Eczema

What is eczema?

Eczema or Atopic Dermatitis is a very common inflammatory disease that affects roughly one in six people in their lifetime.
Atopic Dermatitis is often considered a presentation or “symptom” of other medical issues too – and this cluster syndrome is known as “Atopic March” or “Allergic March”.
The allergic march describes the “progression” of atopic disorders, from eczema rash in young infants and toddlers, through to allergic rhinitis, food allergy, hives and asthma.
This is due to antibody responses to immunoglobulin E (IgE) and clinical symptoms that may appear in childhood and can often continue for decades, often changing with age.
Today, one in five infants have eczema and it is quite common in children below 5.
The good news is that many children grow out of their eczema, allergy and hives after puberty.
A meta-analysis including over 110,000 subjects found that while 20% of children with atopic dermatitis had persistent disease 8 years later; fewer than 5% had persistent disease 20 years later.*
Interestingly, children who develop atopic dermatitis before the age of 2 years, have a lower risk of persistent disease than those who develop atopic dermatitis later in childhood or adolescence.
Atopic dermatitis is a chronic disease that generally has a flare and remission pattern.

What are the different types of eczema?

There are several different types of eczema including

Contact Dermatitis – also known as allergic dermatitis. It can be brought on by
triggers such as not washing clothes before use or certain washing powders,
fabrics or chemicals that come into contact with the skin or excess
hand washing or latex gloves. A common form of eczema.

It is possible to have more than one type of eczema on your body at the same time, and different types of eczema can impact different body parts. For instance ear eczema is often seborrheic dermatitis, face eczema often atopic eczema, and hand eczema may be dyshidrotic eczema from frequent hand washing.

What are the symptoms of eczema?

• Intensely itchy, dry, rough, flaky, inflamed, and irritated skin – this can, in some cases, flare up and then subside and then return later.
• Skin will be visually thicker in eczema patches and skin is often scaly and cracked
• The patient will typically have a strong urge to scratch their skin, including during sleep and this can severely impact sleep quality and daytime performance at school or work
• Visually noticeable patches can cause embarrassment and impact socialising.
• Pink to red patches on the skin will develop as the skin becomes more inflamed this will cause it to change colour.
• Small, raised bumps, which may crust over and leak fluid when scratched are a common aspect of eczema.
• Atopic Dermatitis may have different features in different age groups and skin types. Apart from severe itching or cracking, dryness, fissuring it can be complicated by viral and staphylococcal infection.
• This can cause yellowish pussy scabs which signal infection that can be painful more than itchy.
• Diagnosis for eczema is generally clinical and no test is needed. Patch testing should be considered in treatment resistant eczema
• Eczema sufferers tend to have skin that doesn’t “keep in” moisture very well, however scratching only creates an endless cycle that is highly frustrating and can impact sleep, performance and productivity.
• Atopic eczema usually crops up on hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of the elbows and knees, and in infants on the face and scalp
• Eczema can be mistaken as psoriasis, seborrheic dermatitis or contact dermatitis

What causes atopic eczema?

Inherent and genetic factors
Essentially, atopic eczema is caused by the following innate factors

• Genetics (Mum, Dad or siblings have it)
• An inability for the skin to act as a barrier
•  Abnormal behaviour of the immune system (defence cells) in the skin
• Changes to the microbiome – the natural bacteria that live on the skin

    Environmental factors also contribute to the development or flares of atopic eczema. These include

• Fragrance Soaps and detergents – these remove natural oils from the skin and cause drying
• Friction (eg rough, scratchy materials)
• Sweat (can be due to synthetic fabrics that do not breathe – e.g. nylon or polyester)
• Heat (too many blankets)
• Sudden drop in humidity
• Stress and anxiety
• Food allergies (more likely in babies and young children)
• Contact with an allergen – e.g. animal fur, house dust mite, grasses or pollens
• Swimming pools – chlorine and salt can both cause dryness
• Repeated “wet-dry” cycle – e.g. repetitive hand-washing or taking multiple showers on the same day

Eczema tends to run in families and often accompanies other allergic conditions including asthma and hay fever.
The Australasian Society of Clinical Immunology and Allergy has performed studies that show how many people with eczema already have hay fever, dust mite allergy or food allergy.
About 30% of infants with eczema, who have a family history of allergy will develop a food allergy, while up to 40% develop asthma and/or allergic rhinitis.

How can I prevent atopic eczema?

The best prevention is to keep your skin care routine simple so try to

• Avoid triggers where possible.
• Apply moisturiser all over the body once to twice per day. Lather heavily on eczema patches.
• Avoid scrubbing with a loofah
• Use a soap-free wash in the shower or a bath oil in the bath, for instance Cetaphil, Eucerin or QV. Ask your chemist.
• Limit bathing to a maximum of once per day and keep them short (<3 minutes) where possible and keep as lukewarm as possible.

What are the best tips for treatment of atopic dermatitis?

The most suitable treatment plan for your eczema depends on where your eczema is, the severity of the eczema and how it is impacting your sleep and emotional health.

How do I “wet wrap” my eczema?

1. After a very quick shower, apply cortisone or creams as prescribed, to all areas affected with eczema
2. Then apply moisturiser over the cortisone ointments and to the whole of the body and face.
3. Wrap damp tubular bandages from the chemist around the eczema. These can be cut to size, soaked in warm water and squeezed as dry as possible first.
4. As skin improves, taper off wet wrap frequency rather than stopping abruptly.
5. Moisturisers should be applied 3-4 times a day otherwise the skin will become dry and itchy again.
6. Do not leave the dressings on dry (unless your child is sleeping) as dry dressings can irritate the skin by causing it to become hot, dry and itchy
7. Use a spray bottle of warm water to moisten bandages if needed.
   Note: Do not use antiseptic bath oils in the wet dressings as these may irritate and burn your child’s skin

Watch Dr Parisa perform a wet wrap on a child with eczema here.

How do I use a cool compress for facial eczema?

Cool compressing is an ideal wet dressing for the face using wet disposable towels in a bowl of cool water and bath oil.

1. Hold the towels on to the face for 5–10 minutes
2. Apply moisturiser immediately after compressing
3. Cool compressing should be applied as often as needed until the itch is relieved

How do I make a bleach bath for my child’s eczema?

Bleach baths can help reduce Staphylococcus aureus bacteria on the skin and improve the severity of disease.

1. Fill the tub with lukewarm water.
2. Then add half a cup of household bleach to water.
3. Soak in the water for 10 minutes being careful not to submerge the head.
4. Rinse off completely using warm water
5. Apply moisturizer quickly and continue with a regular skin care routine.

Can food allergy cause atopic dermatitis?