Eczema

Atopic eczema is a complicated skin condition. It can be caused by a number of things, including your genes and the environment around you.

One important gene is called filaggrin. It helps control a protein important for keeping the skin barrier strong and healthy. If this gene does not work properly, the skin barrier becomes weaker, and the affected person can develop eczema.

A weak skin barrier makes it easy for bacteria and viruses to enter the skin and cause skin infections. It also allows irritating substances to enter the skin, making it inflamed and itchy.

Things that can irritate the skin include allergens (for example, pollen and dust), soaps, detergents and other chemicals.

Atopic eczema often runs in families, especially if other family members have asthma or hay fever. But it is important to know that eczema is not contagious – you cannot catch it from someone else.

Is atopic eczema hereditary?

Yes, atopic eczema tends to run in families. If one or both parents have eczema, their children are more likely to develop it too.

Around 1 in 3 children with atopic eczema will also develop asthma and/or hay fever. Atopic eczema affects both males and females equally.

The main symptom of atopic eczema is itching (pruritus). This can be very uncomfortable and lead to scratching that can make the skin look and feel worse. The itch can be so strong that it affects sleep, causing tiredness and irritability.

Atopic eczema often comes and goes in flare ups – times when the skin gets worse. Sometimes flare-ups have a clear cause, but often there is no obvious reason.

Atopic eczema can appear anywhere on the body, including the face. Most commonly it appears on the creases of the joints at the elbows, knees, wrists and neck (known as a flexural pattern). It can also appear as coin-sized areas of inflammation (a discoid pattern), or as many small bumps around the hair follicles (a follicular pattern).

The skin usually feels dry, itchy and sore. Scratching can cause marks, and sometimes the skin may bleed.

During a flare-up, the skin feels warm and looks red. On brown or black skin, the redness may be harder to see, but the area may also become darker or lighter than the surrounding unaffected skin. This is called post-inflammatory hyperpigmentation (darker) or hypopigmentation (lighter).

Sometimes, the skin can also become wet and weepy. In some cases, small water blisters develop, especially on the hands and feet. This is called pompholyx. If the skin is scratched repeatedly over time, it can become thicker. This is known as lichenification.

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A healthcare professional can usually recognise atopic eczema just by looking at the skin. Blood tests and skin tests are usually unnecessary.

What makes atopic eczema flare-up?

Many things in a person's environment can make atopic eczema worse and cause a flare up. These include:

• Irritants such as soaps, detergents and other chemicals, heat, dust, woollen clothing, and pets.
• Being unwell, such as having a common cold
• Skin infections caused by bacteria or viruses:
• Bacterial infection (usually with a type of bacteria called Staphylococcus) makes the affected skin yellow, crusty and inflamed, and may need specific treatment.
• An infection with the cold sore virus (herpes simplex) in the skin affected by eczema can cause a sudden painful widespread flare-up of atopic eczema, with weeping small sores. This condition is called eczema herpeticum. This condition can be very serious if not treated quickly.
• Dryness of the skin
• Teething in babies
• Food allergens, which can trigger eczema in some people.
• Stress, which can make symptoms worse.

Can atopic eczema be cured?

Atopic eczema cannot be cured, but there are many ways of controlling it. Most children affected by it will see improvements as they get older, with 4 out of 5 clear of it by their teens.

Many people continue to have dry skin in adulthood. It is important to use moisturisers on a regular basis and avoid irritants such as soaps, detergents and bubble baths.

Atopic eczema may be troublesome for people in certain jobs that involve contact with irritant materials, such as catering, hairdressing, cleaning, or healthcare work. In later life, atopic eczema can present as hand dermatitis. Therefore, exposure to irritants and allergens should be avoided both in the home and at work.

Can atopic eczema be prevented?

Currently, there is no proven way to stop eczema from developing.

Some people think that breastfeeding might help prevent eczema in babies. However, there's no strong evidence that it works.

There is also no clear proof that eating organic food or taking fish oil during pregnancy lowers the risk of eczema in children.

Can someone with atopic eczema lead a normal life?

Yes, people with eczema can lead a full life which can include participating in sports, swimming and travel. They may need to make minor changes such as keeping moisturiser with them at school, work or when away from home.

How can atopic eczema be treated?

There are many treatments that can help manage atopic eczema and reduce flare-ups. Treatment depends on how severe the eczema is.