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Eczema

Eczema, also known as dermatitis, describes a group of skin conditions in which your skin is inflamed and itchy.

Eczema can develop anywhere on your body. There are various types of eczema, all with slightly different causes and symptoms. This factsheet will focus on atopic eczema but other types are also described.

Atopic eczema is the most common type of eczema. It’s an itchy skin condition that commonly affects parts of your body where your skin creases, such as the backs of your knees and the inside of your elbows, as well as your chest, face and neck. The term ‘atopic’ refers to having family tendency to develop a variety of allergic conditions, including asthma, hay fever as well as eczema.

In the UK, up to two in 10 children and up to one in 10 adults have atopic eczema. It affects men and women equally.

Other types of eczema

Allergic contact eczema

If substances come into contact with your skin and cause an allergic reaction, you may develop allergic contact eczema. Nickel, perfume and hair dye are common substances that may cause allergic contact eczema.

Discoid eczema

It’s unknown what causes discoid eczema but it’s often harder to treat than other types of eczema. Disc-shaped patches of inflammation appear on your skin and it can occur at any age, but most commonly in middle age.

Irritant contact eczema

If you’re in frequent contact with substances that damage the surface of your skin, this can cause irritant contact eczema. Substances such as detergents or cleaning products are common irritants.

Seborrhoeic eczema

This is thought to be caused if your immune system reacts to a yeast called Malassezia. Seborrhoeic eczema causes inflammation on areas of your skin that are often hairy and more greasy or oily – such as your eyebrows, scalp and chest. You can get seborrhoeic eczema at any age and it’s often so mild that you don’t notice it.

Varicose eczema

If you have varicose veins in your lower leg, this type of eczema affects the skin over and around them. It’s usually worse around your ankle, often affecting both legs and is common in older people, especially women.

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Details

  • Symptoms Symptoms of atopic eczema

    Symptoms of atopic eczema are often described by how your atopic eczema looks. If you have atopic eczema, your skin may be:

    • red or inflamed
    • dry
    • cracked or broken
    • itchy
    • thickened

    It’s common to get an itchy rash in the skin creases of your knees or elbows. If your eczema becomes itchy, try not to scratch it. Scratching can damage and break your skin, which can lead to an infection.

    These symptoms may be caused by problems other than atopic eczema. If you have any of them, see your GP for advice.

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  • Diagnosis Diagnosis of eczema

    Your doctor will ask you about your symptoms and examine your skin. If your GP suspects your eczema may be infected, he or she may rub a sterile swab (cotton bud) over the affected area on your skin. This will be sent to a laboratory to find out what is causing the infection.

    You will usually be treated by your GP, but he or she may refer you to a dermatologist (a doctor who specialises in identifying and treating skin conditions) if your eczema is severe or infected.

  • Treatment Treatment of atopic eczema

    If you had atopic eczema as a child, you may find it improves as you get older, although certain triggers may still cause it to flare up.

    Self-help

    Keeping a diary about your eczema symptoms may help you spot any triggers that may make your eczema worse.

    Scratching can make your eczema worse and make your skin feel more itchy. Anti-scratch mittens for babies and young children can be helpful. If you need to relieve an itch, rub the skin with your fingertips instead of using your nails. You may want to put something cold onto the area, such as ice cubes or frozen peas wrapped in a towel, to relieve itching. Don’t apply ice directly to your skin as it can damage your skin.

    If your eczema isn’t getting better, it’s especially important to avoid skin irritants such as soaps, shower gels and bubble baths.

    Medicines

    Although there isn’t a cure for eczema, there are a range of medicines available from your GP or pharmacist to help control your symptoms. Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

    Emollients

    Emollients are moisturisers that prevent water loss from your skin and can also help repair your skin. They reduce the dryness of your skin and ease itching. Emollients also help to prevent your skin becoming infected. Emollients are most effective at preventing eczema when they are used frequently, even when you don’t have eczema symptoms.

    You can apply emollients directly to your skin as creams, lotions, oils or washes as often and as much as you need. There are many different types of emollient that can be used on the whole of your body. Examples are shown in the table below.

    Non-branded products Branded creams Branded ointments Branded gels, lotions, and sprays Branded washes and bath and shower additives

    Aqueous cream, BP

    Emulsifying ointment, BP

    Hydrous ointment, BP

    Liquid and White soft paraffin ointment, NPF

    Aveeno

    E45

    Hydromol Cream

    Vaseline Dermacare

    Epaderm

    Hydromol Ointment

    Kamillosan

    Dermamist spray application

    Doublebase gel

    QV lotion

    Aveeno colloidal bath additive

    Cetraben emollient bath additive

    Imuderm bath oil

    Oilatum emollient bath additive

    Generally, most emollients will help improve the appearance of your eczema. However, if your eczema is severe, you may need to try a greasier emollient, such as an ointment. You may have to try several different emollients before you find the best one for you. For emollient that comes in pots, use a clean spoon or spatula to remove it when you’re applying it to your skin.

    Steroid creams

    These creams contain steroids, such as hydrocortisone, which reduce inflammation and help to relieve itching. There are different strength steroid creams, from mild and moderate, to potent and very potent. Mild steroid creams (such as hydrocortisone) are available over the counter. Your pharmacist can offer advice about how much you can use and how often you can apply it. Use the mildest cream that works for you.

    If your GP prescribes a steroid cream, always follow his or her advice about how much to use. You can apply them directly to your skin, but only on areas that have symptoms. They’re usually applied only once a day. However, if this doesn’t help to relieve your symptoms, your GP or dermatologist may recommend using them twice a day.

    You can use steroid creams before or after applying your emollient, but you need to leave at least half an hour between applying the two creams. This prevents the active ingredients in your steroid cream from being diluted by your emollient.

    Potent or very potent steroid creams, such as betamethasone valerate, are available on prescription. Using stronger steroid creams too often, or on delicate skin (such as on your face), can thin your skin. This can make your skin bruise more easily. Always follow your GP or dermatologist’s advice about using any type of steroid cream. For more information, see our FAQs.

    Other prescription medicines

    If emollients or steroid creams don’t help your eczema, there is a range of other medicines your GP or dermatologist may prescribe you.

    • Topical immunosuppressants, such as tacrolimus or pimecrolimus are creams or ointments that you apply to your skin to reduce inflammation. These new treatments don’t contain steroids so won’t cause thinning of your skin. You may notice a burning sensation or redness on your skin when you first start to use the cream. This side-effect usually clears up after about a week of using the cream.
    • Antibiotics, such as flucloxacillin or erythromycin, are used if your eczema has become infected. For large areas of infected eczema, you’re likely to be prescribed antibiotic tablets. For smaller areas, an antibiotic cream may be prescribed.
    • Oral immunosuppressant medicines, such as ciclosporin or azathioprine, are tablets that can be highly effective and are prescribed only by dermatologists specialised in the treatment of severe eczema.
    • Oral steroids, such as prednisolone tablets can be a very effective treatment for severe eczema, but are not recommended for most people. You will be prescribed these for as short a time as possible, but they should only be used as a last resort.
    • Antihistamine tablets are not often recommended, but if your eczema is stopping you from sleeping, they may be useful to reduce irritation and itching.
        

    Other therapy

    If you have severe eczema, you may need medicated paste bandages to soothe and protect your skin. They contain emollients and other substances, such as ichthammol, to help relieve itching. They’re usually applied to your arms or legs and act as a barrier to prevent scratching. Usually bandaging is only used for up to two weeks to control a flare-up of your eczema.

    Another option is using wet wraps, which are cooling bandages that can help to soothe severe eczema. These are wet bandages applied over emollient creams. Dry bandages are placed over the top. These wet wraps help to prevent you from scratching and allow your skin to absorb as much of the creams as possible. These are often useful when treating young children with severe eczema, particularly at night. It’s important to remember not to use bandages or wet wraps if your eczema is infected because this can lead to the infection spreading.

    You may find ultraviolet light treatment, known as phototherapy, helpful for relieving your symptoms. This is usually given in hospital by a dermatologist.

    Complementary therapies

    Some people find that complementary treatments, such as herbal creams and homeopathy, are helpful. However, there is currently little evidence to suggest they are useful in treating eczema. It’s important to remember that natural doesn’t mean harmless. Herbal remedies contain active ingredients and may interact with other medicines or cause side-effects. Always speak to your GP or dermatologist before trying complementary therapies. If you do decide to try a complementary therapy, check that your therapist belongs to a recognised professional body.

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  • Causes Causes of atopic eczema

    Eczema isn’t infectious, so you can’t catch it from anyone else.

    You can inherit a tendency to develop atopic conditions such as eczema, asthma and hay fever.

    Although eczema can flare up for no obvious reason, you may notice certain triggers that make your atopic eczema worse.

    Common triggers may include:

    • infections caused by bacteria such as Staphylococcus aureus
    • allergens, such as pollen, house dust mites, mould or pet dander (fur or hair)
    • irritants, such as detergents, soaps or shampoo
    • rough clothing fabrics, such as wool
    • sweat
    • stress
    • if you’re a woman, changes in hormone levels, for example at different times in your menstrual cycle or if you’re pregnant

    It’s rare but certain food or drink, such as milk, eggs, soya, nuts or wheat, may cause your eczema to flare up. For more information, see our FAQs.

    You may find the severity of your eczema varies throughout the year. Your eczema may improve over the summer months because of increased exposure to sunlight and get worse during winter when the air is drier or vice versa.

  • Living with eczema Living with eczema

    If you think that certain food or drink causes your eczema to get worse, see your GP before you make any changes to your diet. Excluding certain foods from your diet may not improve your eczema and can lead to deficiencies of essential nutrients. Dietary changes should only be considered for children under the supervision of your GP or a dietitian.

    The itch from eczema can feel unbearable for some people and lead to sleep loss, stress and depression. You may find it helpful to seek support from charities, such as the National Eczema Society (see further information), who can provide advice on ways to help you cope.

    With good management and appropriate treatment, most people are able to control their atopic eczema.

  • FAQs FAQs

    Can aqueous creams make my eczema worse?

    Answer

    Some people find that aqueous cream may irritate their eczema symptoms so it’s important to use the right emollient that works for you.

    Explanation

    Aqueous cream, just like most other emollients, is a type of moisturiser that soothes and adds water to (hydrates) your skin. Emollients are an important part of treating and preventing your eczema symptoms. However, different types of emollient affect people differently so you may need to try several before you find the one that's right for you.

    The National Institute for Health and Care Excellence suggests that some children may find aqueous cream irritates their symptoms of eczema more than other types of emollient. Leaving aqueous cream on your skin may increase the risk of a skin reaction if you have eczema. It may still be useful as a bathing product, where it’s used in place of soap and rinsed off thoroughly.

    If you're using aqueous cream or another type of emollient and you think it may be irritating your eczema, see your GP.

    Can I go swimming with eczema?

    Answer

    Yes, you can go swimming if you have eczema. However, the water and chlorine from the swimming pool may irritate your skin and make your eczema worse.

    Explanation

    The effect of swimming depends on how severe your eczema is, how much chlorine there is in the swimming pool and how long you spend in the pool. If the swimming pool contains a lot of chlorine, it’s more likely to irritate your skin.

    To reduce the harmful effects that swimming may have on your skin, apply a thick layer of emollient before you swim. Shower straight after swimming to rinse the chlorinated water off your skin. Apply more emollient after swimming once you have dried. You may need to use extra emollient or a steroid cream if you find that swimming has made your eczema worse.

    Can the sun make my eczema better?

    Answer

    Yes, many people find that their eczema improves when they have been out in the sun. However, it’s important to be careful not to be in the sun for too long and always use sunscreen to protect your skin.

    Explanation

    Ultraviolet (UV) radiation, which is given off by the sun, reduces inflammation of your skin. This may help to clear your symptoms of eczema, but the effect is temporary and won’t cure your condition.

    However, too much UV radiation can damage your skin. This may cause sunburn, cause your skin to age prematurely and can increase your risk of skin cancer. Because of this, you need to be careful not to stay in the sun for too long and you should always wear sunscreen. When using sunscreen, apply your emollient first then wait at least 15 minutes before applying your sunscreen. Mixing the two types of creams or lotions may change how well the ingredients in either of them work.

    You can have special medical UV light treatment for your eczema, called phototherapy. Controlled doses of UV radiation are applied to your skin over several weeks. The dose of UV radiation that you’re given is increased gradually so that your skin doesn’t burn. This treatment is given in hospital, usually by a dermatologist, if you have severe eczema. Your GP will be able to advise you on whether this would be a suitable treatment for you.

    Could my eczema be caused by a food allergy?

    Answer

    It’s rare for food allergies to cause eczema but certain foods may more commonly cause flares of eczema.

    Explanation

    You may find that certain foods or drinks cause your eczema to get worse. However, it’s rare that diet alone will trigger your eczema, therefore, food allergy tests aren't often offered to you if you have atopic eczema.

    Young children under the age of three who have eczema are more likely to have a food allergy but it’s unclear how this affects eczema. Children may find that their eczema gets better as they get older, whether they have food allergies or not. To help spot certain triggers, try to keep a diary, noting down what you eat and drink, and your eczema symptoms.

    If you’re pregnant or breastfeeding, don’t change your diet without advice from your GP or dietitian.

    What side-effects may I get from using steroid creams to treat my eczema?

    Answer

    Using too much of potent steroid creams can cause side-effects, such as thinning of your skin, stretch marks or acne.

    Explanation

    Most people who use steroid creams find them highly effective and if used correctly never get any side-effects. However, some of the possible side-effects caused by using too much include:

    • untreated infections getting worse
    • thinning of your skin – this may be reversed after stopping treatment but your skin may never recover completely
    • stretch marks and broken veins
    • acne or rosacea
    • changes in skin colour
    • excess hair growth on your skin

    If you have any concerns about how much steroid cream to use or if you feel you are developing side-effects, see your GP. He or she may refer you to a dermatologist to discuss alternative treatment options.

    Will stress make my eczema worse?

    Answer

    At present, it’s unclear how stress relates to eczema symptoms. Each person with eczema is different and reacts differently to certain triggers, but you may find that your symptoms are worse when you feel stressed.

    Explanation

    There may be circumstances in your life that cause you stress, such as changes in your job situation, a house move, divorce or bereavement. It’s possible that the combination of your usual triggers with added stress is causing a flare-up of your eczema. Continue with your usual treatments, including emollients, and see your GP or dermatologist if your symptoms don’t start to clear up within a few days. If your eczema is causing you to feel very itchy, it can disturb your sleep and begin to affect your quality of life.

    Getting the right treatment for you will help to ease your eczema symptoms. Finding ways to relax and using distraction techniques to break the itch-scratch cycle may help to tackle how stress affects your eczema. Techniques you might like to try to help you relax include deep breathing, muscle relaxation and imagery (using your imagination to think of a relaxing scene). See your GP or dermatologist for advice if you think stress may be affecting your eczema.

  • Resources Resources

    Further information

    Sources

    • Eczema – atopic. Clinical Knowledge Summaries. cks.nice.org.uk, published July 2008
    • Joint Formulary Committee. British National Formulary (online) London: BMJ group and Pharmaceutical Press. www.medicinescomplete.com, accessed 23 January 2013
    • What is eczema? National Eczema Society. www.eczema.org, accessed 23 January 2013
    • Contact dermatitis. The British Association of Dermatologists. www.bad.org.uk, published November 2010
    • Atopic eczema in children: management of atopic eczema in children from birth up to the age of 12 years. National Institute for Health and Care Excellence (NICE), December 2007. www.nice.org.uk
    • Discoid eczema. The British Association of Dermatologists. www.bad.org.uk, published December 2009
    • Seborrhoeic dermatitis. The British Association of Dermatologists. www.bad.org.uk, published January 2012
    • Seborrheic dermatitis. eMedicine. www.emedicine.medscape.com, published 23 March 2012
    • Venous eczema. The British Association of Dermatologists. www.bad.org.uk, published April 2010
    • Hormonal influences on eczema in women. National Eczema Society. www.eczema.org, accessed 25 January 2013
    • Eczema and the sun. National Eczema Society. www.eczema.org, published 25 May 2010
    • Atopic dermatitis. eMedicine. www.emedicine.medscape.com, published 4 April 2012
    • Eczema. Map of Medicine. www.mapofmedicine.com, published 31 October 2011
    • Itching and scratching. National Eczema Society. www.eczema.org, published March 2009
    • Management of atopic eczema in primary care. Scottish Intercollegiate Guidelines Network (SIGN). www.sign.ac.uk, published March 2011
    • Emollients. National Eczema Society. www.eczema.org, published 2008
    • Topical steroids. National Eczema Society. www.eczema.org, published 2008
    • Tacrolimus ointment. National Eczema Society. www.eczema.org, published 2011
    • Bandaging, wrapping and therapeutic clothing. National Eczema Society. www.eczema.org, accessed 24 January 2013
    • Diet and eczema in children. National Eczema Society. www.eczema.org, published 2008
    • Phototherapy. The British Association of Dermatologists. www.bad.org.uk, published February 2012
    • Sunbeds. The British Association of Dermatologists. www.bad.org.uk, accessed 25 January 2013
    • Swimming. National Eczema Society. www.eczema.org, published 2011
    • Eczema. The British Association of Dermatologists. www.bad.org.uk, published April 2009
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    Reviewed by Louise Abbott, Bupa Health Information Team, May 2013.

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