Eczema is a term that describes skin that is often dry, itchy and red. The word ‘eczema’ originates from the Greek language meaning to ‘boil over’. It is very common and affects almost everyone at some point in their life. Internationally, the term ‘dermatitis’ is also often used interchangeably for eczema.
Frequent questions and answers
Atopic eczema is the most common subtype of eczema and is often what people are referring to when they say they have ‘eczema’ or ‘dermatitis’. Other types of eczema include:
- Contact eczema (irritant or allergic)
- Pompholyx also known as dyshidrotic eczema
- Discoid eczema
- Venous eczema
- Asteatotic eczema
- Seborrheic dermatitis
Atopic eczema is characterised by chronic — generally 6 weeks or more — patches of red, itchy, skin. Over time this can lead to lichenified skin changes, where the skin becomes thicker and darker.
Chronic eczema classically flares from time to time as a result of triggers such as stress. Typically, areas affected include inside the elbow creases, behind the knees, neck and around the eyes. It affects 11-20% of children and 5-10% of adults in the UK and prevalence is increasing1. Approximately 70-90% of cases develop before the age of 5 years, and usually before 12 months of age2. The severity is twice as likely to be severe if it presents before 12 months of age.
Atopic eczema is the first step of what is known as the “Atopic March”, with 30% of children affected going on to develop hay fever and 30% developing asthma2.
It is important to know that although this type of eczema normally first develops when you are a child it can also develop for the first time as an adult.
There is a lot of research underway to try to understand why some people get atopic eczema and others don’t. We know that it’s due to a combination of genetic and environmental factors. For example, we know if one or both parents have a history of atopic eczema their child has approximately a 60% chance of developing it, too2.
In approximately 50% of cases15 there is a filaggrin mutation. Filaggrin is a protein which is important in the changing of keratinocytes into corneocytes and defects in this lead to a leaky skin barrier. If the filaggrin protein is not working well then there is also a reduction in the production of natural moisturising factors (NMFs) in corneocytes reducing their ability to absorb and retain water which can then dry the skin. The loss of NMFs also affects pH levels increasing the risk of bacterial colonisation.
Environment also has an important role and triggers such as stress, pollen, food allergies, pets, cosmetics, detergents, pollution and, possibly, hard water can flare eczema.
Eczema management has evolved rapidly in recent years, with lots of safe and effective treatments available for children and adults. The mainstay of treatment remains topical treatments.
Moisturisers and emollients are very important in eczema management and need to be applied regularly. There are many different brands available.
It’s important to find one that suits each individual — so that they will actually use it — as it is time consuming and cumbersome to have to apply moisturiser 2-3 times a day. Both moisturisers and emollients help prevent water evaporation and help keep in water in the skin. Some also have ingredients, such as ceramides, to actively repair the skin barrier.
Water can be drying on the skin, so instead of using regular bars of soap, using a moisturising soap lotion, or oil, can be helpful. People often think plain water is better when eczema is active, but this actually dries the skin out even more.
Topical steroids come in a variety of strengths and should only be used under the supervision of a doctor as prolonged, or overuse can cause side effects including skin thinning and lightening. Different strengths are suitable for different areas of the skin. For example, skin on the face is much more delicate than the hands and feet. They often alleviate the symptoms of eczema rapidly and are used intermittently for flares. They can come as creams, ointments or medicated tapes.
It is important to raise public awareness regarding reputable websites for evidence-based information and support — such as the British Association of Dermatology and National Eczema Society. Under-treated eczema can lead to reduced quality of life, increase the risk of infection and chronic skin changes. In rare cases, it can require hospitalisation.
NICE — the National Institute for Health and Care Excellence — recommends a stepped approach with treatment tailored to the severity of the eczema. Flare-ups should be treated quickly, using medical creams and ointments as well as medicated skin tapes prescribed by a doctor or healthcare professional.
1 Cork MJ, Danby SG, Ogg GS. Atopic dermatitis epidemiology and unmet need in the United Kingdom. Journal of Dermatological Treatment.
2 National Institute for Health & Care Excellence (NICE) Guidelines – Eczema – atopic. January 2018