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Eczema, also known as atopic dermatitis, is a skin condition characterised mainly by problems with dry skin which can become inflamed and itchy in patches. If not managed properly, eczema can cause the skin to thicken over time (known as ‘lichenification’), which can then crack and become painful. It is a very common condition, particularly in infants and children, and is estimated to affect up to 20% of children and up to 3% adults in the UK.
The pattern of eczema on the skin is fairly characteristic, often presenting across the upper body in adults, in the flexural surfaces (inside the elbow and wrist and behind the knee) in children and on the face spreading down to the trunk and limbs in smaller infants.
Eczema often occurs alongside a personal or family history of conditions such as asthma, hay fever and allergic conjunctivitis, which are all classed as allergy-associated or ‘atopic’ conditions.
One of the many jobs of normal skin is to act as an effective barrier to help protect the body from harmful substances in the outside world. As the skin becomes dry, this ability to act as an effective barrier becomes impaired, allowing irritants to get into the skin and cause it to become inflamed and itchy. Therefore, the mainstay of managing eczema effectively is through the application of appropriate lotions and creams (known as ‘emollients’) to battle dry skin and avoidance of certain irritants that can cause inflammation. Education about applying emollients regularly and avoiding irritants has been shown to significantly improve the symptoms of eczema in scientific studies.
Short-term prescriptions of steroid-based creams are also used to help curb inflammation in episodes of, particularly bad eczema. Whilst steroid creams are excellent agents for clearing up sudden flare-ups of eczema, long-term or repeated use of steroids on the skin can sometimes cause depigmentation and can have side effects. Many episodes of eczema can be avoided with regular and appropriate use of emollients; an effective strategy for avoiding unnecessary steroids. However, it is important to use steroid creams in cases of bad inflammation, as these are unlikely to clear up with emollients alone.
People who suffer with eczema are at risk of developing infected eczema, which can make them feel very unwell. These cases require treatment with antibiotics and sometimes hospital admission.
There are several products that can act as irritants and worsen eczema, so are important to avoid where possible to maximise treatment benefits. Air pollution itself can irritate dry skin and bring on inflammation. Whilst this can be difficult to avoid in busy cities, there are some everyday products that can be substituted to avoid additional irritation. Many soaps, cleansing and beauty products are alcohol based or contain chemicals and fragrances that dry out the skin. These are best avoided and substituted with mild, non-soap cleansers or an emollient-based soap or shampoo. It is also helpful to wear protective gloves when using household cleaning products to avoid direct contact.
In general, the oilier the emollient, the better it is for restoring moisture to the skin. However, sometimes these can make the skin look and feel greasy, which often discourages people from the necessary regular application needed. A good middle ground is to have two products: a lighter emollient for the day and a more oily preparation to apply at night time. This kind of regime works well to give good all-around treatment whilst avoiding unpleasant oily skin during the day.
The following common emollient constituents are some of the compounds that have been shown to give good results in managing eczema and prevention of symptoms:
There is a wide range of effective emollient products – the key to finding the right treatment for you is to find something that you like the feel of and would be happy to apply regularly. When selecting an emollient, it is also important to ensure that it does not contain any chemicals or compounds that may cause irritation to the skin. Many of these products are available on prescription and over the counter, so it is best to speak to your dermatologist or GP about which option would be most suitable.
Regular application indicates a minimum of twice-daily application, which can be increased depending on the dryness of the skin, exposure to daily irritants (for example, if you live in a more polluted area or go swimming often, you may need to apply emollients more often) and current level of eczema-related symptoms. Another way to maximise benefits from your emollients and prevent contamination is to get a product that comes with a pump on top, or use a single-use wooden spatula to get the emollient out of the tub. For maximum comfort following application, it is recommended to apply the emollient in small patches and rub it in either in the direction of the body hair growth or in a downward motion to avoid irritation of the hair follicles.
Something that many studies on the long-term use of emollients have concluded is that it is essential to continue regular application of the emollients even when the skin appears clear and is asymptomatic. This helps to maintain a good skin barrier and effectively prevent eczema. These studies also observe that people often forget to apply such regular emollients when they are not experiencing symptoms and this often contributes to exacerbations later on.
The use of emollients as bath soap substitutes is a commonly recommended strategy. The evidence for this to prevent the onset of eczema symptoms has been controversial, although evaluation of recent studies suggests that there is no overall benefit from using the emollients in this way. However, there are still advantages in that use of emollients as bath soap substitutes helps to avoid many irritants that may trigger symptoms.