Often overlooked, eczema can be a major cause of depression, disrupt our sleep, and generally have an adverse effect on our work and the way we live our lives on a day-to-day basis.

So what is eczema?

The skin is made up of three layers: the epidermis (top layer), dermis (middle layer) and subcutaneous layer (bottom layer).  Normally the skin cells in the upper (epidermal) layer are tightly packed so they help create a barrier. With eczema, the layers do not provide the normal barrier function. This can lead to exposure to the elements and so produce inflammation.

Inflamed skin can be very itchy and prolonged rubbing and scratching leads to thickening of the epidermis making the skin appear thick and leathery. Sometimes inflamed skin can become infected especially the areas of skin that have more folds and creases.

The words eczema and dermatitis are interchangeable and mean the same thing.  Atopic eczema (or atopic dermatitis) is the most common form of eczema. Atopic describes sensitivity to allergens.

There is unfortunately no cure for eczema. It is a matter of avoiding allergens and preventing the skin from becoming dry by using medical moisturisers. Different people react to different allergens so should find out what you are allergic to and try and avoid it.

What can make eczema flare up?

Eczema may be aggravated by:

  • Changes or extremes in temperature
  • Sweat, soap, detergents, shower gels, bubble baths and water may all irritate the skin
  • Stress
  • Bacterial or viral infections
  • Anything you may be allergic to such as food, the material your underwear is made from or any other substances your skin may be in contact with, such as latex.
  • Friction from tight clothing.

What is the treatment for eczema?

Atopic eczema is usually treated in a step by step way depending on the severity of the condition.

Treatment for mild atopic eczema (dermatitis);

  • using moisturising soap substitutes and
  • applying moisturising creams and
  • mild steroid creams or ointments for flare up.

Treatment for moderate atopic dermatitis;

  • using moisturising soaps substitutes and
  • applying moisturising creams and
  • mild steroid creams or ointments for flare up
  • taking antihistamine that do not cause drowsiness
  • applying acrolimus or pimecrolimus cream
  • and bandages if needed.

Treatment for severe atopic dermatitis;

  • using moisturising soaps substitutes and
  • applying moisturising creams and
  • mild steroid creams or ointments for flare up
  • taking antihistamine that do not cause drowsiness
  • applying acrolimus or pimecrolimus cream
  • and bandages if needed
  • taking antihistamine that cause drowsiness
  • using phototherapy using ultraviolet light or your doctor may give you medicines that supress the immune system such as ciclosporin and azathioprine
  • and steroid tablets.

These steps can be stepped up or down as the condition changes.

Dupilumab and Crisborole may also be prescribed:

Dupilumab is the first monoclonal antibody for treatment of moderate to severe atopic eczema and it is given as an injection twice weekly. In clinical trials it has shown to greatly reduce inflammation.

Crisaborole is available as an ointment for the treatment of mild to moderate atopic eczema. It works by inhibiting an enzyme that is involved in atopic eczema.

Although there is no cure for atopic eczema, the condition can be managed so to avoid flare ups.

How to avoid flare ups

One of the best ways to manage eczema is to avoid using soap.  Alternatives to soap are:

  • Oilatum bath additive or shower gel
  • Cetraben bath additive
  • Oilatum Plus shower gel
  • Doublebase shower gel or bath additive
  • Dermol 200 shower gel or Dermol 600 bath additive (both contain antiseptic agent)

After washing it is important to dry yourself thoroughly before applying any moisturiser.

Moisturiser creams or ointments will help to repair damage to the skin’s natural barrier, which can often occur when the skin becomes dry and cracked. They can help to reduce redness, swelling and itching and they protect the skin from becoming irritated and from infections.

There are several medical moisturiser creams available, either prescribed or over-the-counter:

  • Aveeno cream
  • Cetraben cream
  • Diprobase cream or ointment
  • Doublebase cream
  • Epaderm cream or ointment
  • Hydromol Cream or ointment
  • Oilatum cream
  • Zerobase cream or ointment

Whether you choose to use a cream or ointment is entirely personal but the differences between the two are: creams are water soluble and so are easily rubbed into the skin whereas ointments are greasy and so not as easily applied.  However, the advantage of using an ointment is that once applied it is more difficult to wash away and so will retain moisture for longer.

What about antihistamine?

When we scratch, our skin becomes irritated, increasing the risk of infection and making the eczema worse so taking an antihistamine tablet will help to stop the itching and reduce the urge to scratch.

What else can help?

The way to avoid flare ups is to work out what may be aggravating your condition and then avoid them.  This may not be an easy, however, as inflamed areas of skin tend to flare up from time to time and then may settle down again. The severity and duration of flare-ups varies from person to person and from time to time in the same person.

Steroid creams or ointments can help to reduce inflammation and it is usual to start with mild strength steroids and then move on if the eczema has not cleared.

Steroid strengths are as follows:

  • Hydrocortisone – mild
  • Eumovate – moderate (2.5 times stronger than Hydrocortisone)
  • Betnovate – strong (10 times stronger than Hydrocortisone) Often works more quickly than a mild steroid cream so you may be prescribed a short course of this stronger steroid
  • Dermovate – very potent (50 times stronger than Hydrocortisone)

Steroid creams or ointments should be spread thinly on the inflamed skin only using a very small amount of the cream or ointment once or twice daily. It should be used continuously on a daily basis until the eczema has disappeared altogether.

When applying steroids it is important to follow your doctor’s advice as long term use of steroid creams can lead to thinning skin and other side effects.

Once the eczema has cleared it is important to continue to keep the area clean, dry and moisturised on a daily basis.

What about Immunotherapy?

Rashes such as eczema and nettle rash cannot be treated with immunotherapy. However, research is ongoing into whether certain forms of immunotherapy might be helpful in severe atopic eczema.

Eczema (atopic) – NHS

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