Eczema

Eczema is an inflammation of the skin which may cause dryness, flakiness, heat, and probably most importantly, itching. Dermatitis is a term which is sometimes connected, in people's minds, with exposure to chemicals. It really only means inflammation of the skin, and could be used interchangeably with eczema, as it often is by doctors.
Eczema can be caused by a number of different factors, and may result in just a small patch of skin being affected, but can affect skin anywhere on the body.

Symptoms

Whatever causes your eczema, it leads to itching and redness, and may make the skin dry and flaky. Sometimes, itchy blisters form. When these burst, or when scratching damages the skin, the surface may be left moist and crusty.
Often, in the commonest form of eczema (atopic eczema), the problem is worst in the folds of the skin where your limbs bend.
The itch is intense, and makes you want to scratch. You should avoid this if you possibly can, as scratching only makes the symptoms worse. People say that if you have to do anything, gentle rubbing, with the flat of your hands, is better than scratching.
Whatever the cause of your eczema, the skin becomes more sensitive, and you may well notice that you are more easily upset by cosmetics, soaps, detergents, etc.

Causes

Many things cause eczema. The commonest is a general allergic over sensitivity (atopy). This sort of eczema is known as atopic eczema, and it is linked with asthma and hayfever. That is, these conditions often run together in a family.
The other possible causes include:

• Infantile eczema which often affects young babies. This may lead to a patch below their chins, which gets wettest from dribbling, and may be associated with cradle cap.
  
• Contact with substances which irritate the skin chemically. This is caused by direct contact between the skin and the substance, which might be such things as detergents, soaps, diesel or engine oils, strong chemicals, cleaners etc.
  
• Contact with substances which the body has become allergic to. Commonly this involves nickel, rubbers etc. If a woman was sensitive to nickel in the past it would cause a reaction where the bra hooks and suspenders came near her skin, as these typically contained nickel. Plastics have helped to overcome this risk, but jewellery and watches are still a common cause. Suddenly people need to spend a bit more on their presents to you!
  
• Varicose veins can lead to a form of eczema affecting the lower legs. This is known as varicose or gravitational eczema. As well as treatment of the skin, it is important to improve the blood circulation in the legs, and for most people this includes wearing support stockings and staying active on your feet. Your doctor will discuss the options.
  

Diagnosis

Your doctor will usually come to the diagnosis from examining you. If in doubt, or if he or she feels that you need further tests, then you may be referred to a skin specialist (dermatologist).
Further tests may include blood tests, patch tests (where little patches of different substances are stuck to your skin for a few days, to see if you react to any of them) and other allergy tests.

Treatment

There is essentially no cure for eczema. It involves a sensitivity of the skin that you are likely to have to some degree from now on. There are, however, a number of approaches which help to minimise your symptoms.

1. The mainstay of treatment is moisturising the skin. For this we use creams, ointments and shower and bath oils which help to replenish the skin's natural protective oils.
   You should discuss these with your doctor, nurse or pharmacist. Washing tends to dry out the skin and make eczema worse. It helps to use an emollient cream as a substitute for soap, and you can apply it liberally at other times during the day. The special bath oils and shower gels also leave a coating of oils on the skin. Some of the creams and oils contain an antiseptic, as it has been found that eczema often flares up as a result of a germ infecting the skin.
   
2. Your doctor may prescribe a cream or ointment containing a steroid (topical steroid). These are very effective at reducing inflammation and itch. Your doctor will want you to use this sparingly, and only while the eczema is bad. There are different strengths of steroid applications, and the tendency is to use the lowest strength that the skin requires at the time, in order to minimise the risk of possible side effects of using steroids.
   
3. In moderate to severe atopic eczema, where topical steroid treatment has not worked, your doctor may prescribe a new type of treatment to be applied to the skin (topical treatment). The preparations are made from a type of drug known as immunomodulators (calcineurin inhibitors, eg tacrolimus and pimecrolimus) that are used, when taken internally, for such things as preventing rejection of transplanted organs. They are strong drugs, but given as an ointment they do not affect your general immunity, and the main possible side effect is a burning sensation. They are certainly effective on atopic eczema and, used under the supervision of your doctor, may make a difference where the previous treatments were not doing enough. In England and Wales there are guidelines on their usage from the National Institute of Clinical Excellence.
   
4. Antihistamines taken by mouth may be helpful in reducing the itch. Your doctor will advise.
   
5. If the skin becomes obviously infected, which is more likely as its normal protective surface has been damaged, your doctor will prescribe antibiotics.
   
6. There are a number of older fashioned remedies which are still effective and may be suggested by your doctor or specialist. For example tars, menthol.
   
7. Evening primrose oil supplements are used for eczema, and are a safe treatment, but have not consistently proved to be effective in research trials. It would appear that the evidence may not support them being any more effective than capsules or medicine containing no active ingredient (placebo).
   
8. If the skin is not responding well, your doctor will probably ask a skin specialist (dermatologist) to see you. There are a number of options that the specialist may use. These may include:
   
   • Bandages and wet wraps.
   • Drugs to suppress the immune system of the body as a whole. These are only used in severe cases, and include Cyclosporin, a drug otherwise mainly used to stop rejection in patients receiving transplants.
   • Phototherapy. Ultra-violet light treatment (UVB and PUVA) can be used in the treatment of atopic eczema. Ultra-violet therapy potentially increases the risks of skin cancer, so it is only used in severe cases.
9. Naturally, if your eczema is a result of a specific allergy or sensitivity, then it is wise to avoid the thing which causes it if you can.
   

Prevention

• Use the cream or ointment which your doctor recommends on a regular basis, and as a soap substitute, to keep the skin supple and to prevent drying.
  
• Avoid scratching when you itch. If you can not stop yourself, then gently rubbing, with the flat of your hand, is less likely to do damage.
  
• Avoid exposure to chemicals and strong detergents. It is usually better to avoid using biological agents altogether. Use protective gloves when you use such things in the house or at work.
  
• If you have been found to be allergic to a specific substance, avoid contact with it, if this is feasible.
  
• Use your treatments according to the instructions from your doctor and the pharmacist.