Eczema causes and treatment

Atopic dermatitis, also known as atopic eczema, is the most common form of eczema. It is identifiable by dry and itchy skin, often appearing with a red rash. Atopic eczema usually starts in childhood and gets milder or clears completely by adulthood.

The term ‘atopic’ is used to describe a group of conditions including eczema, hay-fever, asthma and allergic conjunctivitis. Atopic conditions are characterised by increased activity of the allergy side of the body’s immune system.

If your skin has developed eczema following close physical contact with a substance, you may have contact dermatitis. Contact dermatitis is caused by contact with irritants or allergens, leading to burning, itching and redness on the skin. Thankfully, the inflammation passes when the irritant or allergen is removed.

There are two types of contact dermatitis. Allergic contact dermatitis is caused by an immune system reaction to an allergen such as hair dye or nickel (for example earlobe dermatitis from costume jewelry). Irritant contact dermatitis occurs when a chemical or other substance (often soap or detergents) irritates your skin.

Discoid eczema, also referred to as nummular eczema and nummular dermatitis, is a common type of eczema. It can occur at any age but is more common in middle aged adults..

People with discoid eczema develop round, coin-shaped spots on their skin which can be very uncomfortable and itchy. Treatment is usually with anti-inflammatory creams (often steroid creams) mixed with anti-bacterials.

Dyshidrotic eczema, also known as pompholyx, is a type of eczema that causes small blisters to form on your fingers, hands and feet. Allergies, stress, moist hands and feet, or exposure to irritants such as detergents may trigger dyshidrotic eczema.

Dyshidrotic eczema can affect people at any age, but most often occurs in adults under the age of 40. It is also twice as common to affect women than men.

Also known as venous, gravitational or stasis eczema, varicose eczema is a long-term skin condition that affects the lower legs. Varicose eczema is most common in people with varicose veins, occurring when fluid leaks out of weakened veins into your skin, and thereby setting up an inflammatory reaction. This is why wherever possible varicose eczema is best treated and prevented by using compression stockings (as well as anti-inflammatory steroid creams at the start or during flares).

Varicose eczema can cause the lower part of the legs to swell up, varicose veins, open sores, swelling, redness, itching and pain.

Seborrheic eczema, also known as seborrheic dermatitis, is a chronic form of eczema appearing on the body where there are a lot of oil-producing glands. Seborrheic eczema causes itchy, red, scaly rashes to form on the scalp, eyelids, eyebrows, sides of the nose and behind the ears.

Seborrheic dermatitis can develop at any age including infants (referred to as “cradle cap”). It is slightly more common in men than in women. People with conditions that affect the immune system or nervous system are also believed to be at increased risk, such as HIV or AIDS or Parkinson’s disease.

The symptoms of eczema may vary depending on the type and severity of your condition. However, common symptoms include:

• Dry, sensitive skin
• Red and inflamed skin
• Frequent itching
• Swelling, oozing or crusting
• Rough, leathery or scaly patches of skin

Although most commonly appearing on the face, back of the knees, wrists, hands or feet, eczema can affect other areas as well. Depending on what type of eczema you have, it is possible for symptoms to affect your eyelids, scalp, ears, nipples, lips, breasts, penis or neck.

Mild eczema is characterised by areas of dry skin and/or infrequent itching. It may also include small areas of redness, but not always.

Moderate eczema is characterised by areas of dry skin, frequent itching and redness. There may also be localised areas of skin thickening.

Severe eczema is characterised by widespread areas of dry skin, constant itching and large amounts of redness. There may also be skin thickening, bleeding, oozing, cracking and alteration of pigment.

You should seek medical advice for eczema if the itching and redness don’t fade over time, or if your condition starts to interfere with your day-to-day life. Most often your doctor will be able to identify if you have eczema by looking at your skin and asking a few simple questions.

The cause of eczema is not fully known, but it is believed to be an overactive response by the body’s immune system in a genetically predisposed individual. Quite often there may be an external reason why the eczema has appeared or made it worse, such as hair dye, detergents or contact with furry animals. It is also commonly found in families with a history of other atopic conditions, as well as people with defects in the skin barrier which may allow moisture out and germs in.

There are several risk factors that can increase your chances of developing eczema. Children who suffer from other atopic conditions, such as asthma or hay fever, or adults who develop these conditions before the age of 30, are more likely to have eczema.

Sometimes there is an external component to the eczema, such as an allergen (nickel is the most common) or irritant (often detergents).

Atopic eczema is often hereditary. If one or both of your parents have eczema, then it is more likely that you will develop it too. In addition, roughly one third of children with atopic eczema will develop other atopic conditions such as asthma or hay fever.

Eczema is not contagious, meaning you cannot catch it from another person. While the exact cause of eczema is not currently known, it is believed to be a combination of genes and environmental triggers.

There are a number of environmental and biological factors which can increase the risk of atopic eczema flaring up. These include:

• Environmental factors such as heat and dust
• Contact with irritants (wool clothing, pets, soaps, detergents)
• Other illness, such as a common cold
• Dry skin
• Stress
• Bacterial or viral infections
• Food allergies may rarely cause a flare-up

A medical professional will usually recognise eczema simply by looking at your skin. It is rare for blood tests or skin tests to be necessary. Occasionally, the skin may need to be swabbed to check for viral or bacterial infections and sometimes allergy tests may be taken.

Most eczema treatments are topical, however, in more severe cases people may need to take oral medication as well. The most common eczema treatments are emollients (moisturisers), which should be applied regularly.

Applying emollients throughout the day helps the outer layer of your skin better shield against your environment. If your skin is particularly dry, you may have to apply moisturiser more frequently. Using soap substitute creams reduces the disruption to the skin barrier from soapy detergents.

There is a range of over-the-counter products which can help prevent and reduce the symptoms of eczema. As eczema makes the skin dry and itchy, lotions and creams help to keep the skin moist. Furthermore, cold compresses may also be used to help relieve itching.

Creams and ointments containing corticosteroids are often prescribed to help lessen any inflammation from eczema. These treatments reduce swelling, redness and itching during flare-ups.

If you are uncertain which emollient is best suited for you, consult your GP. The best moisturiser is the one you are most comfortable using on a daily basis.

There are a number of self-care steps you can take to help prevent or ease the symptoms of eczema. These include:

• Try to avoid scratching where possible. Eczema is very itchy, and it can be tempting to scratch the skin. However, this often damages the skin and makes the condition worse.
• Avoid triggers. Your GP will work with you to identify what might trigger your eczema, such as certain fabrics, heat or detergents. Take steps to avoid these triggers where possible.
• Adjust your diet. Certain foods, such as eggs and milk, can trigger eczema. However, you should only make significant adjustments to your diet after consulting your GP first.

Following these tips can help you avoid or manage eczema outbreaks:

• Moisturise often
• Avoid overheating or sweating
• Avoid sudden temperature or humidity changes
• Destress
• Avoid any foods that may cause an outbreak
• Avoid scratchy materials, such as wool
• Avoid harsh detergents, soaps and solvents
• Use a humidifier in the room where you sleep

Studies suggest that applying coconut oil to the skin can help reduce the number of staph bacteria and decrease the risk of infection. Coconut oil is one of the most regularly recommended natural remedies for eczema.

Apply coconut oil one or two times a day to damp skin. Make sure to use only virgin or cold-pressed oils, as these methods of oil extraction are chemical-free.

Sunflower oil can help to boost the skin barrier and help it retain moisture. It is also known to have anti-inflammatory properties. Apply sunflower oil twice a day to the skin. One of these times should be shortly after bathing, while the skin is still wet.

Aloe vera gel has antibacterial and antimicrobial properties. These can help to prevent skin infections which can be caused by eczema’s dry, cracked skin. The wound-healing effects of aloe vera may also help to soothe the broken skin.

Try to choose aloe gel products with few ingredients as preservatives, alcohol, fragrances and colours can all irritate sensitive skin. Start by applying a small amount to check for skin sensitivity. If it does not cause any burning or stinging, continue to apply daily.

Cardiospermum is a flowering tropical vine native to India and Africa. When extracted and put into a topical ointment, Cardiospermum may reduce inflammation, itchiness and help fight bacteria on the skin.

Tea tree oil is often used to help with a number of skin conditions including psoriasis and acne. Studies have identified antibacterial, anti-inflammatory and wound-healing properties in tea tree oil. These properties may relieve skin dryness, itching and help fight infections.

Make sure to dilute tea tree oil before applying to the skin. Try mixing tea tree oil with a carrier oil, such as almond or olive oil, before using the treatment.

If your child has recently developed a red rash on their arms, legs, hands or face this might be eczema. Eczema, also known as atopic dermatitis, is a non-contagious skin condition characterised by redness, itching and rashes.

These symptoms can be painful, sometimes causing changes in skin colour and blisters. The itching may also interrupt sleep, with scratched skin at risk of infection. However, they can be easily alleviated by identifying potential irritants and using topical treatments.

While the exact cause of eczema is unknown, it is believed to be a mixture of genetic and environmental triggers. For instance, if you have a family history of atopic dermatitis, asthma or hay fever, it is more likely your child will develop eczema.

Eczema affects infants and toddlers differently to older children. The location and appearance of eczema often alter, so it is important to know what to look for during each stage of development:

• Infants (first 6 months). For infants, eczema usually appears on the face, cheeks, chin, forehead and scalp. It may spread to other areas, but usually not to the nappy area. The affected areas tend to look redder and “weepy”.
• Babies (6-12 months). For babies, eczema most often affects the face, elbows and knees as these places are easily scratched and rubbed as they’re crawling. If the eczema rash becomes infected, it may form a yellow crust or very small bumps of pus on the skin.
• Toddlers (2-5 years). Above the age of two, your toddler’s eczema will most likely affect the creases of their elbows and knees, or their wrists, ankles and hands. Sometimes, it may also affect your toddler’s mouth and eyelids. The skin may look dry and scaly at this stage.
• Children (5+ years). Above the age of five, eczema usually affects the folds of the elbows and/or knees. Sometimes, it may only affect your child’s hands. Other affected areas may include behind your child’s ears, their feet or their scalp.

There are a number of simple steps you can take and treatments you can use to help soothe your child’s eczema. These include:

• Apply an unperfumed moisturiser to the affected areas several times a day. This helps to keep their skin moist and protected. Gently smooth the moisturiser into the skin, don’t rub it in.
• Avoid aqueous creams as these can cause stinging, itching, burning and redness. Also, try to avoid soap, baby bath and bubble bath as these may further dry and irritate the skin.
• Where possible, keep your child’s bedroom cool. Hot and moist temperatures can make their eczema worse.
• As long as suggested by your GP or pharmacist, steroid creams can help prevent eczema from getting worse.
• Try to identify and avoid any irritants that might be making your child’s eczema worse. These may include soap, animals, chemicals or fabrics.

Note the redness and the scratch marks from tearing at the skin. There is some erosion of the skin and skin thickening over the wrist. Image source.

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Dr Goheer grew up in Glasgow and attended Hutchesons’ Grammar. She qualified from Aberdeen University Medical School in 2010. She returned to Glasgow for her GP training. Saira is now based in Edinburgh working as a qualified GP. She started working for Medicspot in 2019 and has a real passion for travel and fitness.

Dr Anthony Bewley is a Consultant Dermatologist at Barts Health (The Royal London Hospital and Whipps Cross University Hospitals NHS Trust). He qualified from Bristol University Medical School in 1987 and has trained in general dermatology in London, becoming a consultant in 1996. Dr Bewley has developed an interest in how the skin interacts with the brain and the mind. He has a specialist clinic with a multidisciplinary team at least every week at the Royal London Hospital, which was awarded ‘BMJ Dermatology Team of the Year’ in 2017.

Dr Bewley has written many peer reviewed papers, chapters and textbooks on a variety of skin disease, and continues in active dermatology research. He is the co-author of Practical Psychodermatology (Wiley 2014) and a range of other texts. Dr Bewley is the secretary of the European Society for Dermatology and Psychiatry and co-chair of Psychodermatology UK. He also writes Twitter updates on current psychodermatology training events using #psychodermatologyuk.

Dr Hussain is a GP based in Edinburgh. He qualified as a doctor from the University of Manchester in 2010. He did his foundation training in Glasgow and then went on to do GP training in Lanarkshire. He now works across practices in Edinburgh and is also a member of the urgent care service in Fife. Jackir joined Medicspot in 2019 and is passionate about how technology can improve primary care.

This article is for general information only and should not be used for the diagnosis or treatment of medical conditions. Medic Spot Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. In the event of an emergency, please call 999 for immediate assistance.