Eczema (Atopic Eczema)
What is atopic eczema?
Atopic eczema is an inflammatory condition of the skin. Atopic is the term used to describe conditions such as eczema, asthma, seasonal rhinitis and hay fever, which often have a genetic basis. Eczema is the term used to describe changes in the upper layer of the skin that include redness, blistering, oozing, crusting, scaling, thickening and sometimes pigmentation (although not all of these changes will necessarily occur together). The words eczema and dermatitis are interchangeable and mean the same thing: thus atopic eczema is the same as atopic dermatitis. For simplicity we shall use atopic eczema in this leaflet.
Atopic eczema affects both sexes equally and usually starts in the first weeks or months of life. It is most common in children, affecting at least 10% of infants at some stage. It usually disappears during childhood, although it can carry on into adult life or come back in the teenage or early adult years. It may occasionally develop for the first time in adulthood.
What causes atopic eczema?
This is still not fully understood. A tendency to atopic conditions often runs in families (see below) and is part of your genetic make-up. In people with atopic eczema, the function of their skin as a barrier to the outside world does not work well, so that irritant and allergy-inducing substance enter their skin, and may cause dryness and inflammation. Atopic eczema is not catching.
Is atopic eczema hereditary?
Yes. Atopic eczema (as well as asthma and hay fever) tends to run in families. If one or both parents suffer from eczema, asthma or hay fever, it is more likely that their children will suffer from them too. In addition, there is a tendency for these conditions to run true to type within each family: in other words, in some families most of the affected members will have eczema, and, in others, asthma or hay fever will predominate.
What are the symptoms of atopic eczema?
The main symptom is itch. Scratching in response to itch may be the cause for many of the changes seen on the skin. Itching can be bad enough to interfere with sleep, causing tiredness and irritability.
What does atopic eczema look like?
Atopic eczema can affect any part of the skin, including the face, but the areas most commonly affected are the bends of the elbows and knees, and around the wrists and neck (a flexural pattern). Other common appearances of atopic eczema include discrete coin-sized areas of inflammation (a discoid pattern), and numerous small bumps that coincide with the hair follicles (a follicular pattern).
If you have eczema, it is likely your skin will be red and dry, and scratch marks (and bleeding) are common. When the eczema is very active (during a ‘flare-up’) you may develop small water blisters on the hands and feet, or the affected areas of your skin may become moist and weepy. In areas that are repeatedly scratched, the skin may thicken up (a process known as lichenification), and become even more itchy.
What makes atopic eczema flare up?
Many factors in a person’s environment can make eczema worse. These include;
- Heat, dust and contact with irritants such as soap or detergents
- Being unwell: for example having a common cold can make eczema flare
- Infections with bacteria or viruses can make eczema worse. Bacterial infection (usually with a bug called Staphylococcus) makes the affected skin yellow, crusty and inflamed, and may need treatment with antibiotics. An infection with the virus that causes cold sores (herpes simplex virus) can cause a painful widespread (and occasionally dangerous) flare of eczema, and may need treatment with antiviral tablets
- Dryness of the skin
- Perhaps stress
How is atopic eczema diagnosed?
It is usually easy for health care professionals, such as health visitors, practice nurses and general practitioners, to diagnose eczema when they look at the skin. However, sometimes the pattern of eczema in older children and adults is different, and the help of a hospital specialist may be needed. Blood tests and skin tests are usually not necessary. Occasionally the skin may need to be swabbed (by rubbing a sterile cotton bud on it) to check for bacterial or viral infections.
Can atopic eczema be cured?
No, it cannot be cured, but there are many ways of controlling it. Most children with atopic eczema improve as they get older (75% clear by their teens). However, many of those who have had eczema continue to have dry skin and need to avoid irritants such as soaps or bubble baths. Eczema may persist in adults, but it should be controllable with the right treatment. Atopic eczema may be troublesome for people in certain jobs that bring them into contact with irritant materials, such as catering, hairdressing or nursing.
For information on available treatments please visit this page on the website of the British Association of Dermatologists.