Eczema explained
Atopic eczema is the most common type of eczema. It usually comes and goes, and most sufferers will experience flare-ups (where the condition worsens) interspersed with periods of remission (where the symptoms are less severe and under control). However, some people have exacerbations as often as two or three times or month, and in severe cases, it may feel as though such episodes run into each other.
Generally, atopic eczema improves with age. A study of children who had the disease at age seven found that by 11 years of age, just over half were clear of eczema, and this rose to just under two-thirds by age 16. However, there is some evidence that the prognosis is worse in cases of early onset, and in children who also have asthma.
The complications of eczema vary. Probably the best known is a bacterial infection, which usually presents as worsening eczema with increased redness, oozing and crusting, and viral and fungal infections can also occur. But the high levels of distress that the condition can cause are sometimes overlooked. For example, pre-school children with atopic eczema have higher rates of behavioural issues, fearfulness and dependency on their parents, and as they get older, problems can include bullying, social anxiety, impaired performance and time away from school. Poor self-image and a low self-confidence can also have a significant impact on social development and lead to psychological problems.
Other issues associated with atopic eczema include irritant conjunctivitis and the development of cataracts, and sleep is frequently disturbed, not just for the sufferer but also for those they live with.
Because there is no cure for eczema, it has to be managed using the following strategies:
- Minimising scratching. This can be very difficult because scratching gives an immediate sense of relief. However, the act of scratching also damages the epidermis (top layer) of the skin, which in turn leads to water loss and drying, and this then triggers a cycle of itching and more scratching
- Avoiding triggers (see panel below)
- Using emollients frequently and liberally
- Applying topical corticosteroids to areas of red skin and continuing to do so for 48 hours after the flare-up has been controlled.
In more severe cases, other treatments may be needed, such as antibiotics if there are signs of infection and antihistamines to help break the itch-scratch cycle.
Trigger points
There is no single cause of atopic eczema. Instead, many factors play a part. For example, genes have a role. Research shows that a child whose parents both have atopic eczema has an 80 per cent chance of having the condition themselves, with 60 per cent affected if only one parent has eczema. Children whose parents have the condition are also more likely to experience symptoms earlier and to have symptoms that are more severe.Â
In all cases, identifying triggers that can be modified or avoided can make a significant difference to symptoms:
- Food allergens, most commonly cows’ milk and eggs, are associated with atopic eczema
- Hormonal changes can influence the severity of symptoms. For instance, premenstrual flare-ups occur in 30 per cent of women, with up to 50 per cent noticing a worsening during pregnancy
- Other triggers include stress, and exposure to pets, house dust mites and pollen.