Eczema and contact dermatitis are very common skin conditions affecting 5.8 million people (including 1 in 5 school-age children). Although 90 percent of child sufferers grow out of it by the age of 12, eczema is common in adults and tends to be recurrent. Eczema can be extremely debilitating and in severe cases, growth in children can be affected and adult sufferers are often unable to carry out routine activities. Around 3 in 10 people who visit their GP with a skin problem are diagnosed with atopic eczema and this number is increasing. Three in a hundred people will experience eczema at some time in their lives.
Eczema is an inflammation of the skin which may cause dryness, flakiness, heat and itching. Another often-used word: Dermatitis, is a term which is sometimes connected in people’s minds with exposure to chemicals. It really only means inflammation of the skin, and could be used interchangeably with eczema, as it often is by doctors.
Eczema can be caused by a number of different factors, and may result in just a small patch of skin being affected or sometimes larger areas. It can affect skin anywhere on the body.
Three-quarters of patients who have eczema have also endured other allergic disorders. Approximately 30 percent of those with eczema have asthma, and up to 60 percent experience allergic rhinitis.
Eczema often occurs during infancy and the early childhood years. In most cases the symptoms will decrease, and usually disappear by about the age of six. In about a third of the cases however, the condition will linger, often through adolescence and beyond.
In infants, symptoms include small red patches that appear on the face, torso, and outside of the arms and legs. Infantile eczema affects young babies. This may lead to a patch below their chins, and is particularly distressing. Older children may experience these patches in the creases of the elbows, knees, and on the wrists, ankles, and feet. Skin may become drier, thicker, and have deeper creases. Patches may scale, crust, or ooze. Patients are very susceptible to bacterial and viral skin infections while experiencing these symptoms.
Whatever the causes of eczema – it usually leads to itching and redness, and may make the skin dry and flaky. Sometimes itchy blisters form. Often, in the most common form of eczema, (atopic eczema) the problem is worst in the folds of the skin where your limbs bend.
Many things cause eczema. The most common is a general allergic over-sensitivity (atopy). This sort of eczema is known as atopic eczema, and it is linked with asthma and hay fever. These conditions can often be part of your heredity.
The other possible causes include:
- Contact with substances which irritate the skin chemically. This is caused by direct contact between the skin and the substance, which might be such things as detergents, soaps, diesel or engine oils, strong chemicals, cleaners etc.
- Contact with substances which the body has become allergic to. Commonly this involves nickel, rubber etc. Where plastics have been used in place of these materials, they have helped to overcome this risk, but jewellery and watches are still a common cause.
- Varicose veins can lead to a form of eczema affecting the lower legs. This is known as varicose or gravitational eczema. As well as treatment of the skin, it is important to improve the blood circulation in the legs, and for most people this includes wearing support stockings and staying active on your feet. Your doctor will discuss the options.
Western Medical View
Diagnosis starts with physical examination, and if necessary, further tests will be carried out which may include blood tests, patch tests (where little patches of different substances are stuck to your skin for a few days, to see if you react to any of them) and other similar allergy tests.
Eczema is mostly caused by a sensitivity of the skin and there are a number of approaches which help to minimise the symptoms:
Moisturising the skin: For this we use creams, ointments and shower and bath oils which help to replenish the skin’s natural protective oils. Always discuss these types of products with your doctor, nurse or pharmacist. Washing tends to dry out the skin and make eczema worse. It helps to use an emollient cream as a substitute for soap, and you can apply it liberally at other times during the day. The special bath oils and shower gels also leave a coating of oils on the skin. Some of the creams and oils contain an antiseptic, as it has been found that eczema often flares up as a result of a germ infecting the skin.
Your doctor may prescribe a cream or ointment containing a steroid. These are very effective at reducing inflammation and itch. Your doctor will want you to use this sparingly, and only while the eczema is bad. There are different strengths of steroid applications, and the tendency is to use the lowest strength that the skin requires at the time, in order to minimise the risk of possible side effects of using steroids.
Antihistamines taken by mouth may be helpful in reducing the itch. Your doctor will advise.
If the skin becomes obviously infected, which it is more likely to do, as its normal protective surface has been damaged, your doctor will prescribe antibiotics.
There are a number of older fashioned remedies which are still effective and may be suggested by your doctor or specialist. For example tars, menthol.
Evening primrose oil supplements are used for eczema, and are a safe treatment, but have not consistently proved to be effective in research trials. It would appear that the evidence may not support them being any more effective than capsules or medicine containing no active ingredient (placebo).
If the skin is not responding well, your doctor will probably ask a skin specialist (dermatologist) to see you.
There are a number of options that the specialist may use. These may include:
- Bandages and wet wraps;
- Drugs to suppress the immune system. These are only used in severe cases, and include Cyclosporin – which is otherwise mainly used to stop rejection in patients receiving transplants;
- Phototherapy. Ultra-violet light treatment (UVB and PUVA) can be used in the treatment of atopic eczema. Ultra-violet therapy potentially increases the risks of skin cancer, so it is only used in severe cases.
- The conventional treatment mainly involves the application of topical steroids, which can have serious side effects, such as irreversible skin thinning, adrenal suppression and stunting of growth in children.
Chinese Medical View
More and more people have become aware of these side effects and are turning to Chinese Medicine for the treatment of eczema. Chinese Medicine views any skin disorder as the result of an imbalance within the body. Eczema is a skin condition associated with the functioning of the lungs, stomach, the heart and the blood. In Chinese medicine there are many different types of eczema. For example, if the skin is weeping and hot, the cause is likely to be Damp Heat; dryness and redness indicate Heat in the Blood and itchiness is usually attributed to Invasive Wind.
According to Chinese Medicine theory acupuncture and Chinese herbs can be prescribed to treat complex skin conditions such as eczema.
Having established the particular type of eczema, our doctor will then prescribe a course of Chinese herbs. According to CM theory there is also a comprehensive range of herbal creams and lotions to complement the Chinese herbs. You should seek advice on which cream or lotion is most suitable for your particular condition.
Like Western medicine, Chinese medicine also recognises insects, e.g., house mites, as a cause for eczema as well as other sources of allergy, e.g., food, chemicals, and animal hair (cats, dogs and horses). These factors are also considered during consultation.
Lifestyle Advice for the prevention and treatment of Eczema
In general, patients should avoid spicy food, seafood, alcohol and anything that may cause an allergy.
The itch can be intense – making you want to scratch more. You should avoid this if you possibly can, as scratching only makes the symptoms worse. People say that if you have to do anything, gentle rubbing, with the flat of your hands is better than scratching.
Use the cream or ointment which your doctor recommends on a regular basis, and as a soap substitute to keep the skin supple and to prevent drying.
Avoid exposure to chemicals and strong detergents. It is usually better to avoid using biological agents altogether. Use protective gloves when you use such things in the house or at work.
Eczema patients must develop a systematic treatment program to keep skin moist, and to alleviate itching. By managing the symptoms we can minimize discomfort and complications until the patient outgrows the ailment.
For personalised advice on diet and lifestyle, please ask the doctor during your consultation.
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