case covering a small area, you could see your pharmacist and they can recommend emollients, which are medical grade moisturizers.

Is eczema contagious?

Eczema is not contagious, but there is a genetic link, so family members may suffer from eczema or other associated conditions such as asthma or hay fever.

There are three main areas to consider when managing eczema. The first is to avoid using irritants to the skin wherever possible, secondly to use moisturizing creams frequently to help prevent eczema patches from developing, and third to use steroid creams when the eczema flares up. Emollients are moisturizers which soothe, smooth and add water to hydrate the skin. They are the most common overall treatment for eczema and should be used every day - examples include Aqueous cream and E45 cream – and these can be applied directly as lotions, creams or ointments. Mild steroid creams, such as hydrocortisone are also excellent at calming flare-ups of eczema and these act by suppressing the body's inflammatory response, but always ask the advice of a pharmacist or see your doctor before using any steroid cream, and the stronger steroids are only available on prescription. Emollients should be used at the same time as steroid creams for most people.

If emollients and mild steroids don't help, your doctor can prescribe other treatments such as stronger steroid creams. However, these should be used sparingly, since if used for too long or on a delicate area of skin such as the face and armpits, it can thin the skin, leading to wrinkles and blemishes. Other possible treatments include oral steroid tablets (prednisolone) used for very short periods of time, immunosuppressant tablets, such as azathioprine or cyclosporin, used only with severe eczema, and immunosuppressant creams or lotions applied to the skin to reduce inflammation. These are sometimes prescribed if other treatments have not worked or have unacceptable side effects. Antibiotics can be prescribed if the skin is infected, and antihistamine tablets can help some people with irritating eczema to sleep better.

Depending on how bothersome the eczema is, you may be fit for work. If you suspect or know that allergens or irritants at work are responsible for your eczema, you may need to avoid these while awaiting medical advice.

Can lifestyle changes help?

Yes. Always avoid soaps, bubble baths, detergents and any other things that seem to irritate (e.g., woolen clothes and extremes of temperature). Washing the skin itself can be aggravating, so it is best to keep washing and bathing to a minimum and use cool water with a soap substitute plus a bath or shower emollient (moisturizer). Some people with eczema say that cutting out dairy products and refined sugars from their diet significantly improves their eczema, although hard evidence for this is lacking. Taking a daily multivitamin rich in the antioxidant vitamins A and E plus 50 mg of zinc per day can also prove to be beneficial, as can quercetin, found in foods such as garlic and onions, broccoli, and red cherries, but also available in supplement form.

Complementary treatments do seem to help many eczema sufferers but several may need to be tried before the full benefits for each individual treatment are seen. Examples of these include rosehip oil, massaged into the affected skin daily, which can help reduce itching and irritation of that area, and starflower cream that can be good at relieving the itching of eczema, both in children and adults.

Using the descriptions above, if you would rate your eczema as severe, infected or not responding to treatments from your pharmacist or any eczema treatments you have been prescribed previously, book an appointment with your doctor. Depending on how bothersome and widespread the eczema is, you may decide to ask for an urgent or routine appointment.

The doctor can prescribe steroid creams, antibiotics or emollients to treat the eczema, depending on their assessment.