Eczema is a common skin condition affecting approximately one in every five children. The condition is slightly less common in adults, only affecting one in every twelve. As these statistics suggest, a significant number of children will ‘grow out’ of eczema during their teenage years.

The skin on our bodies is designed to provide a protective barrier against irritants and infections. It consists of three layers; a thin outer layer (epidermis), an elastic middle layer (dermis) and a fatty inner layer (hypodermis). All three layers contain skin cells, water and fats that help maintain and protect the condition of the skin.

Someone who suffers with eczema may not produce sufficient fats and oils to properly maintain these skin layers. This will also reduce the skin’s ability to retain water, causing the skin cells to become dry and cracked. This dryness can lead to tiny gaps opening up in the skin, making it easier for irritants and bacteria to penetrate its surface. It’s these irritants that cause the skin to become damaged, red and inflamed. This can lead to the sufferer scratching and splitting the skin open, causing it to bleed and leaving the wound open to infection.

There are different types of eczema that can affect the sufferer in different ways:

Common types

Atopic Eczema: This is the most common form of eczema, characterised by red inflammation and bumps on the skin’s surface. It is primarily seen in children but can affect people of all ages. Fortunately, most kids will grow out of this type of eczema by their teenage years. The term ‘atopic’ refers to the fact that it generally has an unknown cause. These conditions are usually hereditary, although they are not always passed directly from parent to baby and may skip a generation.

Atopic eczema will present itself as an itch that chiefly affects the creases and folds of the body, such as the inside of the elbows, backs of knees and the hands. It is also known to affect the armpits, breasts, nipples, wrists, mouth, lips, neck, fingers and eyelids. This itch can become dry and red, with flare-ups occurring in small patches or all over the body. Spontaneous flare-ups are usually the result of an external trigger, the most common being: soaps, pollens, animal dander, overheating, house-dust mites, stress and harsh clothing.

Contact dermatitis: This is sometimes referred to as contact eczema. Contact dermatitis affects around 10% of the UK population making it the most common type of work related skin disease. This form of eczema can cause red, itchy and scaly skin that can sometimes sting and burn. It can lead to the skin becoming dry, cracked and blistered. Contact dermatitis can affect any part of the body, though the most commonly affected area tends to be the hands and knuckles.

Most cases of contact dermatitis are caused by the skin coming into contact with irritants, substances that physically damage the skin. Examples of these are detergents, soaps, antiseptics, perfumes and solvents. These irritants account for approximately eight out of ten cases of contact dermatitis. Another cause comes in the form of an allergen, which is a substance that causes the body’s immune system to react in a way that affects the skin.

Seborrhoeic eczema: This form of eczema affects the areas of the body that contain a large number of sebaceous glands, such as the scalp and the sides of the nose. It is characterised by a red rash or in case of the scalp; dandruff. It most commonly affects the scalp and face but it can spread to the centres of the chest and back. The armpits, under the breasts, groin, genitals and in between the buttocks can also be affected. The cause of seborrheic eczema isn’t fully understood. It is thought to be caused by a yeast known as pityrosporum ovale. This yeast is found on the skin of those affected by seborrheic eczema, however it is unclear whether the yeast is the sole cause or just a contributing factor to this form of dermatitis.

Less common types

Discoid eczema: This is sometimes referred to as nummular dermatitis and is usually found in adults with dry skin. This form of eczema presents as coin shaped discs of affected skin that are roughly the size of a two-pound coin. These discs have a slightly bumpy texture before they begin to ooze and crust over. The surface of the discs can then become scaly before the centre of the discs clears, leaving the skin dry and flaky. Discoid eczema will usually affect the lower legs, forearms or trunk. As with other forms of eczema the exact causes of nummular dermatitis is unclear. However, most sufferers presenting with the condition tend to have dry skin.

Gravitational eczema: This is sometimes referred to as varicose or stasis dermatitis. This form of eczema affects the lower legs and is more commonly experienced in later life. Poor circulation, blood clots and varicose veins put a person more at risk of developing this condition. Gravitation eczema will appear as dark red or brown patches under the outer layer of skin. As the condition progresses the skin becomes very thin and fragile and can easily break down, potentially causing an ulcer. In more severe cases the skin can start to weep, causing larger areas to crust over, leading to a varicose leg ulcer. This form of eczema is the result of poor circulation, which causes an increased pressure in the lower legs, leading to blood leaking through the very small vessels in the legs.

Asteatotic eczema: This is sometime referred to as eczema cracquele. This form of dermatitis will in most cases only affect those over the age of sixty years. Asteatotic eczema will present as small islands of dry rough skin clustered closely together. The appearance resembles ‘crazy paving’ with red and pink fissures or grooves separating each ‘slab’. Sufferers will experience soreness and itching in the affected areas. This type of eczema will initially occur on the shins but can be found on the upper arms, lower back and thighs as well. Asteatotic eczema is thought to be caused by a significant decrease in the oils on the skin’s surface. This may be the result of over cleansing or vigorous scrubbing. Low humidity can also contribute to developing the condition.

Pompholyx eczema: This can sometimes be referred to as dyshidrotic eczema. The main symptom of this form of eczema is a blistering that is confined to the hands and feet. These blisters are mainly found along the sides of the fingers and on the palms of the hand. In feet, they are predominantly found on the soles. The skin will be inflamed and feel very itchy. The blisters are prone to breaking and weeping with the skin beginning to peel as it starts to dry out.

In most cases eczema and dermatitis can be easily diagnosed by your GP or pharmacist through a visual examination of the skin coupled with questions about your symptoms. Mainly they will want to know when the symptoms first appeared and what substances you have been exposed to. They will likely ask questions about your occupation and lifestyle in an attempt to identify what triggers or factors are causing your symptoms. Most common cases of eczema are not serious and symptoms can be kept under control.

If your GP is unable to diagnose eczema, they may refer you to a dermatologist. Seeing a dermatologist may also be necessary if your eczema has been successfully diagnosed but you are not responding to conventional treatment.

Treatment for eczema is split into two main categories:

Emollients - regular use of moisturisers (up to four times daily) to keep skin moisturised and healthy
Steroid creams - used in short courses to control flare-ups in eczema
Emollients

Emollients are moisturisers designed to keep the skin feeling hydrated, flexible and less itchy. One of the most important aspects of treating all types of eczema is keeping the skin soft and supple. This can be achieved by frequently applying generous amounts of emollients. Emollients are available in a variety of preparations, including; creams, ointments and lotions. If used on a daily basis, emollients effectively controls mild to moderate eczema.

Emollients, such as Dermol Cream, contain cleansing properties and are especially useful when used as a soap or shower gel substitute. Bubble baths, like soaps, can dry and irritate the skin. By using an emollient bath oil, such as Balneum Medicinal Bath Oil you can still cleanse, moisturise and indulge without the irritation. Emollients work best if applied directly after showering or bathing as water is still trapped in the skin. It is recommended that they be applied both generously and frequently (at least 3 - 4 times a day).

Emollient creams

Many people prefer using creams during the day as they feel lighter on the skin. However, all creams contain preservatives, which for some, can cause irritation over time. Examples of emollient creams include:

Balneum & Balneum Plus Cream
Dermol Cream
Diprobase Cream
Doublebase Gel
E45 Cream
Epaderm Cream
Hydromol Cream
Oilatum Cream
Emollient ointments

Unlike creams, ointments do not contain preservatives so are less likely to cause irritation. Ointments are by nature more greasy and for this reason many find them cosmetically unattractive. For this reason, many people use emollient ointments at night for intensive moisturising when the greasiness is less of an issue. It is not recommended to use ointments on weeping skin as ointments are effective at holding moisture, a cream or lotion is more appropriate in these circumstances. Ointment emollients are ideal for very dry and thickened skin. Examples of emollient ointments include:

Diprobase Ointment
Epaderm Ointment
Hydromol Ointment
Emollient Lotions

The preparations are ideal for areas of the body that are hairy. They contain more water and less fat than creams so aren’t as effective as a moisturiser. Examples of emollient lotions include:

Aveeno Lotion
Dermol 500 Lotion
E45 Lotion
Specially formulated products designed for use in shower and bath include:

Hydromol Bath and Shower Emollient
E45 Emollient Shower Cream
Dermol 600 Bath Emollient
Dermol 200 Shower Emollient
Doublebase Emollient Shower Gel
Doublebase Emollient Bath Additive
Cetraben Emollient Bath Additive
Balneum & Balneum Plus Antipruritic Medicinal Bath Oil
Aveeno Body Wash
Topical Corticosteroids:

Topical corticosteroids refer to creams or ointments that contain steroids. When used as directed by your doctor or pharmacist, corticosteroids are one of the most effective treatments for eczema and dermatitis. Usually, a corticosteroid will be used if the skin has become very inflamed and red. These preparations are applied directly to the skin and work to rapidly reduce the inflammation. When using corticosteroids, a thin layer is applied to the affected area, usually no more than twice a day. For most cases, a single daily application will only be required.

There are varying types and strengths of topical corticosteroids, the appropriate selection will be made based on the severity of symptoms and where on the body they are located. Weaker corticosteroids are usually recommended for cases of mild eczema, or for the more sensitive areas of the body. A stronger corticosteroid will likely be recommended for use on the palms of the hands, knuckles or the soles of the feet and areas where the skin is thicker. If presenting with severe eczema or dermatitis, a strong corticosteroid may be prescribed for short-term use only. Examples of topical corticosteroids include:

Weaker preparations:

Hydrocortisone Cream 1%
Eumovate Cream (Clobetasone)
Eumovate Ointment (Clobetasone)
Stronger preparations:

Betnovate Cream (Betamethasone)
Betnovate Ointment (Betamethasone)
Stronger preparations for the scalp:

Betnovate Scalp Lotion (Betamethasone)
Betacap (Betamethasone)
Elocon Scalp Lotion (Mometasone)

Antibiotic preparations - only for use where infection is present:

Fucibet Cream (Betamethasone & fusidic acid)
Fucidin H Cream (Hydrocortisone & fusidic acid)
If the use of emollients and topical corticosteroids have proven ineffective at controlling your eczema, it may become necessary to seek alternatives treatments from a dermatologist.

There are many self-help ways in which eczema flare-ups can be reduced or prevented. Including:

• Use an appropriate emollient regularly to keep skin soft and moisturised.
• Avoiding exposure to extreme temperatures, such as very hot baths or showers.
• Avoid using harsh soaps, bubble baths and cosmetic products that can irritate the skin.
• After bathing or showering, pat areas dry with a soft cotton towel. This technique will leave a little moisture on the skin. By then applying a moisturising cream or lotion more moisture is locked into the skin.
• During the winter months use a humidifier. This will add moisture to the dry air experienced during the heating season.
• If contact dermatitis is the cause of your eczema flare-up, avoid contact with known triggers, such as detergents, cleaning solutions, other chemical irritants, jewellery, plants and any substance that triggers skin allergies.