Skin Topic of the Day: Eczema – How to diagnose and how to treat.
Today Dr. Anita discusses ECZEMA
Dermatitis (or eczema) affects one in ten adults and one in five children, causing patches of dry, scaly, red, inflamed and itchy skin.
In some cases, an unknown allergy to substances such as perfumes, creams, hair dyes or nickel jewellery can be enough to prompt the body to mount an attack against the substance. The body’s immune system thinks it is an unwanted ‘foreign’ object and triggers an inflammatory reaction in the skin, in its attempt to try to get rid of it.
Most eczema is atopic eczema, an inherited condition that is linked to other sensitivities such as hayfever and asthma. The distinctive, red, itchy patches of skin are a sign that your immune system has over-reacted to harmless allergens and has triggered the inflammatory process in its defence.
The usual cause is an inherited gene that leads to a deficiency in a protein that’s supposed to keep the skin moist and act as its protective barrier. I often describe this barrier like a brick and mortar wall. The protein is the mortar that holds the bricks together. If the mortar is ineffective it won’t hold the bricks, in this case the skin cells, together. The brick wall starts to break down and let bad things through the gaps like bacteria in and water / moisture out.
This deficiency means the skin dries out and can become itchy and inflamed. Because the barriers are weaker the skin becomes more prone to skin infections with bacteria or viruses.
Other inherited genes can trigger the body to mount an abnormal immune response in the skin to allergens such as house mites or even certain foods.
Very often eczema sufferers have to endure a combination of the two: the deficient skin barrier and an abnormal response to allergens.
Dry skin is itchy skin. So when you start scratching away this just makes the problem worse and produces more inflammation. When you itch you release an inflammatory chemical called histamine which leads to more redness and inflammation and more itching which makes you scratch more, so it becomes a vicious itch scratch cycle
To break this eczema cycle I recommend a triple therapy approach.
Step 1: Bathing
Wash with aqueous creams such as Dermal 500 or E45
Stop using all soaps . Eczema skin absolutely hates soaps, as these tend to dry and irritate the skin. Also avoid skin products containing preservatives or washes containing sodium laurel sulphate, which can irritate eczema.
Try having an oil bath 2-3 times a week. I love Oilatum bath oil. This is great for adults and children.
Step 2: Moisturisation
Use emollient moisturisers at least twice daily. This an essential step to repairing those vital skin barriers, as well as helping to keep moisture locked into the skin.
Step 3: Inflammation fighting
The tool here are a group of medications called Steroids. They come in the form of creams, ointments and tablets.
Many people are scared of Steroids but you shouldn’t be. When used correctly they really are your skins best friend when it comes to fighting inflammatory skin disease, such as eczema. Steroids used at the right dose in the right place are the superheroes of eczema control. I recommend using HC ointment twice daily on the face once daily and twice daily on the body for 3-4 weeks during an eczema flare. Many dermatologists then advice a gentle maintenance therapy, where twice a week you use your Steroids to keep the skin calm. I often advise Monday and Friday treatments.
GPs can also prescribe stronger medications to calm down the immune response such as Tacrolimus, which can be used for adults and children for more severe eczema . We also have various forms of light therapy and immune therapy available
Remember though NEVER ignore itching skin which doesn’t settle with these simple measures. Extreme cases it could be a sign of iron deficiency, diabetes, thyroid, kidney disease, liver disease or even a Scabies infection, so always see your GP if the itching persists.