Atopic eczema

It is not entirely clear what causes eczema, but genetic, environmental and immunologic factors play a role. Research has shown children who have 1 or both parents with atopic eczema, or who have other siblings with eczema, are more likely to develop it themselves. 

There are a number of things that may trigger eczema symptoms. These can vary from person to person. 

Common triggers include:

• irritants – such as soaps and detergents, including shampoo, washing-up liquid and bubble bath
• environmental factors or allergens – such as cold and dry weather, dampness, and more specific things such as house dust mites, pet fur, pollen and moulds
• food allergies – such as allergies to cows’ milk, eggs, peanuts, soya or wheat
• certain materials worn next to the skin – such as wool and synthetic fabrics
• hormonal changes – women may find their symptoms get worse in the days before their period or during pregnancy
• skin infections

Atopic eczema causes areas of skin to become itchy, dry, cracked and sore.

There are usually periods where the symptoms improve, followed by periods where they get worse (flare-ups). Flare-ups may occur as often as 2 or 3 times a month.

Some people’s symptoms get worse when the air is dry or dusty, or when they are stressed, sweaty, or too hot or too cold.

Atopic eczema can occur all over the body, but is most common on the hands (especially fingers), the insides of the elbows or backs of the knees, and the face and scalp in children.

Atopic eczema in adults is drier than in younger children and often has raised lesions.

The severity of atopic eczema can vary a lot from person to person. People with mild eczema may only have small areas of dry skin that are occasionally itchy. In more severe cases, atopic eczema can cause widespread inflamed skin all over the body and constant itching.

Inflamed skin can become red on lighter skin, and darker brown, purple or grey on darker skin. This can also be more difficult to see on darker skin.

Scratching can disrupt your sleep, make your skin bleed, and cause secondary infections. It can also make itching worse, and a cycle of itching and regular scratching may develop. This can lead to sleepless nights and difficulty concentrating at school or work.

People with atopic eczema often have very dry skin because their skin is unable to retain much moisture. So it is important to use moisturizing creams. These should be massaged properly into the skin several times a day. They also prevent atopic eczema from getting worse or coming back. 

Other tips for preventing atopic eczema:

• Use soap for sensitive skin instead of regular soap. If your skin is very dry, you should also avoid soap altogether.
• Lubricate your skin with non-prescription drugs containing cortisone. However, cortisone should not be used in children under two years without a doctor’s prescription.
• Avoid bathing or showering too often.
• Sleep in pajamas to prevent itching.

Treatments for atopic eczema can help to ease the symptoms. There’s no cure, but many children find their symptoms naturally improve as they get older.

The main treatments for atopic eczema are:

• Emollients (moisturisers) – used every day to stop the skin becoming dry
• topical corticosteroids – creams and ointments used to reduce swelling and redness during flare-ups

Other treatments include:

• topical pimecrolimus or tacrolimus for eczema in sensitive sites not responding to simpler treatment
• antihistamines for severe itching
• bandages or special body suits to allow the body to heal underneath
• more powerful treatments offered by a dermatologist (skin specialist) eg UV radiation therapy to reduce inflammation

Self care includes: 

• avoid scratching to avoid skin damage, lesions and infection
• avoid triggers – eg heat/soaps and other irritants 
• dietary changes – Some foods, such as eggs and cows’ milk, can trigger eczema symptoms. But you should discuss with your doctor before implementing dietary changes.

Contact a doctor if you or your child has atopic eczema that:

• is still itchy and has not resolved after 2 weeks of emollient cream treatment 
• has not improved after cortisone treatment for 1 week
• has become infected
• is spreading.

APPOTEK can help you with atopic eczema. In the initial consultation, a nurse or doctor will make an individual assessment based on your symptoms. You may then be prescribed treatment or referred for further examination. If your child is affected, they should also attend the consultation.