Eczema
Eczema (atopic dermatitis) is a common form of dermatitis (skin
inflammation) that causes the skin to become itchy, red, swollen and
painful. Symptoms can vary from a mild rash that disappears quite quickly
to a more severe condition that’s present for a long time. The main
goal of treatment is to eliminate itching which, in left untreated,
can provoke or worsen the other symptoms.
General information
Causes
Signs and symptoms
Treatment
Other effects of eczema
Preventive measures
Eczema generally occurs in babies and children, although it can
occur at any time of life. Approximately one in seven children will get
the condition at some time - the first signs usually begin at nine to twelve
months of age, although sometimes it can start as early as four months.
Eczema usually starts on the face followed by the hands and
feet. Older children tend to be affected in the elbow and knee creases,
neck, wrists, ankles and feet. The hands and feet tend to be the most
commonly affected areas in adults. Eczema is not a contagious condition.
If eczema appears in the first year of life there is a 50% chance
it will not be a problem by the age of five. Even if it continues into
school age only one in twenty will still have trouble in adult life.
However, there are no hard and fast rules and each case is different.
Causes
A child who has eczema makes extra amounts of a certain type of
antibody (IgE). This tendency is genetically inherited but, even so, some
children who have the genetic disposition towards eczema may never suffer from the
condition.
Fifty per cent of children who make extra amounts of this antibody
are more prone to suffer from asthma and hayfever. Also, children who
have eczema often have an allergic reaction against environmental
particles. These particles include pollen, dust, animal hair and skin
cells, fungus spores and mites.
Certain substances or conditions called trigger factors can cause
eczema to flare. These trigger factors can be:
·
Irritants such as wool, skin
infections, dry skin, low humidity, heat, sweating or emotional stress.
·
Allergens such as dust mites,
pollen, moulds or foods.
Consultation with your doctor may be helpful in identifying the
triggers.
An infant with eczema is more likely to be allergic to food than
other children are. There is at least a 40 to 50 per cent chance that food
allergies may be triggers if your child has moderate to severe eczema. The
foods responsible for 90 per cent of these reactions are egg, peanut, milk,
soy, wheat, fish, nuts and shellfish. Salicylates and some preservatives can
also trigger eczema.
The classic symptoms of eczema
are:
·
Itching. This is the worst aspect because it can be
upsetting for the child. It also makes the child scratch causing further rawness
of the skin and possible infections to develop.
·
Redness caused by extra blood flowing through the blood vessels in
the skin in the affected area.
·
A grainy appearance to the skin, caused by tiny fluid filled
blisters just under the skin called “vesicles.”
·
Weeping when the blisters burst, either by themselves or because
of scratching, and the fluid oozes on to the surface of the skin.
·
Crusts or scabs that form when the fluid dries.
·
Children with eczema often have dry, scaly skin. This may be
the result of the disease or it may also be the natural skin type of the
family. Dry skin can be a predisposing factor to developing eczema.
·
Pale patches of skin may appear because eczema can disturb the
production of pigment which controls skin colour. The effect does fade and
disappear.
·
Lichenification - a leathery, thicker skin area in response
to scratching.
Treatment
The main goal of treatment is
to eliminate the itching which provokes or worsens the other symptoms and
causes the most discomfort.
In some very mild cases eczema can be managed by:
In some very mild cases eczema can be managed by:
·
Avoiding likely sources of irritation (triggers)
·
Using emollients such as special bath oils and moisturisers.
It is necessary to work with the child's doctor in order to
develop a treatment plan that works best for each child. Treatment may
need to be reassessed, especially if the condition worsens or fails to respond
to treatment. In some cases the doctor will refer the child to a skin
specialist (dermatologist).
Steroids, such as hydrocortisone, reduce the inflammation in response to an allergic reaction. There are different strengths of steroid creams and ointments available on prescription. Care needs to be taken, especially if applying a very strong steroid as it can cause the skin to become thin. These creams should not be put on liberally but instead only the thinnest smear should be applied to the rash. The best time to do this is after a bath, as the skin is more absorbent.
Discuss with a doctor or pharmacist the correct use and
application of the steroid cream or ointment prescribed. Establish when
it is appropriate to use and when to stop using it. It is not advisable
to use a steroid on the face unless prescribed by a doctor. Occasionally,
steroid medication may need to be given orally.
Consult the doctor if the child's skin shows signs of
damage. A weaker steroid or non-steroid cream can often reverse the
damage if caught in time.
Pimecrolimus cream (Elidel) is a topical, steroid-free,
anti-inflammatory medication used to treat eczema, amongst other inflammatory
skin conditions. It is available on prescription and can be applied to affected
skin on the face, head and around the eyes where steroid creams are not
recommended.
Tar preparations such as coal tar have anti-itching and anti-eczema
properties. They are available in various bath oils, shampoos and
gels. Talk to the doctor about the use of these preparations.
Special diets that exclude certain foods (elimination diets) have been effective in treating eczema in some children. However, not all children respond to diet therapy. Talk to your doctor or a dietitian about this.
Antihistamines may help the itching. The drowsiness they
cause can also be useful at night to conquer sleeplessness caused by the
irritation.
In some cases, medications to suppress the immune system may be
needed to treat the condition.
In severe cases, phototherapy or ultaviolet (UV) treatment may be
suggested. This involves controlled exposure to UV-A and/or UV-B for a
few minutes, two to three times each week. A treatment course may
continue for several months.
Other effects of eczema
Skin that is broken and damaged is more likely to be infected by
bacteria or yeasts. One common type of bacterium (staphylococcus aureus)
produces yellow crusts or pus filled spots.
Should bacterial infection occur, this can be treated with a
course of antibiotics. Antibiotics can be taken orally in the form of
syrup, capsules or tablets. Once infection has broken out, it may be
useful to add antiseptic solutions to a child's bath. If the child is
prone to infections, talk to your doctor about using an antiseptic solution as
a preventative measure.
Poor temperature control can occur as a result of eczema.
Too much heat is lost through inflamed skin so the body tries to compensate by
“turning up the heating”. The result is that the child can feel too cold
and then when moving into a warmer atmosphere quickly get too
hot. Sweating is another way of losing heat when we get too hot.
Eczema also prevents the sweat glands from working properly.
The following may help alleviate the symptoms and prevent future
outbreaks of eczema:
·
Use pure cotton or cotton mixtures instead of wool or synthetic
·
Do not use soap. Instead add bath oils to bath water and use
emulsifying ointment or a water dispersible cream instead of soap
·
Avoid enzyme detergents and fabric softeners when washing clothes
as these can irritate the skin
·
·
Avoid acid fruits and vegetables like tomatoes and citrus fruits.
They can cause a reaction on the hands and around the mouth. Salty foods
can also cause a similar reaction
·
Direct use of antiseptics and solvents should also be avoided
·
Environmental factors, such as heat, sunlight and cold can
irritate the condition. If this is the case, protect the child from them
or avoid them as much as possible
·
Moisturise the skin. Washing with water alone rapidly
results in drying, but adding oil to water will moisturise dry, eczema-prone
skin effectively. Discuss with the doctor or a pharmacist what is
available. It may take some time and experimentation to find the best product
for the child
·
Bandages can be used to stop scratching at night. Cotton
mittens can be especially helpful
·
Fingernails should be kept short to decrease the damage caused by
scratching.
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